Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights

Abstract

ImportanceSeveral recent US Supreme Court rulings have drawn criticism from the medical community, but their health consequences have not been quantitatively evaluated.ObjectiveTo model health outcomes associated with 3 Supreme Court rulings in 2022 that invalidated workplace COVID-19 vaccine or mask-and-test requirements, voided state handgun-carry restrictions, and revoked the constitutional right to abortion.Design, Setting, and ParticipantsThis decision analytical modeling study estimated outcomes associated with 3 Supreme Court rulings in 2022: (1) National Federation of Independent Business v Department of Labor, Occupational Safety and Health Administration (OSHA), which invalidated COVID-19 workplace protections; (2) New York State Rifle and Pistol Association Inc v Bruen, Superintendent of New York State Police (Bruen), which voided state laws restricting handgun carry; and (3) Dobbs v Jackson Women’s Health Organization (Dobbs), which revoked the constitutional right to abortion. Data analysis was performed from July 1, 2022, to April 7, 2023.Main Outcomes and MeasuresFor the OSHA ruling, multiple data sources were used to calculate deaths attributable to COVID-19 among unvaccinated workers from January 4 to May 28, 2022, and the share of these deaths that would have been prevented by the voided protections. To model the Bruen decision, published estimates of the consequences of right-to-carry laws were applied to 2020 firearm-related deaths (and injuries) in 7 affected jurisdictions. For the Dobbs ruling, the model assessed unwanted pregnancy continuations, resulting from the change in distance to the closest abortion facility, and then excess deaths (and peripartum complications) from forcing these unwanted pregnancies to term.ResultsThe decision model projected that the OSHA decision was associated with 1402 additional COVID-19 deaths (and 22 830 hospitalizations) in early 2022. In addition, the model projected that 152 additional firearm-related deaths (and 377 nonfatal injuries) annually will result from the Bruen decision. Finally, the model projected that 30 440 fewer abortions will occur annually due to current abortion bans stemming from Dobbs, with 76 612 fewer abortions if states at high risk for such bans also were to ban the procedure; these bans will be associated with an estimated 6 to 15 additional pregnancy-related deaths each year, respectively, and hundreds of additional cases of peripartum morbidity.Conclusions and RelevanceThese findings suggest that outcomes from 3 Supreme Court decisions in 2022 could lead to substantial harms to public health, including nearly 3000 excess deaths (and possibly many more) over a decade.

Firearm Policy in the Hospital Setting—Recognizing Health Care as a “Sensitive Place”

“…Firearm violence represents another court-exacerbated public health threat and imposition on the field of medicine. According to research from 2023, without any state intervention, Bruen was predicted to raise firearm homicides by 9%—and this is only considering the strict type of law at issue in Bruen , without calculating the larger impact of the courts’ new methodology for evaluating firearm restrictions …”

The impact of abortion restrictions on American mental health

“…Since that time, the medical and academic communities have scrambled to understand the implications of these bans, with confusion emerging surrounding the conditions under which abortion remains permissible (3), giving rise to legal action (4,5). To date, received research indicates that these restrictions increase projected patient travel costs (6), change patterns of health information seeking (7), decrease trust in clinicians (8), contribute to excess mortality (9), and even alter firm recruitment strategies to cover out of state travel if an abortion is needed by an employee (10).…”

Laboratories of Democracy

“…States like New York where legislatures had adopted more restrictive gun laws may be composed of people already less likely to own or want guns, and actions by businesses and individuals may discourage carrying guns despite a newly discovered freedom from a state restriction. On the other hand, if there are more people less familiar with guns in those states, will firearm-related deaths from accident or suicide, which Gaffney et al exclude, increase more than would be expected in more gun-friendly states? Gaffney et al point out that criminalization of abortion care may change the way obstetrical providers manage pregnancy-related complications, resulting in a new and less safe standard of care.…”

“…In a timely and important study, Gaffney et al synthesize data to estimate public health outcomes associated with 3 major legal decisions wrought by the US Supreme Court in 2022. They examine outcomes associated with (1) invalidating COVID-19 vaccination or mask-and-test workplace requirements ( National Federation of Independent Business v US Occupational Safety and Health Administration [ OSHA ]), (2) invalidating New York’s firearms licensing regime providing for discretion in who could be issued an unlimited concealed carry permit ( New York State Rifle and Pistol, Inc v Bruen ), and (3) upholding Mississippi’s abortion ban and overturning the constitutional right-to-privacy protections for abortion recognized in Roe v Wade and its progeny ( Dobbs v Jackson Women’s Health Organization ) .…”

“…A maxim of decision modeling, promulgated by the statistician George Box, is “all models are wrong, some are useful.” Despite the limitations of outcome studies to help us predict how people will respond to changing laws, Gaffney et al show that under reasonable assumptions, these decisions will result in avoidable deaths. That most accrue from the OSHA decision reflects the high incidence of COVID-19 in pandemic conditions.…”