The Obama administration suffered a setback in its efforts to strengthen the individual insurance market when a federal appeals court last week struck down an HHS rule barring the sale of certain limited-benefit plans as stand-alone products.
In Central United Life v. Burwell, the U.S. Court of Appeals for the District of Columbia Circuit overturned a 2014 HHS rule restricting the sale of fixed-indemnity insurance plans that pay policyholders fixed dollar amounts to cover medical services regardless of how much the provider bills. These plans, which are cheaper to buy than comprehensive plans but exclude pre-existing conditions, do not comply with Affordable Care Act provisions on minimum essential benefits or guaranteed issue.
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A federal appeals court has ruled that consumers must be allowed to buy certain types of health insurance that do not meet the stringent standards of the Affordable Care Act, deciding that the administration had gone beyond the terms of federal law.
The court struck down a rule issued by the Obama administration that barred the sale of such insurance as a separate stand-alone product. “Disagreeing with Congress’s expressly codified policy choices isn’t a luxury administrative agencies enjoy,” the United States Court of Appeals for the District of Columbia Circuit said on Friday in a decision that criticized “administrative overreach” by the Department of Health and Human Services.
At issue is a type of insurance that pays consumers a fixed dollar amount, such as $500 a day for hospital care or $50 for a doctor’s visit, regardless of how much is actually owed to the provider.
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Last year, healthcare leaders had their eyes trained on one big case – King v. Burwell – and they celebrated when the justices voted to uphold a key provision of the Affordable Care Act.
This year wasn’t nearly so straightforward for healthcare leaders watching the Supreme Court, which wrapped up its latest term last week. At least half a dozen notable cases fragmented healthcare wonks’ attention. The outcomes of those cases left some in the industry cheering and others wringing their hands.
Healthcare-related cases focused on abortion, the ACA’s contraception mandate, patents, unions, claims data and the False Claims Act, among other topics. And the mid-term death of Justice Antonin Scalia looks to have affected the outcomes of some of those cases.
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Friday, the U.S. Court of Appeals for the D.C. Circuit released two opinions in Patient Protection and Affordable Care Act (PPACA) cases. In one case, the federal government prevailed. In the other, it did not.
In the first case, West Virginia v. Department of Health and Human Services, a unanimous panel concluded that the state of West Virginia lacks Article III standing to challenge the Obama administration’s decision to waive some of the PPACA’s requirements governing minimum coverage requirements. This litigation responds to the Obama administration’s response to outrage over insurance plan cancellations — cancellations that were politically problematic because they revealed that the president’s promise that “if you like your health insurance plan, you can keep it” was a lie. (Indeed, it was Politifact’s “Lie of the Year” for 2013.)
In a second case decided Friday, the administration did not fare so well. In Central United Life Insurance, Co. v. Burwell, another unanimous panel invalidated an HHS regulation for exceeding the scope of its delegated powers under the Public Health Service Act (PHSA), as amended by the PPACA. Specifically, HHS had adopted regulations seeking to prevent consumers from obtaining fixed indemnity policies that fail to satisfy the PPACA’s minimum essential coverage requirements, despite the PHSA’s exemption of such plans from such requirements.
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Maryland’s health cooperative filed a lawsuit Monday seeking to block the federal government from requiring it to pay more than $22 million in fees for a program designed to cover insurance company shortfalls.
The lawsuit by Evergreen Health Cooperative Inc. is the latest twist in the saga of health insurance co-ops set up under the Affordable Care Act to compete against larger, established insurers.
The co-ops were supposed to help keep premiums down by injecting competition into the industry. Instead, 13 of 23 startups that launched successfully have since collapsed, forcing more than 700,000 consumers to seek new insurance. A number of co-op officials have said they were hurt by the federal program because of a formula it used to spread out risk, which they say hurts them while benefiting large, already established insurance companies.
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Blue Cross and Blue Shield of North Carolina sued the federal government, becoming the latest health insurer to claim it is owed money under the Affordable Care Act.
The suit, filed on Thursday in the U.S. Court of Federal Claims in Washington, D.C., says the U.S. failed to live up to obligation to pay the insurer more than $147 million owed under an ACA program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets.
The suit argues that the federal government violated the language of the health law, as well as a contractual obligation to the North Carolina insurer.
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A few weeks back, I noted that a judge had ruled against the Obama administration in a dispute over health-insurance subsidies. Some background: Obamacare makes insurers reduce out of pocket costs, like deductibles, to low-income people who purchase qualifying plans; the government is supposed to reimburse the companies directly. However, Congress didn’t appropriate any money to pay for these subsidies. When the administration went ahead and paid the insurers anyway — distributing about $7 billion without congressional approval — House lawmakers sued.
Now it appears that House Republicans, and Judge Rosemary Collyer, aren’t the only folks who thought the administration’s actions were questionable. A report in the New York Times this weekend says that IRS officials raised concerns that the administration had no legal authority to spend the money.
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House Republicans and the Obama administration are clashing over subpoenas for ObamaCare documents. Republicans are upping the pressure on the administration, saying officials are withholding documents that Congress has every right to see.
At issue are two separate portions of ObamaCare. One is the Basic Health Program, which states can choose to implement and is aimed at providing choices for low-income people with slightly too much income to qualify for Medicaid. The other is the law’s “cost-sharing reductions” which are payments that help lower out-of pocket-costs for low-income ObamaCare enrollees.
“Your refusal to provide the requested documents and information raises serious concerns about the Department’s willingness to be accountable for the lawful execution of laws passed by Congress,” Energy and Commerce Chairman Fred Upton and House Ways and Means Chairman Kevin Brady wrote to Health and Human Services Secretary Sylvia Mathews Burwell on Tuesday.
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Two recently filed lawsuits illustrate continuing difficulties the administration faces in implementing the Affordable Care Act, particularly under the constraints imposed upon it recently by Congress. Specifically, the suits illustrate the legal difficulties for the administration created by Congress’ limiting of “risk corridor” payments—made to insurers with high claims costs—to amounts contributed to the risk corridor program by insurers with low costs. Last year, CMS announced that it would have only $362 million in contributions to pay out $2.87 billion in requested payments, and so would only pay out 12.6 cents on the dollar for payment claims.
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The Obama Administration is unlawfully diverting billions of dollars from taxpayers to insurance companies that sell Obamacare policies.
That is the conclusion reached in a legal opinion letter released today by former Ambassador and White House Counsel Boyden Gray.
Mr. Gray’s letter reinforces the conclusion of legal experts at the nonpartisan Congressional Research Service who found that the administration’s actions “would appear to be in conflict with the plain text” of the Obamacare statute.
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