In its June 27 decision in Janus v. AFSCME, the Supreme Court tossed out a 4-decade precedent that had allowed unions representing public sector workers to collect “agency fees” from non-members who benefit from the unions’ collective bargaining activities.

The decision, some legal experts and politicos say, could deal a serious blow to safety net agencies like CMS and programs like Medicare and Medicaid, which many unions and their members spend to politically support.

The deeply divided court ruled 5-4 against allowing unions to continue collecting agency fees, which will result in cuts to unions’ aggregate funding and potentially reduce their political clout.

“Unions—which represented 7.9 million, or 34.4%, of public employees in 2017 compared with 8.5 million, or 10.7%, of employees in the private sector—are one of the strongest political forces advocating for protecting Medicare, Medicaid and other social programs,” wrote Modern Healthcare‘s Harris Meyer.

“In states that allow mandatory agency fees, membership in public-sector unions averages 53.7%, much higher than in states that don’t allow it,” he noted. “Researchers say rates of union membership have a direct political impact.”

Read Harris’s full story here, in Modern Healthcare.