The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010
(12/11/13)- Because 25 states have refused to go along with expanded Medicaid, federal spending will be about $45 billion lower in 2016 according to calculations made by the Urban Institute and the Kaiser Family Foundation.
The Patient Protection and Affordable Care Act sets an annual out-of-pocket maximum of up to $6,350 for individuals and $12,700 for families, after which the insurer would be responsible for the cost. If you are choosing a plan, be very conscious of the co-pay for the drugs in the plan you choose. Also, make sure the drugs you use are included in the formulary of the plan you select.
(11/30/13)- Officials from the Health and Human Services Department announced that there would be a delay for the online enrollment in the Small Business Health Options Program (SHOP exchange), which enabled businesses with less than 50 employees from joining up in 2014, unless they did so through an insurance broker, agent or insurance company.
That date has now been pushed back to November 2014 for coverage that takes effect in January 2015.
“The agent, broker or insurer will help the employer fill out a paper application for SHOP eligibility and send it into the SHOP marketplace”, according to administration officials. The insurer can enroll the employers and determine what premiums they would have to pay.
Some small businesses may qualify for tax credits worth up to 50% of their premium costs, but the credit can be obtained only by plans that are purchase through the small business exchange.
Department of Health and Human Services also announced that Terremark, a subsidiary of Verizon Communications, the contractor that handles the computer servers for the federal health exchange will be replaced in March by Hewlett-Packard.
(11/26/13)- Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services (CMS) announced on Friday that the government would give people 8 more days, taking the deadline up until the 23rd of December, to sign up for health insurance coverage that would take effect on January 1, 2014. The government was giving recognition to the fact that because of the computer snafus and technical glitches in connection with the federal website, the delay was necessary.
Premiums for the coverage would have to be paid by December 31 for the coverage to begin January 1 for the policy to qualify for the program,
The administration also announced a one month delay until November 15, 2014 for the second enrollment period which was to have ended on October 15th under the terms of the Affordable Care Act.
Jeffrey D. Zients, President Obama’s troubleshooter on the federal exchange repair project said that the federal site could now handle 25,000 users at the same time, and would be able to handle 50,000 users simultaneously by the end of this month.
Sara R. Collins, a vice-president for The Commonwealth Fund, a foundation that specializes in health policy said that the 14 states handling their own exchanges had signed up 173,268 people, and that the federal site had signed up 26,764 as of the latest count.
(11/24/13)- Although the Republican governor of Alaska favored his state’s entry into the expanded Medicaid program the legislature refused to go along with him. The number of enrollees in the health insurance exchanges continue to lag expectations, the same is not true for those entering the expanded Medicaid program.
The administration announced that 396,261 individuals have enrolled in expanded Medicaid, which is far in excess of the anticipated number.
(11/14/13)- A new Kaiser Family Foundation state-by-state analysis estimates that 17 million people nationally will be eligible for tax credits under the Affordable Care Act (ACA) next year if they purchase coverage through new health insurance marketplaces. This includes 2 million in Texas, 1.9 million in California and 1.6 million in Florida -- the three states with the largest number of residents eligible for tax credits.
Another problem has surfaced in connection with the interconnect ability of the 36 federally operated health-insurance exchanges and the 14 state operated exchanges. The federal website, HealthCare.gov was intended to be a gateway to Medicaid allowing eligible Medicaid beneficiaries to pass from the federal site directly to the state site to enroll there in one step.
That has not transpired since the federal government has been unable to transfer its files to the state Medicaid programs, so that entryway has been closed for the last 6 weeks. This is true even for those states that have opted for expanded Medicaid.
Many people going to the health exchanges do not know they are even eligible for Medicaid or for tax credits to subsidize the purchase of private insurance on the exchanges. As things now stand, a state pays anywhere from 27% to 50% of Medicaid costs. Under the expanded Medicaid program, the federal government will pay 100% of the cost for the next 3 years, and 90% of the cost for the next 3 years.
(11/10/13)- The Patient Protection and Affordable Care Act assesses a levy of $63 on each person covered in a health plan, which goes into a fund to compensate the health insurance companies that end up paying big medical bills for new customers who buy their insurance on the government exchanges.
The levy is applied to spouses and dependents, as well as to the policy-holder.
Kaiser Health News, a nonprofit news organization reported that the government intends “to propose in future rulemaking to exempt certain self-insured, self-administered plans from the requirement to make reinsurance contributions for the 2015 and 2016 benefit years.” This exemption would apply to unions and some businesses.
(11/8/13)- The Department of Health and Human Services issued a ruling that copayment assistance drug cards can continue to be used under the Affordable Care Act, and usage of these cards or coupons is not to be considered an illegal rebate. Pharmaceutical companies are contributing $85 to $90 billion in fees, drug-price discounts and other givebacks under the law, according to Prevision Policy LLC, a health-policy consulting firm.
Drug-payment assistance cards and coupons help offset copayment and co-insurance for those who use these items, and thus help to reduce the cost to the holders. You may argue that the rest of us, in turn are the ones who are really paying for it, but I believe the benefit to the lower income individual outweighs the ultimate cost for the rest of us.
(11/5/13)- The latest figures through October 25 indicate that 700,000 people had applied for health-insurance, with about one-half coming from the federal site and the other half from the state-exchanges.
Julie Batile, a spokeswoman for the Centers for Medicare and Medicaid Services, which has responsibility for the federal website stated: “All of that is covered with our contractual obligation that already exist, that $630 million number.”
The Obama administration assigned new responsibilities to Quality Software Services, a unit of UnitedHealth Group, saying it would be the general contractor, coordinating work on the project. CGI Federal, a unit of CHI Group has been the lead contractor for the project.
(10/30/13)- One of the major problems afflicting the federal health care insurance exchange is that there are at least 55 separate contractors reporting to the Department of Health and Human Services. Many computer experts feel that the department did not have the technical expertise to oversee such a project.
Thus, an outside coordinator, Jeffrey D. Zients has now been brought in by President Obama to oversee the operational capability of the federal health-care exchange insurance site.
It is estimated that the computer project has cost at least $400 million up to now, with at least another $500 million having to be spent before it can become fully integrated with the needed databases from the federal government.
(10/26/13)-Obama administration officials announced that people won’t have
to pay a tax penalty in 2014- which starts at $95,or 1% of taxable income-if
they sign up for health-care coverage by March 31.
With President Obama conceding that there have been numerous snafus in the federal computer system for its health-care exchange enrollment, the promise has been made that it will be corrected by the end of November.
(10/25/13)- Ohio became the 25th state plus the District of Columbia to accept expanded Medicaid coverage, according to the Kaiser Family Foundation. Republican Governor John R. Kasich, who was one of the leading opponents of the Affordable Care Act, took the issue to the 7 member state Controlling Board to release $2.5 billion in federal funds sent to the state for the expansion, after the Republican legislature refused to go along with it.
