Wednesday, June 29, 2011

Appeals court upholds healthcare law

The new healthcare law President Obama signed last year survived its first test before a federal appellate court Wednesday, as the Sixth U.S. Court of Appeals in Cincinnati concluded that the law’s insurance requirement is constitutional.

“We find that the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause,” the judges said in rejecting a legal challenge to the law by the conservative Thomas More Law Center.

The Thomas More lawsuit has not attracted as much attention as two other legal challenges being pushed by Republican state officials in Virginia and other states. Those suits are being reviewed by federal appellate courts in Atlanta and Virginia.

And few legal experts expect that the constitutionality of the Patient Protection and Affordable Care Act will be settled until it is reviewed by the U.S. Supreme Court, likely next year.

But the ruling Wednesday nonetheless marked a legal victory for the Obama administration and its Democratic allies who have argued that Congress could require Americans to get health insurance starting in 2014.

To view the entire article, click here.

Monday, June 27, 2011

Previous Rules on External Reviews Eased in Regulations

WASHINGTON—Revamped health care reform regulations involving external reviews and coverage decisions ease rules proposed last year.

“Generally, this is good. This eases up—compared to the initial guidance—some requirements that would have been problematic for employers,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

Urgent care decisions

One change involves the amount of time health care plan enrollees have to be notified of an urgent care coverage decision. Last year, regulators said enrollees would have to be notified of an urgent care decision within 24 hours of receipt of a claim.
But in a joint amendment to the 2010 regulations published in Friday's Federal Register, the Health and Human Services, Labor and Treasury Departments said they will allow plans to make notification of coverage decisions within 72 hours, closely following a Labor Department rule.

“This is a welcome change for employers. A 24-hour deadline would have been extremely challenging to meet,” said Sharon Cohen, an attorney with Towers Watson & Co. in Arlington, Va.
“A 24-hour standard—think, for example, of Thanksgiving weekend—would not have been practical,” said Andy Anderson, a partner with Morgan, Lewis & Bockius L.L.P. in Chicago.
Regulators, though, noted that the 72-hour limit is a maximum “and that in cases where a decision must be made more quickly based on the medical exigencies involved, the requirement remains that the decision should be made sooner than 72 hours after the receipt of the claim,” according to the rules published in Fridays' Federal register.

Notifications in languages besides English

The latest rules also amend a requirement that notices of available and external claims appeal processes and review be provided in a “culturally and linguistically appropriate manner.”
Under the previous rules, the requirement to provide notices in a language other than English was based on the percentage of plan enrollees who were literate in a common non-English language. For plans that cover more than 100 participants, the threshold was 10% of plan participants, or 500 participants, whichever was less.

Under the latest rules, the requirement applies if at least 10% of the population residing in a county where an employer’s health care plan enrollees reside are literate in the same non-English language. Currently, 255 U.S. counties meet this standard, including 78 of which are in Puerto Rico, according to the rules.

To view the entire article click here

To view the official release click here

Wednesday, June 22, 2011

Waiver Application Period to End September 22, 2011

The Center for Consumer Information and Insurance Oversight2 (CCIIO) has previously published guidance, on September 3, 2010, November 5, 2010, and December 9, 2010, setting out the process that a group health plan or health insurance issuer that offers a limited benefit, or "mini-med" plan, should follow to apply for a waiver of the restrictions on annual limits on the dollar value of essential health benefits (as defined in section 1302(b) of the Affordable Care Act) for plan years beginning on or after September 23, 2010 but before September 23, 2011. CCIIO will conclude the annual limit waiver application process on September 22, 2011.

To see the entire release click here.

Wednesday, June 8, 2011

Order in the Courts! Healthcare Reform Update

ATLANTA (Reuters)—A U.S. appeals court in Atlanta will hear a lawsuit Wednesday challenging the constitutionality of the health care reforms signed into law by President Barack Obama a year ago.

The suit, filed by more than half the states, could reach the U.S. Supreme Court during its 2011-2012 term, which begins in October. Individuals, advocacy groups and hospitals have also sued.
Following are details of current lawsuits:

Lawsuit being heard in Georgia

• A lawsuit filed by 26 states and led by Florida Judge Roger Vinson said the requirement that individuals buy health insurance is unconstitutional. The 11th U.S. Circuit Court of Appeals will hear arguments Wednesday in Atlanta. While Judge Vinson said the entire health care law "must be declared void" because the requirement is inextricably linked to other parts of the law, he put his decision on hold pending appeal. Judge Vinson had ordered the Obama administration to seek a fast-track review of its appeal.

