The DOL has begun to audit PPACA compliance, is your plan ready?
Continue Reading The DOL Has Started Auditing Group Health Plans for PPACA, as well as GINA and Wellness Program Compliance
PPACA
More Health Care Reform Fees – Redistribution of Risk
Employers wrestling with how to budget for the additional costs associated with the 2010 health care reform law have one more cost to consider: the “transitional reinsurance program” fee. Barely discussed in the public forum up to now (probably because the amount per plan was not determinable), the government has clarified how this fee could impact…
How Employers Can Approach Health Care Reform’s Shared Responsibility Penalty
Many employers put off making plans to deal with the employer shared responsibility penalty provision of the 2010 health care reform law until after the November elections. With President Obama’s re-election and no real possibility of legislative repeal, procrastinating further would be ill-advised. Employers need to understand now the way the penalty can be triggered…
How Should Employers Handle Health Insurance Rebates?
Some employers that sponsor insured group health plans will receive rebates this year from insurers due to the medical loss ratio limits imposed on insurers under the Patient Protection and Affordable Care Act of 2010 (as amended by the Health Care and Education Reconciliation Act of 2010, together “Health Care Reform”). Under applicable Health Care…
Group Health Plan Summary of Benefits and Coverage Due By Next Open Enrollment
The agencies primarily responsible for enforcing the Patient Protection and Affordable Care Act of 2010 issued 150 pages of final regulations implementing the mandate that group health plans and insurers provide a four-page summary of benefits and coverage to individuals who enroll in health plans.
Under the regulations issued February 9, 2012, plan administrators and…
Eleventh Circuit Decides Health Care Reform Individual Mandate Is Unconstitutional
The individual mandate provision of the 2010 health care reform law is unconstitutional, the U.S. Court of Appeals for the Eleventh Circuit decided in Florida v. HHS on August 12th. The Sixth Circuit previously held in Thomas More Law Center v. Obama that the individual mandate is constitutional. Therefore, the Eleventh Circuit decision creates a…
Employers Find Relief in Repeal of Certain Health Reform (PPACA) Provisions
The U.S. Supreme Court has refused to engage in expedited review of the decision of a Virginia District Court that held unconstitutional the individual mandate contained in the Patient Protection and Affordable Care Act (“PPACA”). The Supreme Court’s April 25 decision suggests there will be a long road to resolution of the constitutional attack on…
Score Tied 2-2 as the Healthcare Challenge Heads to the Legal Superbowl – The Supreme Court
Federal District Court Judge, Roger Vinson, for the Northern District of Florida, Pensacola Division struck down the Patient Protection and Affordable Care Act (“PPACA”), the Federal health reform law dubbed by its critics as “Obamacare,” on Constitutional grounds yesterday. Judge Vinson agreed with the Attorneys General of 26 states that the mandates of the law exceeded the authority granted to the Federal government under the Commerce Clause to the U.S. Constitution. See Bondi v. U.S. Dept. of Health and Human Services, (N.D. Fla. 1/31/2011). The decision follows three prior Federal District Court decisions, two upholding the law and one striking it down for similar reasons.
The essence of the decision is that the law’s “individual mandate” – which requires all Americans to purchase a minimum level of health insurance beginning in 2014 or incur a penalty, goes beyond the Federal government’s power to regulate interstate commence rooted in what is known as the “Commerce Clause” of the Constitution. The District Court also held, citing the Justice Department’s own arguments concerning the critical function the individual mandate serves with respect to the PPACA as a whole, that the law “cannot survive without the individual mandate” and must therefore fail along with the individual mandate. In so ruling, Judge Vinson wrote:
Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications. At a time when there is virtually unanimous agreement that health care reform is needed in this country, it is hard to invalidate and strike down a statute titled The Patient Protection and Affordable Care Act.
The Bondi decision, although it represents a significant victory for opponents of the health reform law, was not a total victory on all points for the Attorneys General and others who filed the lawsuit. Significantly, the District Court declined to order the Federal government to cease its activities in implementing the PPACA. It also rejected the plaintiff’s argument that the PPACA’s provisions requiring States to pay for a portion of the expansion of Medicaid beginning in 2014 improperly interfered with State sovereignty.
As a result of these limitations, Bondi will have little immediate practical effect on the implementation of the health reform law. The U.S. Justice Department immediately announced that it would appeal the District Court’s decision to the Eleventh Circuit.
It is unclear how the Eleventh Circuit or the Supreme Court will resolve these legal issues should the case proceed as most expect it will, or what changes might be made to the law in the coming days and weeks as Republicans buoyed by the decision are marshaling their forces in Congress to advance legislation to “repeal and replace.” We’ll all be staying tuned.
The following are some excerpts from the decision which provide a view into the reasoning of the Court . . .
HHS Updates Guidance on Obtaining Waivers from PPACA Annual Limits
The Patient Protection and Affordable Care Act (Affordable Care Act), requires the Secretary of Health and Human Services (HHS) to impose restrictions on the imposition of annual limits on the dollar value of essential health benefits in a new or existing group health plan for plan years beginning on or after September 23, 2010 and prior to January 1, 2014. Interim final regulations published on June 28, 2010, established these restricted annual limits, along with the possibility for a waiver from these restricted annual limits as granted by HHS if complying with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums.
Continue Reading HHS Updates Guidance on Obtaining Waivers from PPACA Annual Limits