The 5-2 vote will allow 275,000 Ohioans who previously were not eligible for Medicaid to be covered by the program. A budget was sent to the governor by the General Assembly that forbade Medicaid expansion without lawmaker’s approval. Mr. Kasich vetoed that item.
Under the act, the federal government will pay 100% of the additional cost for Medicaid expansion for the first 3 years, and 90% of the cost for the next 3 years.
(10/22/13)- Federal judges in Washington, D.C and Virginia will consider whether or not the language in the Affordable Care Act allows subsidies to be paid to help reduce the premiums paid by low income earners who purchase their health-care insurance from an exchange set up by the federal government in states that did not set up such marketplaces. 14 states and the District of Columbia have set up their own exchanges, so the question does not pertain to these jurisdictions.
The act states that people qualify for subsidies if they obtain health insurance through an exchange “established by the state”. Thus should the subsidy also apply to insurance purchased through an exchange set up by the federal government for the state?
(10/21/13)- According to data compiled by the Wall Street Journal, at least 38,000 people have signed up for new health care plans in the 14 state-run exchanges that opened on October 1. The federal government, which is running the exchanges for 36 states said that it would not release enrollment data until November.
Of the 14 states that reported numbers, Kentucky led the way with 9,500 enrollees. The Congressional Budget Office has estimated that 7 million people will enroll in a health plan from one of the exchanges set up under the Affordable Care Act
New York state said last week that it had 40,000 completed applications, putting it atop that list.
5.2 million people who won't qualify for Medicaid or Subsidies for private insurance live in the 26 states not expanding Medicaid under the Affordable Care Act.
Q: What is the "reinsurance" tax?
A: It is a $63 tax assessed on nearly every health insurance plan enrollee for the next three years. The money collected is then used to help insurers in the individual market with high-cost cases that reach beyond a catastrophic cap. The fund would reimburse insurers for 80 percent of costs for claims between $60,000 and $250,000 per person.
(10/16/13)- One of the biggest complaints being voiced in connection with the federal health exchanges is that it requires you to register before you can view the different health-plans that are available and compare them. This problem has now been corrected, and you can now view the different plans being offered without having to first register.
We at therubins recently received the following e-mail from Jeffrey Redd, an Outreach Director and have reprinted that email below since we know the topic is of great interest to many of our viewers
Hello, my name is Jeffrey Redd.
I was doing some research about healthcare, insurance, and what the future brings. I saw you mention Healthcare.gov along with a few other great places on http://www.therubins.com/index.htm.
Thank you for mentioning them. The information they provide the public is exceptional.
I put together some data, and information in regards to substance abuse, and mental health treatment. It is an extremely important aspect of
healthcare, but for some reason is not talked about nearly enough. I wanted to see your thoughts, and if possible help me spread the word. You can see it here: http://www.quitalcohol.com/health-insurance-and-addiction.html
Let me know your thoughts, and thank you very much for your time. Take care.
(10/13/13)- When you purchase your health-care insurance on one of the exchanges, the exchange will verify your income by checking your tax return from last year, as well as your present income. If your self-attested income varies by more than 10% from this amount, you will be asked to provide additional documentation to verify the amount.
Whether or not you pay full price or qualify for a premium tax credit depends on your modified adjusted gross income on your latest tax return. If your household’s modified adjusted gross income is from 100 to 400 percent of the federal poverty level ($11,490 to $45,900 a year if you are filing an individual return and $23,550 to $94,200 for a family of four), you may be eligible for a premium tax credit.
Your adjusted gross income is found on line 37 of your income tax return form, but you must add back in your dividends, interest income, Social Security income and retirement account withdrawals. You also must add in any income from a dependent who has to file his/her own income tax return
(10/7/13)- One of the least discussed items in the Affordable Care Act is the provision calling for a government-funded test authorizing Medicare to set up pilot ACOs. More than 250 health systems have signed on since 2011, covering more than 4 million Medicare beneficiaries.
It is estimated that the sickest 1% of the population cost the medical system about 22% of health spending.
Medicare automatically assigns patients to an ACO, whether they like it or not, if they get most of their primary care from a physician in that ACO. If a patient goes outside the assigned one, the assigned ACO picks up the cost for that treatment even though it had no control over the treatment. Medicare will retroactively reassign a patient to another ACO if the patient, on a quarterly basis uses an unassigned ACO, more than an assigned one.
Under federal rules, if a Medicare ACO meets 33 quality criteria, and lowers average patient cost below an assigned benchmark, it splits the savings with Medicare. Medicare calculates the benchmark using a health group’s historic costs.
Gary M. Cohen, 58, is the director of the Center for Consumer Information and Insurance Oversight, and he is the official in charge of supervising the new health insurance marketplace set up under the terms of the Affordable Care Act. The federal government is running 36 of the exchanges by itself.
He is a graduate of the Fieldston School.in the Bronx, Brown University and Stanford Law School. He was a litigator at Keker & Van Nest, a San Francisco law firm, for 16 years. He also worked at the California Public Utilities Commission and the state’s Department of Insurance.
Even though you must enroll by December 15th for coverage beginning January 1, 2014, the exchanges will be open for enrollment through March 31, 2014.
(10/3/13)- The site, HealthCare.gov, encouraged people to “connect” via Twitter, Facebook and Youtube, and required users to have an e-mail address in order to sign up. It provided a phone number if you wished to call, but there was a long delay in getting the call answered.
If you were able to get onto the site its design and aesthetics were excellent.
You can use your smartphone to get onto the site and register.
(10/1/13)- Obama administration officials announced that the health-insurance market place for small businesses would have to delay its opening by a month to November 1, 2013. The individual health-insurance exchanges will open today as planned, but because of soft-ware snafus, not everyone will be able to enroll online starting today.
For those wishing to enroll, but unable to do so online, the individual will either have to download a printable form, of go to an insurance agent who is licensed to enroll applicants in a plan..
At the same time the administration did also announce that all functions for the Small Business Health Option Program Marketplace will be available in November, and if employers and employees enroll by December 15, 2013, coverage will begin January 1, 2014.
(9/27/13)- The ad campaigns, both for and against the new health care law, are in full swing as we approach the beginning of the enrollment period for health-care coverage under the Patient Protection Act. The federal government will be the sole operator of the health-care exchanges in 36 states. 14 states and the District of Columbia will operate their health-exchanges in conjunction with the federal government
Political groups have spent roughly $500 million since the law was passed either in favor or in opposition to the act according to Kantar Media, an ad-tracking unit of WPP PLC. So far, the majority of spending has been done in opposition to the law.
