Medicare appeals might be getting a little more complicated for skilled care providers, thanks to a recent ruling from the U.S. Supreme Court, legal analysts said.

In late June, the nation’s highest court decreed that administrative law judges for the Securities and Exchange Commission were not properly picked under the Constitution’s appointments clause and should have been appointed by the president. Legal observers told Bloomberg Law that the high court’s decision may be applied to such judges at federal agencies such as those within the Department of Health and Human Services.

President Trump followed the June 21 ruling with an executive order that gave agencies the green light to hire administrative law judges using their own qualifications.

This means ALJs will face new political worries within the context of their decisions, sources told Bloomberg.

Compounding the uncertainty is law judges being granted positions through political appointment rather than the previous process of seven years of trial experience, recommendations from lawyers and judges, and passing written and oral exams.

“It begs the question: If you don’t feel as secure in your position anymore and you’re able to be removed easily, do you have your independence if the CMS or some other agency has some agenda they’d like to push?” Nick Alarif, an attorney at McDermott Will & Emery in Washington, told Bloomberg. “Does your concern about your livelihood change your position or your legal analysis?”

HHS said last year that  there were more than 667,000 pending appeals, with projections of more than 1 million by the end of 2021.