Supreme Court Upholds Mandate

Posted by Kim Egan on June 28, 2012

Contributed by John Slotman.

On June 28, the Supreme Court issued its highly anticipated decision on the constitutionality of portions of the Affordable Care Act (Nat. Fed'n Indep. Business v. Sebelius, Florida v. Dept. of HHS; and Dept. of HHS v. Florida). The majority of the Court concluded the following on the key questions in the case:

1. The individual mandate is constitutional as an exercise of Congress' power under the Taxing Clause (although it could not be upheld based on the Commerce Clause and the Necessary and Proper Clause).

2. The expansion of Medicaid to additional populations is constitutional, but the federal government cannot withhold existing (non-expansion) Medicaid funds for non-compliance with the expansion requirements.

Roundtable discussion examines outcome

The Supreme Court’s ruling on the Affordable Care Act will have significant legal and business impact on the health care industry and beyond. Plans, providers, employers and businesses will need to quickly evaluate options for moving forward and will need to understand the federal and state policy questions resulting from the Court’s decision.

On July 11, our Washington, DC, office will host a breakfast discussion, Health Care at the Crossroads: The Path Forward from the Supreme Court Decision, to examine the full impact of the outcome with esteemed policy and business leaders led by Senator Tom Daschle, Governor Mike Castle and Mary Langowski, Chair of the DLA Piper Health Care Public Policy and Regulatory group.  Visit this page to register for the event.

 

 

 

 

 

Expansion of Medicaid is sign that implementation of health reform well under way

Posted by Devan McCarty on April 29, 2011

Lubbock Heart Hospital, Dec 16-17, 2005photo © 2005 Mark | more info (via: Wylio)

Managed care has long been part of the Medicaid delivery system across the country pursuant to specific waivers obtained by the states from CMS.  Under these programs, the states contract with managed care plans to cover Medicaid beneficiaries.  The state generally pays the plans a set per member, per month payment, and the Medicaid beneficiary is then covered through the plan's provider network.  Driven in part by the expansion of the Medicaid program under the new federal health law, many states are currently in the process of expanding these managed care programs by enrolling new populations and requiring more beneficiaries to enroll in managed care plans.  Among the states currently working on expansion are Maine, Texas, Florida, Louisiana, Michigan, Illinois and California.  In California, the state Medicaid program -- called "Medi-Cal" -- seeks to enroll almost 400,000 new aged, blind, and disabled Medicaid beneficiaries into managed care plans.  You can view more information about California's expansion of Medi-Cal here.    

 

The issues being addressed include whether beneficiary enrollment should be mandatory, creation and expansion of provider networks sufficient to provide accessibility to the new members, and reimbursement rates under the managed care programs.  Stakeholders, including the managed care plans, providers, and patient advocates, are all watching these issues closely.  In many states, the issues are complicated because the legislatures are trying to balance budgets and are looking to reduce spending on public healthcare programs.    

Will Sacramento control health care insurance rates for California?

Posted by John Barnes on April 27, 2011

California's Capitol Buildingphoto © 2005 Peter Dutton | more info (via: Wylio)

California has moved a step closer to allowing the state to regulate health insurance premiums.

On Tuesday, in a closely watched vote, the California State Assembly Committee on Health approved a bill that would allow the state departments that regulate health insurers to reject any proposed rate change that the departments find to be "excessive, inadequate, or unfairly discriminatory."  The bill, Assembly Bill 52, defines "rates" to include the premium charged to the consumer, as well as any copayments, deductibles, co-insurance, and other out-of-pocket costs.   The bill would also allow a consumer who disagrees with a regulator's decision to intervene in the regulatory process by filing a civil lawsuit.  

 The bill's author, Assemblyman Mike Feuer (D-Los Angeles), contends that the regulations are needed to counter increases in health insurance premiums that have outpaced the general rate of inflation fivefold.  Several health insurers have filed opposition to the bill, citing the increased costs associated with seeking regulatory approval for rate increases.

 The bill must pass several more tests before it will become law, including another Assembly committee vote, a full vote of the Assembly, a vote by the other half of California's bicameral legislature -- the California Senate -- and the Governor.  While some state governments already have this power, it remains to be seen if more states will attempt to adopt this approach.

Health Care Reform: A Snapshot for Employers

Posted by Kim Egan on April 05, 2010

Contributed by employers.jpgEvan M. Migdail and Nicole D. Carelli

After more than a year of congressional debate, President Barack Obama has signed two pieces of legislation into law: the Patient Protection and Affordable Care Act, H.R. 3590, and the Health Care and Education Affordability Reconciliation Act of 2010, H.R. 4872. Together, these bills comprise the health care reform plan (HCR) approved by Congress. Although legislation to modify various aspects of HCR has already been introduced in Congress, the likelihood is that no major additional health care bills will be adopted this year.

Overall, the purpose of HCR is to extend coverage to almost 95 percent of the public through the expansion of existing federal health care programs (Medicare, Medicaid and CHIP) and the creation of new state health care “Exchanges,” coupled with new incentives and sanctions to require employers either to provide health coverage for their employees directly or fund employees’ coverage through an Exchange. Federal subsidies will be provided to help individuals at lower income levels purchase insurance, and tax credits will be provided to encourage small businesses to provide insurance for their employees.

Taken together, the HCR legislation consists of almost 2,700 pages of new laws in a highly complex field, and it will take time to fully understand and assess the impact of these changes on employers and the health care industry. Moreover, the legislation will require extensive implementing regulations from the Departments of Health and Human Services (HHS) and Treasury, none of which have yet been released.

However, it is important to note that few of the provisions in HCR are immediately effective, and some do not take effect for a number of years. For example, the new excise tax on so-called “Cadillac” health plans is not effective until 2018. As a result, employers generally will have ample time to consider the ramifications of these new laws and plan accordingly. It is anticipated that the implementing regulations will be issued sequentially as provisions become effective.

What follows is a general discussion of the HCR provisions affecting employers, with reference to when the provisions are effective and the expected manner in which these changes are likely to be implemented. For the purposes of this Alert, we have focused on the private sector, and, for that reason, do not discuss changes related to Medicaid and Medicare.

Continue Reading