(9/12/13)- California officials said that the state will be able on October 1 to enroll its residents online in a health-insurance plan set up under the terms of the Affordable Care Act. Dana Howard, a spokesman for Covered California, the agency operating the exchange in the state in which individuals or small businesses can select and enroll in a plan.
Mr. Howard said, exchange officials had completed test of the online system, including creating accounts, selecting plans and assessing eligibility for subsidies
(9/6/13)- The National League Football team the Baltimore Ravens, the winner of last year’s Super Bowl, will help to promote the word about the state of Maryland’s new health-care- insurance exchange which was created under the terms of The Patient Protection and Affordable Care Act (PPACA).
The Obama administration had hoped that the league as a whole would help to promote the law, but several of the team owners had objected to doing same, after being warned by some Republican lawmakers to all sports leagues to avoid doing so.. About 800,000 or 14% of the state’s population of 5.8 million is uninsured.
Former President Bill Clinton has also been in the forefront as an advocate for the health-care law.
Fourteen states and the District of Columbia are running their own health-insurance exchanges, while the federal government will be operating the exchanges in 36 states. People can start signing up for the coverage beginning October for the coverage that will start January 1, 2014.
Danielle Davis, communications director for Maryland Health Connection, said ads will be placed on a Raven related radio show and website.
(9/5/13)- The Michigan State House, by a bipartisan vote of 75-to-32, gave final approval to a measure that would add the state to the expanded Medicaid coverage under the Patient Protection Act. In doing so, it is estimated that almost a half-million more low income adults would be eligible for coverage.
The State Senate narrowly passed the measure last week, with the blessing of Republican Governor Rick Snyder, who had been a vocal opponent of the law. Under the terms of the act, the federal government will pay the entire cost of those low-income individuals who would now be covered under Medicaid, and 90% of the cost for the following 3 years
(8/18/13)- The limit on out-of-pocket medical costs, including deductibles, co-payments and prescription drug costs was not supposed to exceed $6,350 for an individual and $12,700 for a family in 2014 under the terms of the Affordable Care Act of 2010.
It has come to light however that a grace period has been extended until 2015 under a ruling that was contained in the Labor Department's Web site in the "frequently asked questions about Affordable Care implementation".
Under the ruling, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, there could be a $6,350 limit for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a prescription benefits manager.
Some consumers may even have to pay more, as some group health plans will not be required to impose any limit on a patient's out-of-pocket costs, it will not have to impose one in 2014.
The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs.
(8/13/13)- Oregon, which is one of 14 states that will operate its own health-insurance exchange, will open for business on October 1, but consumers will not be able to access it online. Officials at Cover Oregon, as the exchange has been called, should be able to go online to enroll by the end of the month.
For the first couple of weeks of the enrollment period, consumers in Oregon will have to visit an agent's office, or find one willing to come to their house to enroll. Cover Oregon said that it has trained about 1,000 agents and 800 other people to help people enroll.
Officials from Oregon give as the reason for the delay is that they wanted to test the system properly, over a sufficient period of time to make sure that the system worked properly once it started up.
The District of Columbia will operate its own health-insurance exchange.
(8/10/13)- A provision of the Affordable Care Act of 2010 that went into effect last year, penalizes acute care facilities for excess re-admissions of Medicare patients.
The maximum penalty is 1% of a hospital's base Medicare payment, but hat will increase to 2% on October 1, and go up to 3% by fiscal 2015. The penalties are based on the number of patients above the national average who are re-admitted to an acute-care hospital due to heart failure, heart attack or pneumonia and then re-admitted with 30days.
An estimated $227 million in fines will be levied this year by Medicare against 2,225 hospitals starting in October. Last year, 32,214 hospitals were fined a total of roughly $280 million.
(8/9/13)- Under the terms of the Affordable Care Act, a tax would be imposed starting in 2018 on owners of health insurance plans that cost above a certain threshold. The purpose of this so-called "Cadillac Tax" was to make the consumer more aware of exactly the costs involved in their medical treatment.
The tax would be imposed starting in 2018 for plans that cost the employer above $10,200 annually for individuals and $27,500 for family plans, with slightly higher cutoffs for retirees and those in high risk professions like law enforcement. The tax would be 40% on the excess amounts.
Municipal and state unions are mobilizing their resources to deal with this issue since many of their employers have plans in which the government pays a large, if not all of the costs for the individuals health insurance.
(8/2/13)-Individuals earning up to 400% of the poverty level can get federal subsidies to help with the cost of their health insurance premiums, but only if the policy is bought through the newly created health exchange.
This year, 400% of the poverty level is $45,960 for an individual, and $62,400 for two-person households.
Some cities may also provide moderate monthly stipends to help retirees with the cost of their premiums for their health insurance purchased through the new health insurance exchange market.
For taxpayers who itemize their deductions, medical expenses paid for themselves, spouses and dependents will have to exceed 10% of adjusted gross income unless the person paying the bill are 65 or older as of December 31 this year. In that case the threshold will remain at 7.5%
(7/27/13)- As of the latest count, the federal government has full control over the health-insurance marketplace in 19 states, while 17 of the states and the District of Columbia will manage their own exchanges. The health-insurance exchange in 15 of the states will be joint ventures between the federal and state governments.
Getting the computers to communicate with each other will be just one of the many problems the new systems will be faced with once the provisions of the new law come into affect.
(7/24/13)- Individuals buying health insurance on their own in New York State will see their premiums fall next year by about 50%, according to state officials. State insurance regulators say they have approved rates for 2014 that are at least 50% lower on average than those currently available in the state.
Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies costs will be even lower.
(7/21/13)- Equifax Workforces Solutions, a unit of Equifax Inc. has been hired by Obama officials to help verify the incomes of people who apply for federal subsidies to buy insurance under the new health law.
Subsidies, in the form of tax credits, will be available to millions of low and moderate income people who are not eligible for Medicaid, and have not been offered affordable coverage by employers.
The subsidies will average about $5,000 a year. In some cases, the insurance provider can rely on what the consumers say about their income and employer-sponsored coverage if such information cannot be obtained from the employer or other sources.
Contract documents show that Equifax must provide income information "in real time", usually within a second of receiving an inquiry from the federal government. Equifax says that much of its data comes from information supplied by the employers and updated each pay period. It is incumbent on Equifax to make sure there is no fraud involved in the data it uses.
Equifax is also responsible for providing the information about employer sponsored plans and how much the employees pay for it.
The government had awarded an earlier contract to the American unit of the British company Serco Group to provide "eligibility support services' to health insurance exchanges around the country.
(7/5/13)- U.S. Treasury officials announced in a blog, on the department's website, that Obama officials would delay enforcing the provision in the Affordable Care Act for one year that required employers of 50 or more employees who worked 30 or more hours to provide healthcare coverage for their workers or face a penalty starting in 2014.
