“From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall.
Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law. That doesn’t even get to our top three storylines of the summer, so be sure to click through to find out what tops the list.”
“A majority of people are worried about employers moving them on to insurance exchanges, with Republicans reporting the highest level of concern at 72 percent. But once they actually get insurance on the exchange, most Democrats and Independents, 43 percent and 39 percent respectively, think the shift would have “no impact” on their coverage. In contrast, most Republicans, 41 percent, think it would have a “very negative” impact. The majority of Republicans and Independents say they would consider looking for another job if they were shifted onto an exchange, at 62 percent and 52 percent respectively. Democrats reported that they would look for another job at a rate ten percentage points below Independents, at 42 percent.”
“Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled in a reversal of policy stemming from the decision by two Catholic universities to drop elective abortions from their employee health plans.
Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, the director of California’s Department of Managed Health Care said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. The law in question requires such plans to encompass all “medically necessary” care.
“Abortion is a basic health care service,” department director Michelle Rouillard wrote in the letter. “All health plans must treat maternity services and legal abortion neutrally.”
Jesuit-run Santa Clara University and Loyola Marymount University notified employees last fall that they planned to stop paying for elective abortions, but said faculty and staff members could pay for supplemental coverage that would be provided through a third party. The two schools said their insurers, Anthem Blue Cross and Kaiser Permanente, had cleared the move with the state.”
“The state of Oregon filed a lawsuit Friday against Oracle America Inc. and several of its executives over the technology company’s role in creating the troubled website for the state’s online health insurance exchange.
The lawsuit, filed in Marion County Circuit Court in Salem, alleges that Oracle officials lied, breached contracts and engaged in “a pattern of racketeering activity.”
Oracle was the largest technology contractor working on Oregon’s health insurance enrollment website, known as Cover Oregon. The public website was never launched, forcing the state to hire hundreds of workers to process paper applications by hand. The website’s failure became a political problem to Democratic Gov. John Kitzhaber, who is running for re-election.
A related project to modernize functions for social services also was scrapped. The state paid Oracle $240 million for both projects.”
“How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?
Not much, as it turns out, but that hasn’t stopped some from trying.
Kaiser Health News readers still write in regularly about this.
In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.
Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.”
“When the Obama administration in November 2013 decided to allow states to decide if individuals could keep noncompliant insurance plans, speculation began about what effect that decision would have on premiums and enrollment for plans that did comply with provisions of the Patient Protection and Affordable Care Act. Subsequently, the administration this March gave states the option of a maximum two-year extension into 2016.
Early indications of how many individuals opted to keep those plans have begun to emerge as have signs of the effect on premiums. As with so much else related to the ACA, the results depend on what state is being discussed.
Twenty-five states are allowing noncompliant plans to continue through 2015, which creates a continuing impact for insurers attempting to formulate premium levels in 2014, according to data compiled by America’s Health Insurance Plans, an insurer trade group. Twenty-one states are taking the full extension option, through 2016, according to AHIP.
North Dakota has seen 61% of individual policyholders of noncompliant plans from insurers Sanford Health Plan and Medica opt to retain their plans, while 92% of group policyholders chose to stay on their noncompliant plans, said Rebecca Ternes, the state Insurance Department’s deputy commissioner.”
“The Obama administration is moving forward with regulations meant to enable certain businesses and charities to steer clear of the Affordable Care Act’s so-called birth control mandate, while ensuring free contraception coverage for women under the law.
The action amounts to an administrative workaround in response to a slew of legal challenges from groups citing religious objections to portions of the mandate. In June, the Supreme Court ruled that closely held religious companies cannot be compelled to offer their employees certain forms of birth control.
Under the proposal, the government would step in and cover the law’s contraception requirements in instances where employers announce their religious objections in writing. The organizations would not have to play any direct role in providing for contraceptive coverage to which they object, according to a final interim rule from the Centers for Medicare and Medicaid.”
“The Affordable Care Act gives the president’s cabinet officers sweeping powers to implement the law, but the administration managed to overreach these powers by allowing people in 36 states to illegally access health insurance subsidies.
That was the conclusion of the D.C. Circuit Court of Appeals in July.
At issue is the ability of people who sign up for coverage through exchanges established by the federal government to receive credits to reduce the cost of their health insurance.
D.C. Appeals Court Judge Raymond Randolph said the statute was quite clear in repeating seven times that subsidies are available only “through an Exchange established by the State.”
When the health law was passed, its authors apparently believed they had sufficiently cajoled the states. Jonathan Gruber, a chief architect of the law, said in early 2012, “if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.”
But when it became clear that most states would not be coerced, the White House called on the Internal Revenue Service to write a regulation that would allow the subsidies to flow through the default federal exchanges as well.
In Halbig v. Burwell, the D.C. court held that subsidies — as well as the coverage mandates that travel with them — apply only in states that have established their own exchanges.”
“Almost 7 million people can sign up for health plans under ObamaCare even before the new enrollment period begins in November, according to an advocacy group.
Enroll America, an ObamaCare enrollment group with close ties to the White House, said Wednesday that millions of adults are eligible to sign up for insurance before Nov. 15 because they have moved, gotten married, had children, lost insurance or become American citizens.”
“Carondelet Health Network, a Tucson, Ariz.-based division of Ascension Health, has agreed to pay $35 million to settle allegations that two of its hospitals inappropriately billed Medicare and other federal health programs for inpatient rehabilitation care.
The settlement is the highest amount paid in Arizona under the False Claims Act, according to the U.S. attorney’s office in Phoenix. From 2004 to 2011, the Justice Department alleged, the Carondelet hospitals billed the government for inpatient rehab services for patients who didn’t meet coverage criteria.
The Roman Catholic hospital system “expressly denies” the allegations in the settlement agreement.”