A project of the Galen Institute

Issue: "Mandates"

Reform Update: Facing ACA mandates, insurers diversify into technology

Beth Kutscher
Modern Healthcare
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.

Universities nationwide limit student employment to comply with Obamacare

Caleb Bonham, Campus Reform
Wed, 2014-08-27
"Middle Tennessee State University (MTSU) is restricting student work because of compliance issues associated with the Affordable Care Act (ACA), commonly known as Obamacare. In an email last week, MTSU President Sidney McPhee explained that “due to our interpretation of the reporting requirements of ACA,” graduate assistants, adjunct faculty members, and resident assistants are barred from working on-campus jobs that exceed 29 hours of work per week. "[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus." Tweet This Now, they cannot take on multiple campus jobs. “[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus," the email stated. McPhee noted that violations of the law “could add up as high as

This Movie Star’s Planned Parenthood T-Shirt Proves She Doesn’t Understand Hobby Lobby Decision

Katrina Trinko
The Daily Signal
Wed, 2014-08-27
"Planned Parenthood Action Fund released today a t-shirt designed by actress Scarlett Johansson that targets the Supreme Court’s Hobby Lobby decision. The front of the pink t-shirt reads “Hey Politicians! The 1950s called…” and the back reads, “They want their sexism back!” “When I heard that some politicians were cheering the Supreme Court’s decision to give bosses the right to interfere in our access to birth control, I thought I had woken up in another decade,” explained Johansson in a statement. “Like many of my friends, I was appalled by the thought of men taking away women’s ability to make our own personal health care decisions,” she added. Um … what? Let’s look at some facts, beginning with that the Hobby Lobby decision was fairly narrow.

Affordable Care Act exemptions mean millions don’t have to sign up

Nick Madigan, Miami Herald
Tue, 2014-08-26
"When she was eight weeks old, Ashlyn Whitney suffered a severe respiratory-tract infection that put her in an intensive care unit for 12 days. “Because she was so young, she couldn’t handle it,” Ashlyn’s mother, Nicole Whitney, recalled. “They had to give her oxygen.” The baby, now a year old, recovered from her illness, known as respiratory syncytial virus.The bill for her treatment at the West Boca Medical Center in Palm Beach County came to about $100,000 — a sum that included almost $4,000 in fees for her birth and pre- and post-natal care — but every dime of the tab was picked up by a medical bill-sharing organization set up for its Christian membership. Such religious groups are exempt from the Affordable Care Act’s mandate that most Americans obtain health insurance or pay a penalty.

New Birth Control Rules Appear To Track Supreme Court Suggestion

Julie Rovner
Kaiser Health News
Tue, 2014-08-26
"Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month. A demonstrator holding up a sign outside the Supreme Court in Washington in June 2014. The Obama administration announced new measures last week to allow religious nonprofits and some companies to opt out of paying for birth control for female employees while still ensuring those employees have access to contraception. (Photo by Pablo Martinez Mosivais/AP) “We interpret what [the administration] did to be putting into effect that order,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center.

Some Insurers Refuse To Cover Contraceptives, Despite Health Law Requirement

Michelle Andrews, Kaiser Health News
Sat, 2014-08-23
"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.

BREAKING: Feds unveil new birth control mandate

Benjamin Goad, The Hill
Fri, 2014-08-22
"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."

Anthem Blue Cross sued again over narrow-network health plans

Chad Terhune, Los Angeles Times
Wed, 2014-08-20
"Health insurance giant Anthem Blue Cross faces another lawsuit over switching consumers to narrow-network health plans — with limited selections of doctors — during the rollout of Obamacare.. These types of complaints have already sparked an ongoing investigation by California regulators and other lawsuits seeking class-action status against Anthem and rival Blue Shield of California. A group of 33 Anthem customers filed suit Tuesday in Los Angeles County Superior Court against the health insurer, which is a unit of WellPoint Inc. Anthem is California's largest for-profit health insurer and had the biggest enrollment this year in individual policies in the Covered California exchange. In the latest suit, Anthem members accuse the company of misrepresenting the size of its physician networks and the insurance benefits provided in new plans offered under the Affordable Care Act."

Law by other means — a response to Rob Weiner on Halbig

Jonathan Adler
The Washington Post
Tue, 2014-08-19
"Rob Weiner is at it again over at Balkinization. This time alleging he’s found some smoking gun to prove that the Halbig litigation is “anti-democratic” and rests on a flawed legal theory. As with his posts on the D.C. Circuit’s en banc procedures, Weiner’s diatribe is long on bluster, but short on meaningful claims. And, as before, he says some things that are false, irrelevant, or both. Weiner starts with the supposed discovery of a video that shows the theory underlying Halbig was illegitimate from the start. The video is of a December 2010 conference at the American Enterprise Institute at which Vanderbilt law professor James Blumstein and health law attorney Tom Christina discussed pending and potential legal challenges to the PPACA.

HHS pressed on insurance discrimination claims

Ferdous Al-Faruque, The Hill
Tue, 2014-08-19
"Patient advocacy groups say health insurers are violating ObamaCare by discriminating against those with chronic diseases, and the groups are forcing the administration to respond. A Health and Human Services spokesperson cited by The Associated Press says a response is nearly prepped for advocacy organizations fighting AIDS, leukemia, epilepsy and other diseases. Groups such as the National Health Law Program and the AIDS Institute have filed complaints with the administration claiming insurers are in violation of the Affordable Care Act’s provisions that prevent them from discriminating against people with pre-existing conditions and chronic diseases. They argue certain drugs are put on higher tiers, requiring patients with chronic diseases to pay bigger out-of-pocket costs.

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