The penalty is a fine of $2,000 per employee.The decision reflects pressure from companies in the restaurant, retail and agriculture industry, who had cited several practical difficulties posed by the law's requirements.
The provision in the law that requires individuals to carry health coverage or pay a fine starting in 2014 remains in effect. The fine will be assessed when the individual files his or her 2014 income tax return.
(6/27/13)- Kathleen Sebelius, the secretary of health and human services announced that a call service and web site would be available 24 hours a day to help prospective purchasers of health care insurance make decisions needed to be made to comply with the Patient Protection Act of 2010.
The call center number is 800 318 2596 and the web site is www.healthcare.gov . The web site will provide information promoting the new health care law, and it will describe the different options available in the newly established health exchanges.
Consumers can file online applications starting October 1, with coverage beginning January 1, 2014.
The Congressional Budget Office (CBO) predicts that 7 million people will buy private insurance next year through the new exchanges, while 9 million people will gain coverage through expanded Medicaid coverage in those states that applied for the expansion option..
The CBO estimates that the number of uninsured, which is now at 56 million, will be reduced to 25 million under the new law.
(6/11/13)-Under the terms of the Patient Protection Act, employers with 50 or more full-time equivalent employees will need to offer health insurance to all their workers who average 30hours or more a week.
In addition, employers must not ask employees to contribute more than 9.5% of their income to health-insurance premiums. Otherwise the, employers could face penalties. If the employee does not sign up for health-insurance coverage under the company's plan, the employer will not be penalized.
(6/8/13)- The Patient Protection Act requires that 10 essentials be included in all health-insurance policies sold in the health exchanges set up under the law. These include maternity care, substance abuse and mental-health services and prescription-drug coverage, which aren't included in standard individual policies today.
In addition, plans can't exclude pre-existing conditions. Under the law, annual out-of-pocket expenses are capped at $6,350 for a single person, and $12,700 for a family.
Open enrollment will begin October 1 and run through March 31. After that, open enrollment for 2015 will run only from October 15 to December 7, 2014.
Through tax credits, the government will help fund some of the premiums for those whose household income is up to 400% of the federal poverty level. That's $45,960 for an individual and $94,200 for a family of four, based on 2013 numbers.
(6/1/13)- One of the provisions of the Affordable Care Act of 2010 that does not come into effect until 2018 is now coming into the limelight since it can be very costly to companies that provide so called "Cadillac health plans" for its employees.
Under the terms of the law, an employer offering a plan that costs more than $10,200 for an individual and $27,500 for a family would typically pay a 40% excise tax on the amount exceeding the threshold.
In order to lower the impact of this provision, employers could raise the deductible amount its employees would have to pay, before the company's insurance kicks in. Companies have in fact been doing this for the last several years. At last count about one third of workers are in plans with a deductible of at least $1,000.
More and more employers are offering health savings plans to their employees which have lower premiums for its members, but much higher deductibles.
(5/30/13)- California is one of the key states participating in the health-insurance marketplace set up under the Patient Protection Act. Initial indications are that 13 or 14 states will set up their own market-place, with the rest of the states therefore depending on the federal government to set up the program within their borders.
Covered California, the agency set up by that state to create its online market place for health insurance estimated that about 2.3 million residents of that state would enroll in the program by 2017.
The agency said that its initial indication is that the average premium will be $321 a month for its silver plan, which falls in the middle of the spectrum of the plans being offered. State regulators will review the rates, and many people will receive subsidies, depending on their income levels.
So far, 13 insurers have agreed to have plans available on the exchange for Californians. Blue Shield of California said its average premium for preferred-provider organizations in 2014 would be around 13% higher than its current average for individual PPO plans. UnitedHealth Group Inc., Aetna Inc. and Cigna Corp., the nation's 3 largest health-insurers have no present plans to participate in the California program.
The insurers participating in the program said they would limit the choice of medical professionals and medical facilities that its members will be able to use.
Two of the states that initially indicated that they would set up t heir own health-insurance exchange, Idaho and New Mexico, are now asking the federal government for help because they can't have their own exchanges set up by October 1, the cut-off date for having the exchange in place.
(5/12/13)- The Affordable Care Act that goes into effect January 2014 requires all employers who have 50 or more employees who work 30 hours or more a week to have health care insurance for their workers. If they don't, the employer faces fines starting at $2,000 per worker annually.
Some employers are considering cutting back on the number of hours that their employees work to below 30 hours a week, so that they would not be covered under the act.
The Congressional Budget Office estimates employers will pay around $106 billion in penalties between 2014 and 2022 for not meeting the law's insurance requirements.
(5/5/13)- Even though Republican Governor Rick Scott had reversed his position, and had agreed that it would be best for the state to accept the expanded federal program for Medicaid recipients, the legislature refused to go along with him on this issue. Under the expanded program the federal government would have financed the full cost for the first 3 years, and 90% of the cost thereafter.
Florida has one of the highest rates of uninsured people, so that the state's emergency rooms will have to bear the brunt of continuing to be the primary care medical facility for about 1 million uninsured residents who live there.
It is estimated that the state will lose about $1 billion in funding in 2014 by not joining in the expanded Medicaid program.
At last count, 33 states have opted against running their own health insurance exchange, so that the federal government will be operating the exchanges in those places.
(3/29/13)- Republican Governor Bill Haslam of Tennessee announced that he would not expand Medicaid coverage in his state, and thus he joined 18 other Republican governors who also refused to go along with the plan.
When the Supreme Court upheld the constitutionality of the Affordable Care Act, it also declared that the states must be given the option of joining in the expanded Medicaid portion of the law. Even though the federal government will pay for 100% of the increased cost for the expansion from 2014 to 2016, which will decrease to 90% in 2020, the governor refused to join the plan, even though there are about 175,000 residents of the state who might become eligible for coverage..
(3/28/13)- Health and Human Services Secretary Kathleen Sebelius acknowledged that cost could rise in the individual health insurance market, particularly for men and younger people, because of provisions in the Patient Protection and Affordable Care Act due to take effect January 1, 2014.
The law eliminates discriminatory market practices that have imposed higher rates on women and people with medical problems, and limits how much insurers can charge older people.
While the changes will lower the costs for women, older beneficiaries and the sick, men and younger, healthier people are likely to see higher rates as insurers try to hedge their risks.
(3/20/13)- A provision in The Patient Protection and Affordable Care Act that requires an employer to pay a fee of $63 for each employee covered under the act is attracting a great deal of media attention.
It is estimated that companies and other plan providers will pay about $25 billion over three years to create a fund for insurance companies to offset the cost of covering people with high medical bills.
Several of the country's largest employers have asked federal regulators to exclude or shield their insurance recipients from the fee, since it subsidizes individually purchased plans that won't cover their workers.
