Legal Challenges

Commonwealth Fund study finds insurers spend less than 1% of premium dollars on health care quality improvement

Posted on March 22, 2013

The medical loss ratio (MLR), a requirement within the Affordable Care Act (ACA), states that insurers must spend either 80% or 85% of their premium dollars on medical claims or quality improvement. A new Commonwealth Fund study found that in 2011, insurers spent less than 1% of their premium dollars on quality improvement measures, which translates to a combined spending of $2.3 billion, or $29 per subscriber. The study describes how different insurer types (publicly traded, nonprofit, provider-sponsored, etc.) allocate their premium dollars, specifically focusing on measures for quality improvement.

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SCOTUS denies contraceptive coverage emergency injunction

Posted on December 27, 2012

Hobby Lobby, a Christian-run arts and crafts chain, filed for an emergency injunction on December 21, 2012 with the Supreme Court to block President Obama’s birth control coverage rules. Hobby Lobby’s complaint surrounds the Affordable Care Act’s (ACA’s) requirement that most employers cover contraception without copay.

Yesterday, the Supreme Court today denied Hobby Lobby’s request, which was joined by the Christian book company, Mardel. The U.S. Supreme Court said it will not decide the case before lower courts have ruled. Justice Sonia Sotomayor argued that the petitioners did not meet the standards requisite for a preliminary injunction. The court also denied the request that the court take up the entire case, in which they argue that the ACA’s contraceptive coverage requirement forces them to violate their religious beliefs.

The case will return to the district court for a ruling on the merits of whether the Obama administration can require employers who have religious objections to contraceptive coverage to provide said insurance coverage in their employer plan.

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Supreme Court orders Fourth Circuit to hear Liberty case

Posted on November 26, 2012

The Supreme Court on Monday ordered the Fourth Circuit Court of Appeals to examine the constitutionality of the Affordable Care Act’s (ACA’s) employer requirement to cover contraceptives without a co-pay. This move could put the ACA in front of the Supreme Court again as early as next year. The order was in response to a request from Liberty University, one of the groups that sued over the mandate in 2010. After the June ruling, the Supreme Court dismissed Liberty’s entire lawsuit. Over this past summer, Liberty asked the Supreme Court to reopen the arguments pertaining to the employer mandate and the contraceptive coverage mandate. The court agreed to the request and today’s order instructs the Fourth Circuit to review both pieces of the argument.

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Judge exempts religious company from ACA’s contraception requirement

Posted on November 19, 2012

On Friday, U.S. District Judge Reggie Walton granted a preliminary injunction to Tyndale House Publishers, enabling the company to reject the Affordable Care Act (ACA) provision which requires employers to provide its employees with contraceptive coverage. The company argued that it does not want to cover contraceptives, as it  views them as abortions.

Plan B and IUDs are the contraceptives at issue in the case. If a woman is already pregnant, the Plan B pill has no effect. Plan B merely prevents ovulation or fertilization of an egg. Plan B can also prevent a fertilized egg from implanting on the uterine wall. IUDs mainly work by blocking sperm, but may also have the same anti-implantation effect. According to Tyndale, this implantation prevention is not morally different than abortion.

Tyndale president and CEO Mark D. Taylor filed the lawsuit against the U.S. Department of Health and Human Services (HHS) last month, arguing that the provision causes employers to violate their religious beliefs.

In his decision, Judge Walton acknowledged that the government has interests in promoting public health and ensuring that women have equal access to health care, but he said that the government has not offered proof that the ACA’s contraceptive coverage provision furthers these interests.

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Michigan judge grants injunction exempting private business from contraception coverage requirement

Posted on November 1, 2012

Judge Robert H. Cleland of the U.S. District Court of the Eastern District of Michigan granted a preliminary injunction exempting Weingartz Supply Company from the Affordable Care Act’s (ACA’s) contraception coverage requirement. Thomas More Law Center is representing Weingartz. The injunction marks the second time that a judge has issued an injunction for a private company on this provision. However, the Michigan judge did deny a preliminary injunction to Legatus, a nonprofit conservative Catholic business organization that filed suit alongside Weingartz. Because the business is a religious organization, as opposed to a private business owned by a religious individual, Legatus qualifies for the ACA “safe harbor,” and thus is not mandated to cover contraception while the Obama administration finalizes the exemption policy.

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DOJ will not attempt to block new challenges to ACA

Posted on November 1, 2012

The Department of Justice (DOJ) told the Supreme Court yesterday that they would not attempt to block requests to reopen a lawsuit against the Affordable Care Act (ACA). Such a lawsuit could potentially place the ACA in front of the Supreme Court again as early as next year.

