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14 “significant effect” on payments, a condition no doubt present here. H. R. 3545, 100th Cong., 1st Sess., reprinted in 133 Cong. Rec. 30019. Later, the conference committee replaced the House’s language with the current language of subsection (a)(2), which the report said “reflect[ed] recent court rulings.” H. R. Conf. Rep. No. 100–495, p. 566 (1987). The government contends that this was an oblique reference to a then-recent decision discussing the APA’s interpretive-rule exception and an implicit suggestion that interpretive rules shouldn’t be subject to notice and comment. See American Hospital Assn. v. Bowen, 834 F. 2d 1037, 1045–1046 (CADC 1987). But, as the hospitals point out, Bowen was mostly about the APA’s treatment of procedural rules. See id., at 1047–1057. So it seems at least equally plausible that the conference committee revised the House’s language because it feared that language would have subjected procedural rules to notice-and-comment obligations.

The hospitals call our attention to other indications, too, that Members of Congress didn’t understand the conference’s language to track the APA. For example, the relevant provision in the final bill was titled “Publication as Regulations of Significant Policies.” §4035(b), 101 Stat. 1330–78 (emphasis added). And, as we’ve seen, “significant policies” don’t always amount to substantive rules under the APA. The House Ways and Means Committee likewise described the final bill as requiring notice and comment for “[s]ignificant policy changes,” not just substantive rules. Summary of Conference Agreement on Reconciliation Provisions Within the Jurisdiction of the Committee on Ways and Means, 100th Cong., 1st Sess., 12–13 (Comm. Print 1987). So in the end and at most, we are left with exactly the kind of murky legislative history that we all agree can’t overcome a statute’s clear text and structure.

That leads us to the government’s final redoubt: a policy