Insurance companies argue that the fee is necessary to prevent rates from skyrocketing when insurers get an influx of unhealthy customers next year. The fee will be smaller in 2015 and 2016, though regulators haven't set those amounts yet.
(3/10/13)- Under the terms of The Patient Protection and Affordable Care Act, Medicare will cover an annual wellness visit that includes detection of "cognitive impairment". Once diagnosed, patients can be helped with family support, medication management and brain games to help delay further decline.
For more information on the Medicaid terms of the act, please see our article Medicaid Eligibility
(2/28/13)- When the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act, it also ruled that the expansion of Medicaid under the act was an option, not a requirement of the states.
At the time of the ruling several state governors who had opposed the constitutionality of the act stated that they would not expand coverage of Medicaid, even though the federal government would pay the entire cost of the expanded coverage for the first 3 years, and 90% of the coverage thereafter.
As the deadline approaches for declaring their official stands on the matter, seven Republican governors now are cautiously moving to expanding Mediciad coverage in their state. In Florida, Republican Governor Rick Scott has reversed his position and announced that he would favor expansion of coverage in his state. He joins governors from Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio in now favoring expansion of coverage.
Nationally, Medicaid now covers about 60 million people, and the Congressional Budget Office (CBO) estimates that 17 million more people could be enrolled, if all states took the expansion option.
Twenty-two states have accepted the expansion option, 17 have opted against it, and 12 have not announced their position on the matter, according to Avalere Health, a consulting firm. Governor Scott had previously been one of the most vocal opponents of having a state expand its Medicaid coverage.
(2/22/130- Federal officials issued a final rule defining "essential health benefits" that must be offered by health insurers under the Patient Protection and Affordable Care Act starting next year. The rule would require insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse.
Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.
The rule says the new health insurance policies can be offered at four levels of coverage. Minimum benefits will vary from state to state, as each state will have its own benchmark plan.
Aetna Inc. has said it will probably participate in 15 exchanges, while Humana Inc. stated it would likely participate in about 10 states. Cigna Inc. has indicated that it would participate in approximately 10 states also.
Blue Cross and Blue Shield are expected to participate widely in these new health-insurance exchanges, while WellPoint Inc. said it expected to participate in 14 states.
Eighteen states have agreed to set up their own state operated health-insurance exchange as required under the Patient Protection Act. On the other hand there are around 197 million people who live in states that have chosen not to run their own exchanges.
About 18.3 million of the 197 million have no health insurance and have incomes that could qualify them for subsidies to help them pay their premiums for the coverage.
The U.S. Department of Health and Human Services is poised to run exchanges on behalf of these remaining states. Federal officials expect about half of these states to run the exchanges in partnership with the federal government. They have until February 2013 to make this choice.
Five of the states that will run their own exchanges have Republican governors, who said they oppose the law, but would prefer to retain control of them on the state level rather than have the federal government involved in them.
The six are
December 14th is the deadline for states to tell the federal government if they intend to establish their own insurance exchanges. Gary M. Cohen, a federal health official said that the federal government had received applications from 14 states that want to run their own exchanges. The states will have until February 14th to send a "letter of intent", if they want to establish the exchange in cooperation with the federal government.
No phased in expansion of Medicaid eligibility will be allowed.
The letter of intent should state whether the exchange will be operated by the state alone, by the state in conjunction with the federal government, or allow the federal government to operate the exchange by itself.
Under the Patient Protection and Affordable Care Act, the exchanges are supposed to be ready to start enrolling people in October 2013.
Republican Governor Bob McDonnell of
If the letter of intent is sent to the federal government stating willingness to set up an exchange in partnership with the federal government, the state will have until February 15th to do so. If the state intends to set up the exchange on its own, it must now do so by December 14th.
Under the terms of the Patient Protection Act, starting in 2013, the maximum that an employee can contribute to his/her flexible spending account (FSA) is $2,500
The declaration of intent need only be a one or two page letter affirming the state's intent to set up its own health insurance exchange or to do so in partnership with the federal government. Those that want to run it in partnership with the federal government will have until February 15th to file the application. That letter of intent does still have the November 16th deadline.
At last count 15 states and the District of Columbia had created the framework for the exchanges, with 3 others having committed to running an exchange in partnership with the federal government. The Republican governors of Arizona, Idaho, New Jersey, Virginia and Tennessee stated that they would defer acting until after the election, which has now passed.
Families with incomes up to 400% of the poverty level will receive subsidies from the federal government to help them meet their premium requirement for the plan they choose under the state's insurance exchange.
If the state does not set up an insurance-exchange, the federal government will set it up in the non-complying state, and for many state-righters, that is not too pleasant a choice to be faced with..
Under the terms of the law, individuals and small businesses must have health insurance or they will be subjected to levies when they pay their income taxes starting in January 2014.
The marketing of the health plans is scheduled to begin in October 2013 for
If an individual or company with more than 50 employees fails to do so, they will be subject to fines through a tax penalty. People with incomes between 133% and 400% of the federal poverty level can get federal tax subsidies though their insurance exchange.
Only 13 states and the District of Columbia have formally committed to run their own exchanges. The Republican governors in Alaska, Florida, Louisiana, Maine, South Carolina and Texas have said hat they would not set up health insurance exchanges in their states, according to the Kaiser Family Foundation. Twenty-two states have stated that they are still exploring the idea.
The federal government will pay the cost of setting up and running the exchanges.
(9/24/12)-The non-partisan Congressional Budget Office (CBO) estimates that nearly 6 million Americans will face a tax penalty under the terms of the Patient Protection Act by 2016, when the penalty phase becomes fully operational. The amount of the penalty will be based on income.
Shortly after the law was passed the CBO estimated that 4 million Americans would be affected by the tax penalty terms of the act. The budget office estimates that the penalty will cost about $1,200 on average in 2016.
Under the terms of the act almost every legal resident of this country will be required to have health insurance in 2014 or face a tax penalty. There will be exemptions for fainancial hardship, religious objections and certain other circumstances.
States will be setting up health insurance exchanges, but if they fail to do so, the federal government will set up the site. Subsidies will be available to low income individuals under the terms of the law.
(9/19/12)- The percentage of people ages 19 to 25 who lacked health insurance fell to 27.9% from 33.9% in 2010, according to the data from the National Health Survey, which is a federal funded study. This translates to 1.6 million fewer uninsured young people from the prior year.
For the next age group-those 26 to 35 years old-the percentage of the uninsured rose. Medical economists attribute the decline to the provision in the new health care law that extends coverage to the age of 26 under their parent's health care coverage insurance plan.
The share of all Americans without health insurance stood at 15.1% in 2011 or about 46 million people, according to the Centers for Disease Control and Prevention. The percentage of uninsured stood at 16% in 2010.
(9/10/12)-There are 1.8 million nursing homes in this country. 31.5% of Medicaid's $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled.