Challenges in Virginia

• A three-judge panel of the 4th U.S. Circuit Court of Appeals heard oral arguments in May challenging the recent ruling by U.S. District Judge Henry Hudson that the federal government cannot compel a person to buy health insurance. The judges, one of whom was appointed by President Obama, sharply questioned if Virginia had the right to bring the suit just because it passed a state law saying its citizens were not required to purchase insurance. In a twist, both the federal government and Virginia had appealed Judge Hudson's decision. Virginia says the judge erred by not throwing out the entire law.

• The court also heard an appeal in a lawsuit filed by Liberty University, the Virginia college founded by conservative evangelical leader Jerry Falwell. A federal judge had ruled the requirement to have health insurance and a requirement some employers buy coverage for employees was legal under the U.S. Constitution's Commerce Clause.

Other rulings

• Last week, the 6th U.S. Circuit Court of Appeals in Cincinnati heard an appeal in one of the first suits, filed by Michigan's Thomas More Law Center. One of the plaintiffs disclosed that she recently bought health insurance, and the panel of three judges is now trying to decide if there is still legal standing to sue. In October, a federal judge partly dismissed the suit, ruling Congress had the authority to enact the law under the Commerce Clause of the Constitution.

• In April, the U.S. District Court in New Jersey decided two individuals who said they represented "we the people" did not have any standing to sue, primarily because they could not establish they had been harmed by the law. The court had already dismissed on Dec. 9 a lawsuit filed by a cardiologist, a patient and a physicians' advocacy organization that had alleged the law violates the Constitution's Commerce Clause and the Fifth Amendment.

• A California federal court dismissed a lawsuit, now before the the 9th U.S. Circuit Court of Appeals, that said the health care law violates individual rights, increases taxes and violates physician-patient privileges, along with violating the Commerce Clause.

• In November, U.S. District Court Judge David Dowd partially denied and partially granted a motion to dismiss a lawsuit filed by the U.S. Citizen's Assn. in Ohio. While he dismissed arguments that the law violates freedom of association, due process and privacy protections, Judge Dowd is considering arguments that the law exceeds federal authority granted by the
Commerce Clause.

• At least 24 lawsuits have been filed in federal courts by states and private parties. One suit, Shreeve vs. Obama, was filed by a group of 25,000 individuals and entities.

What is at issue?

• States like Virginia have passed, or are considering, legislation declaring that the health care law cannot be enforced in their states. State legislators in Maine, Montana, Nebraska, Oregon, Texas and Wyoming have introduced bills that establish penalties, including fines and jail time, for any agent seeking to enforce the health care law within their states' borders. North Dakota's Legislature passed a "nullification" bill in April authorizing it to enact any measure necessary to prevent enforcement of the law.

• The states' main concern is that the law permits the federal government to force people to buy things, in this case requiring that all Americans purchase health insurance or pay a penalty under the "individual mandate." The federal government counters that everyone will inevitably pay for health care, whether through insurance or during an emergency, and that without the individual mandate premiums will rise.

• If the courts decide the individual mandate is unconstitutional, it is unclear if the mandate can be cut away from the law while leaving the other requirements intact. The states say that without the individual mandate, the law is rendered toothless.

• Parts of the U.S. Constitution that have come into play are the Commerce Clause, which regulates commerce among states; the Supremacy Clause, which makes federal power supreme to states' power; and the 10th Amendment, which leaves to states all powers not explicitly granted to the federal government.

• Some of the suits also focus on whether abortions are funded with taxpayer dollars under the law.

• When President Obama lobbied for the bill, he said there would not be a new tax associated with the individual mandate. The penalty for not having health insurance, though, is collected through tax filings and the federal government argues the fine is indeed a tax it is empowered to levy. States say the U.S. government does not have the authority to charge the fine and point to the discrepancy between President Obama's statements and the U.S. government's arguments.

Sources: Court documents, governors' offices, Pacific Legal Foundation

To view the original article please click here