In 2010, Liberty University sued over the minimum coverage provision and other aspects of the ACA, but the case was set aside when the 26 states and NFIB case went before the Supreme Court. Because the court upheld the constitutionality of the individual mandate in its June 28th decision, it essentially tossed out Liberty’s lawsuit. Liberty now wants the Supreme Court to review its other challenges to the ACA.

Specifically, Liberty claims that the law’s employer coverage requirements are unconstitutional, as the mandate’s contraception coverage requirement violates the right to freely exercise religion. Over 30 such claims have been filed against the Obama administration. Solicitor General Donald Verrilli’s letter to the court states that although the DOJ believes that the Liberty claims “lack merit,” the DOJ does not oppose the courts reviewing the suit.

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Arizona faces complications with Medicaid expansion

Posted on November 1, 2012

With regards to Medicaid expansion, Arizona is in a unique position. Arizona already voluntarily covers many of the beneficiaries who will be newly eligible in states that do decide to expand Medicaid. Whether Arizona will continue to cover its existing population or extend coverage to Affordable Care Act (ACA) levels, remains unclear. Because Arizona already covers childless adults up to 100 percent of the federal poverty level (FPL), the state is not eligible to receive the ACA’s generous reimbursements for many of the “newly eligible” Medicaid beneficiaries.

In its waiver request, Arizona explains that “Arizona’s citizens are penalized for having elected to provide … coverage to all Arizonans under 100% FPL.”

The Obama administration’s solution to this roadbump will provide an indication for how flexible they plan to be in terms of regulating the ACA’s now optional Medicaid expansion. The state’s voluntary coverage of these childless adults is set to end in December 2013, which is when the state assumed the ACA’s Medicaid expansion would automatically kick in. The Supreme Court ruling modified the ACA provision, however, making the expansion optional.

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Update: Legal Challenges to the Affordable Care Act — Liberty v. Geithner Petition for Rehearing

Posted on October 25, 2012

One of a number of lawsuits filed in opposition to the ACA was Liberty University, Inc., et al. v. Geithner et al. Under this lawsuit in 2010, a private Christian university and a number of individual petitioners sued the government to block enforcement of the ACA’s employer requirement to provide health insurance coverage to employees, as well as the individual requirement to maintain health insurance coverage. The district court in the Western District of Virginia rejected all the plaintiffs’ claims, which included challenges based on the Commerce Clause, the Necessary and Proper Clause, the Tenth Amendment, the First Amendment, the Fifth Amendment, and the Religious Freedom Restoration Act (RFRA). On appeal, the Fourth Circuit held that the Anti-Injunction Act (AIA) barred federal courts…

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Courts block defunding of Planned Parenthood

Posted on October 23, 2012

Federal judges Friday and today ruled that Arizona and Indiana, respectively, cannot halt public funding to Planned Parenthood for general healthcare services that don’t include abortion.

In Arizona, the preliminary injunction by U.S. District Judge Neil Wake bars the state from applying a new state anti-abortion law to Planned Parenthood Arizona. The state already prohibits public funding for most abortions. The new law, passed earlier this year but not yet implemented, would go so far as to bar public funding for general health care services provided by entities that also provide abortions. Supporters of the new law said that public funding for agencies like Planned Parenthood indirectly subsidizes abortions. Judge Wake ruled that the subsidies could in no way fund abortions because Medicaid reimbursements to Planned Parenthood Arizona cover only about half of the costs and thus, the Judge ruled that, ”there is no excess funding that could be used to subsidize abortions.” The Judge found that it is in the best interest of Arizona to block the law’s implementation to prevent some 3,000 patients from being denied health care delivery from their chosen health care providers.

In Indiana, a federal appeals court similarly ruled that the state cannot cut off funding for Planned Parenthood just because they provide abortions, amongst many other health care services. The 7th U.S. Circuit Court of Appeals in Chicago upheld a lower court decision that found that Indiana cannot enforce a state law that barred abortion providers from collecting Medicaid reimbursements for any health care services provided.

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Commonwealth Fund report compares and contrasts Romney and Obama on healthcare

Posted on October 8, 2012

President Obama and Governor Romney offer different visions for the nation’s healthcare system. To inform public discussion about health care in the election and beyond, an analysis published by the Commonwealth Fund draws from microsimulation analysis to contrast the potential impact of implementing the Affordable Care Act (ACA) in full with Romney’s proposals to repeal the law, eliminate many of the new requirements for insurance markets, and make changes in Medicaid and Medicare. The report focuses on the following:

• the number of Americans expected to gain health insurance;
• changes in the affordability of insurance;
• changes in consumer protections and consumer choice;
• help for small businesses;
• improvement in Medicare solvency;
• improvement in health care quality; and
• control of health spending growth.

The report’s findings indicate that, in each area, implementation of the Affordable Care Act would likely outperform Romney’s proposals.

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