To be eligible for Medicaid, a person typically can have no more than $14,800 in assets. New York has the biggest Medicaid budget of any state at $54 billion, and spends about 41% of it for long term care, almost half on nursing homes.
By 2015, New York will start requiring some 78,000 nursing home residents to choose one of several managed care plans or be enrolled randomly in one of them.
Children could be liable for Medicaid expenditures for their parents under pending new laws. A 2009 analysis by the Kaiser Foundation found that direct out-of-pocket sending by individuals and families accounts for 22% of the $178 billion spent on nursing homes.
(8/3/12)- The rebate checks that were called for under the terms of the Patient Protection and Affordable Care Act are in the mail to some healthcare policyholders.
Under the terms of the law, insurers are required to give out annual rebates by August 1, if less than 80% of the premium dollars that they collect go toward medical care. For insurers covering large employers, the threshold is 85%.
The Department of Health and Human Services estimates that insurers will have to pay out over $1.1 billion in rebates to their policyholders. The average rebate will be $151. Included in the list of companies that will have to pay rebates are Aetna, Cigna, Humana and Unitedhealthcare.
Self-insured employers are exempt from the new rule, as are Medicare and Medicaid. Of the estimated 75 million people with healthcare plans, about 17% will get rebates.
In those cases where the coverage is through the employer, the rebates are being sent to them, and they can chose to put the rebate toward future premium costs instead of distributing them to the employees directly.
Insurers have the option of directly reducing future premiums instead of sending out rebate checks.
(7/26/12)- Beginning in 2014, the first penalties will be levied on individuals who have not purchased health insurance. The penalty is a flat amount or a percentage of an individual's income, whichever is greater, and it will phase in over 3 years.
For 2014, the dollar penalty is $95, rising to $695 in 2016. The 2014 income percentage is 1%, rising to 2.5% in 2016.
Individuals with employer-provided coverage meeting minimum standards will be exempt from the penalty, as will people covered by Medicare and Medicaid, and members of a religion opposed to accepting benefits.
(7/19/12)- Starting in 2013, there will be a 3.8% tax on net investment income for individual income tax taxpayers with adjusted gross income above $200,000 or $250,000 for joint filers.
The tax applies to gross income from interest, dividends, annuities, royalties and rents, and to net gains from investments. It might even apply to a large net gain on the sale of a home.
A 0.9% Medicare surtax will apply to most joint filers' wages and self-employment income above $200,000 for individual tax payers or above $250,000 for a joint income tax return.
The threshold for taxpayers claiming an itemized deduction for medical expenses rises to 10% from 7.5% of adjusted gross income. For taxpayers (and spouses) 65 or older the AGI threshold continues to be 7.5% until 2017. For those subject to the alternative minimum tax, the threshold remains 10% of AGI.
Contributions to flexible spending accounts (FSAs) are capped at $2,500 per employee, down from $5,000 or more per employee. The new cap is adjusted for inflation starting in 2013.
A medical-device excise tax of 2.3% of the sale price applies to certain products. It does not apply to eyeglasses, contact lenses and hearing aids, but does apply to pacemakers, stents and artificial hips. The House has repealed this provision but the Senate has not acted on it yet.
(7/4/12)- Upon further review here is the breakdown in the voting at the U.S. Supreme Court that upheld the constitutionality of the Patient Protection and Affordable Care Act of 2010.
The 5 to 4 majority opinion upholding its constitutionality was written by Chief Justice John Roberts. Justice Roberts wrote that the mandate requiring individuals to purchase health insurance fell within Congress' power to levy a tax. The other 4 justices who voted to uphold the "mandate" did so because of both the Congressional power to levy a tax and also because it fell under the provision of the commerce clause of the Constitution.
The four Justices who voted in favor of the law were Justice Sotomayer; Justice Ginsburg; Justice Kagan and Justice Breyer- the so-called liberal members of the court.
The four Justices who voted against the constitutionality of the law were Justice Kennedy; Justice Alito; Justice Scalia and Justice Thomas- the so-called conservatives of the court.
In connection with the Medicaid expansion under the law, the same 5 to 4 majority upheld the legality of the expansion, but held that the penalties for states that do not comply was unconstitutional.
The same 4 Justices who voted against the constitutionality of the law's "mandate" also rejected the Medicaid expansion entirely.
(7/2/12)- By a 5 to 4 vote, which was announced at 10 A.M on June 28th, the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010. Chief Justice John Roberts wrote the opinion for the decision in which the 4 liberal members of the court joined him.
The majority upheld the law based on Congress' power to levy taxes, rather than on the commerce clause of the Constitution. The Court did rule however in favor of the 26 largely Republican-led states, that the U.S. government could not expel states from Medicaid if they refused to go along with the expanded eligibility for the federal-state health program that is part of the new law.
Republican President George W. Bush had appointed Chief Justice Roberts to the court.
Starting in January 2014, most Americans will be required to have health insurance or be faced with a penalty for failure to do so. Taxpayers will be required to indicate on their tax returns whether they have health insurance that meets minimal benefits standards. If they fail to do so, they would owe $95, or 1 percent of taxable income, whichever is greater.
The penalty rises to $325, or 2 % of taxable income in 2015, and then $695, or 2.5% of taxable income in 2016, up to a maximum of $2,085 per family.
Beginning in 2014, the law expands Medicaid to cover people who are under 65 and earn income up to 133% of the federal poverty level, or $30,657 for a family of four in 2012. Families who make between 100% and 400% of the federal poverty level-or $92,200 for a family of four in 2012- will be eligible for tax credits for insurance plans that are purchased through state run exchanges.
Beginning in 2013, the law increases the Medicare tax by 0.9% on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. It also imposes a 3.8% tax on unearned income for high-income households.
Firms with 50 or more workers will still have to pay a penalty that starts at $2,000 per full-time employee in 2014 if they don't provide insurance or their plan doesn't meet a standard.
The federal government will pick up the full cost for the expanded Medicaid provisions in the law, and thereafter it will pick up 90% of the expanded cost.
As noted in our item dated 6/27/12 below, people who fall in the "doughnut hole" will receive discounts on the cost of their drugs in "the hole" and the doughnut hole will be gradually phased out.
(6/27/12)- Under the terms of The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 the pharmaceutical industry agreed to give discounts to seniors who have drug expenses that exceed $2,930, but are less than $4,700. This is the famous "doughnut hole" that has caused so much confusion.
Once senior's drug expenses exceed $4,700, the patient is responsible for only 5% of the cost of the prescription drugs.
If the Supreme Court declares the law to be unconstitutional will the drug companies continue this discount program?
(6/9/12)- The House voted 270-146 to repeal a tax manufacturers of medical devices that was intended to pay for expanding coverage to uninsured individuals under the new Patient Protection Act of 2010.
37 Democrats joined with their Republican colleagues in favor of ending the tax. The measure would apply a 2.3% tax on the sales of most medical devices, and is scheduled to take effect in January.
The tax exempts goods such as contact lenses, hearing aids and eyeglasses.
(5/17/12)- The check from your health insurer will be coming in the mail is the refrain that we will be hearing a lot in the next few months. Under the terms of the Patient Protection and Affordable Care Act of 2010, health insurers that don't spend a specified amount of revenue on actual medical care for it policyholders must refund the difference to its customers.
The Kaiser Family Foundation estimates that the refunds will total about $1.3 billion and go to roughly 16 million people. These refunds will apply to employees whose coverage is through their employer or individually insured customers.
The checks will average $72 for those who get their insurance through their employer and $127 for those who bought individual policies, according to estimates from Kaiser.
Included in the envelope with the check will be a statement that begins: "This letter is to inform you that you will receive a rebate of a portion of your health insurance premiums. This rebate is required by the Affordable Care Act-the health reform law."
(3/25/12)- In connection with the issue of the constitutionality of the new health care law that will be argued before the Supreme Court is the issue of "the mandate". Exactly what is the mandate and what is the penalty for violating that issue?
"The mandate" is the requirement that all Americans have health insurance. The penalty for failure to have compulsory health insurance would start at $95 a year or 1% of income, whichever is higher, when the requirement takes effect in 2014.
(3/18/12)- The U.S. Supreme Court will hear oral arguments for 3 days on the constitutionality of the Patient Protection and Affordable Care Act of 2010 starting March 26th. The Court is expected to announce its decision some time in June. There will be no television coverage of the proceeding but the court will release oral tapes of the arguments on its Web site at 2 PM on Monday and Tuesday and at 4 PM on Wednesday
The law requires that 80% of the premiums that insurers collect from individuals be spent on health-care costs. If that threshold is not met, the insurance company will have to send rebates for the excess to its customers. The Department of Health and Human Services has set up a site at health-care.gov to see if a consumer is due a rebate check.
That site will also enable the consumer to determine which plan is best suited to his/her needs. It will list programs and resources available to the consumer on a state by state basis.
The site also reports on health plans that have requested premium increases and why. Starting in September, it plans to offer a summary of plan benefits and coverage for various scenarios.
If you are a senior who reaches the "doughnut hole" because of the cost of your prescription drugs, you will be entitled to a 50% discount on brand-name drugs and a 14% discount on generics.
Under the terms of the new health care law that was passed in 2010, the administration was supposed to establish medical payment reporting procedures by October 1, 2011. The public had until February 17 to comment on the proposals and the Department of Health and Human Services will then issues final rules with the force of law.
Analyses by the New York Times found that about a quarter of doctors take cash payments from drug or medical device manufacturers, and that nearly two-thirds accept gifts of food either for themselves or their staff.
The Obama administration has recently issued the standards required under the law. If a company has even only one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors, medical professionals, pharmaceutical companies and medical equipment companies other than its own employees. The federal government will post the data on a Web site where it will be available to the public.
The administration estimates that more than 1,100 drug, medical device and medical supply companies will have to file reports. Federal officials will inspect and audit the accuracy of the reports. Companies will be subject to a penalty of up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty of up to $100,000 for each violation, up to a total of $1 million a year.
A senior official of the company must attest to the accuracy of each report.
(1/18/12)- Kathleen Sebellius, the secretary of health and human services issued a finding against a health insurance company, Trustmark Life Insurance Company, a unit of Trustmark Mutual Holding Company, that its premium rate increase were unreasonable under federal standards. The finding means the company must either rescind the increase or justify its refusal to do so.
The Patient Protection and Affordable Care Act set detailed federal standards for an annual review of "unreasonable increases in premiums." Under rules issued by Ms. Sebelius, a rate increase of 10% or more must be reviewed and approved by either state or federal officials.
According to the latest statistics from the Department of Health and Human Services, premiums for health insurance totaled $849 billion in 2010, while spending on benefits totaled $746 billion in 2010. The difference includes administrative costs and profits.
This was the second time the provisions of the act has been used to deny a rate increase by a health insurance company. It was first used when Everence Insurance Company in Pennsylvania increased its premiums by an average of 12%.
Under the act, insurers must spend at least 80% of premium revenues on medical care and efforts to improve it. Gary Cohen, acting director of insurance oversight at the Department of Health and Human Services, said Trustmark did not meet this standard in any of the states that the premium rate increase applied to.
Almost 10,000 policyholders in Alabama, Arizona, Pennsylvania, Virginia and Wyoming will be affected by the ruling.
The federal government reviews the premium rate increases in states where it finds no adequate state agency to oversee the legality of the rate increase.
Ms. Sebillius praised Connecticut, New York and Oregon for forcing insurance companies to scale back recent rate increases.
(1/6/12)- Mary Brown, one of the plaintiffs who challenged the legality of the new health-care law based on the fact that her auto-repair shop in Florida could not afford to pay the premiums for her employees as required under the law, starting in 2014. That provision requires most Americans to carry health insurance of pay a penalty.
Two other plaintiffs were listed, i.e. a retired investment banker in the state of Washington, and the National Federation of Independent Business (NFIB), a small-business lobbying group based in Washington, D.C. Ms.Brown was the only plaintiff that the Justice Department had agreed had legal standing to pursue the case.
Ms.Brown closed her shop in August and has filed for personal bankruptcy. Thus her claim that the new law would hurt her business was no longer a valid argument in this matter.
The NFIB has filed a motion with the U.S. Supreme Court to add two members of its organization as plaintiffs. They are Dana Grimes, the owner of a roofing company in Greenwich, N.Y., and David Klemencic, who runs a flooring business in Ellenboro, W.Va. The Justice Department said that it would not oppose the motion
(12/24/11)- The Supreme Court announced that it would set aside 3 days to hear the challenges to the constitutionality of the Patient Protection and Affordable Care Act of 2010.
On March 26, the court will hear arguments on the threshold issues of whether challenges to the law are premature as the U.S. Court of Appeals for the 4th Circuit in Richmond, Va., ruled as we discussed in our item dated 9/17/11. In that ruling the majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
On March 27, it will take up the issue of the legality of requiring people to buy health insurance by Congress under the Commerce clause of the Constitution.
On March 28, the court will hear arguments on whether the provision requiring insurance coverage may be severed from the rest of the law without declaring the rest of the law unconstitutional.
(12/21/11)- Under the terms of the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 most health insurance plans had to allow parents to start adding their adult children, up to the age of 26 to their own plan.
The percentage of those ages 19 to 25 with health insurance rose to 73% this past June from 64% in September 2010, when the provision went into effect, according to the latest survey of insurance coverage from the National Center for Health Statistics. That translated to about 21.5 million young adults, up from 19 million.
(12/15/11)- Obama administration officials announced that they would wind down a $5 billion fund to pay for health insurance for early retirees by December 31, instead of the September 2012 date that had been projected as late as October.
The fund was part of the new health-care law and was originally projected to last until 2014, when provisions in the new law will take effect making it easier for older Americans to buy health insurance without the help of an employer. The Centers for Medicare and Medicaid Services estimated that $4.5 billion of the fund had already been paid out.
(11/16/11)- In indicating how important the constitutionality issue is in connection with the appeal of The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 the U.S. Supreme Court scheduled five and a half hours of oral arguments instead of the usual one hour. The Supreme Court agreed to hear appeals from just one decision, that being the one from the U.S. Court of Appeals for the 11th Circuit in Atlanta as we discussed in our item dated 8/17/11 below.
The justices said they would consider the issue raised in the ruling from the matter before the U.S. Court of Appeals for the 4th Circuit in Richmond, Va., that we discussed in our item dated 9/17/11. In that ruling the majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
Judge Brett M. Kavanaugh, in his 65-page opinion in connection with the ruling from the U.S. District Court of Appeals for the District of Columbia, that we discussed in our item dated 11/14/11, backed the viewpoint that the health care law could not be challenged until it was implemented in 2014. The Justice Department suggested that the Supreme Court appoint a lawyer in favor of this interpretation since it did not fully back this argument.
The justices will hear two hours of argument on whether Congress overstepped its constitutional authority, 90 minutes on whether the mandate for compulsory insurance may be severed from the balance of the law, and an hour each on the Medicaid and Anti-Injunction Act questions.
The Supreme Court agreed to hear three appeals, two from challengers to the law and a third from the Obama administration.
(11/15/11)- As we noted in our item dated 11/1/11, the justices of the U.S. Supreme Court voted to accept the matter as to the constitutionality of the The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010. It is therefore expected that they will announce their decision in June of 2012 after holding a hearing on the case in March 2012.
(11/14/11)- The U.S. District Court of Appeals for the District of Columbia Circuit became the 3rd appellate court to rule in favor of the constitutionality of the new health care law, versus the one appellate court that has ruled against it.
In this latest decision, Judge Laurence Silberman, a leading conservative jurist, whose former law clerks played a key role in the George W. Bush administration, wrote the court's majority opinion. Republican ex-president Ronald Reagan appointed Judge Silberman to the court.
His 37-page opinion stated: "The right to be free from federal regulations is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems". Judge Brett M. Kavanaugh did not join in on Judge Silberman's written opinion, but voted to dismiss the appeal in his 65-page opinion, because the insurance requirement of the law could not be challenged until it was implemented in 2014.
Judge Kavanaugh's in his technically dissenting opinion position, supported the view of the majority in the decision dismissing the challenge to the law in the 4th Circuit that we discussed in our item dated 9/17/11 below. The Justice Department has indicated that it would not support this view when the Supreme Court takes up the case, saying it would hire outside counsel to argue this point.
Judge Kavanaugh cited the 19th-century Anti-Injunction Act, which he said "poses a jurisdictional bar to our deciding this case at this time."
For more information on this case, please see our item dated 3/9/11 below. Five individuals represented by the American Center for Law and Justice, a conservative Christian group, brought the action in the District of Columbia.
(11/1/11)- The justices of the U.S. Supreme Court are scheduled to discuss challenges to the new health care law during their private conference on November 10, according to the electronic docket entries recently posted on the court's Web site.
If the court agrees to consider the law, oral arguments would likely be scheduled for next spring, and a decision would be expected by the end of June. Two of the three appellate courts that have heard appeals in connection with the constitutionality of the law, have upheld it.
(10/28/11)- Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius said in a letter to congressional leaders, that the department would not implement the long-term care portion of the new health care law. The program, known as the Class Act portion of the law was financially unsustainable.
HHS officials said that actuaries spent 19 months attempting to design a voluntary long-term care insurance program that met the requirements of the law, but were unable to come up with any fiscally viable plan.
(10/21/11)- Liberty University filed an appeal with the U.S. Supreme Court of the ruling on September 8th by the Richmond, Va. based Fourth U.S. Circuit Court of Appeal that dismissed its case which claimed that the "individual mandate" provision of the new health care law was a tax that could not be challenged until the provision went into effect in 2014.
For further information on this matter, please see our item dated 9/17/11 below.
Please also note that in our item dated 10/9/11 below, the U.S. Justice Department does not feel that this interpretation of the law is correct, and thus asked the Supreme Court to appoint an outside attorney to defend the decision in regards to the tax point.
(10/9/11)- The U.S. Justice Department had a deadline of September 26th to ask the U.S. Court of Appeals for the 11th Circuit in Atlanta to reconsider its decision that Congress could not require individuals to purchase health care insurance ("individual mandate"). For more information on that matter, please see our item dated 8/17/11 below
That federal appeals court found that Congress exceeded its powers to regulate commerce when it decided to require people to buy health insurance, under the provision in the law known as the "individual mandate". The court did however hold that while this provision was unconstitutional, the rest of the law could stand.
Most legal experts had expected the federal government to postpone taking the constitutionality issue of the new health care law to the Supreme Court, since the delaying tactic would mean that the law is constitutional until ruled otherwise.
The Justice Department could have postponed taking the case to the U.S. Supreme Court until November, but in a surprise development, it brought an appeal of the 11th Circuit court to be heard at its upcoming session. Oral argument on the case, if the Supreme Court decides to hear the case can begin in June 2012, with a decision expected before the election in November.
As we have noted in our items below, 2 appellate courts have upheld the law, while the 11th Circuit voted 2 to 1 against it. A fourth challenge to the law was heard recently by the U.S. Court of Appeals for the District of Columbia Circuit.
The 26 plaintiffs who had lost on the issue of constitutionality in the 11th Circuit have also petitioned the U.S. Supreme Court for a review of that part of the decision that rejected their claim. A second petition to hear the case to the Supreme Court was also filed by the National Federation of Independent Business and two individuals seeking to have the law declared unconstitutional.
A petition has also been filed before the Supreme Court from several individuals and the Thomas More Law Center seeking review of the decision of the 6th Circuit upholding the constitutionality of the law as we wrote about in our item dated 7/31/11 and 7/1/11 below.
The Justice Department also indicated that it did not feel that it could prevail in connection with the thinking of the court in the 4th Circuit about the "tax" not going into affect until 2014, so it requested that the Court appoint a lawyer to defend that position.
(9/26/11)- Officials in the Obama administration said that they may not enact a long-term-care insurance program that was set out in the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010.
With budget deficits and cuts taking front and center in the news lately, officials at the Department of Health and Human Services said that they may not go forward with the program.
(9/17/11)- The U.S. Court of Appeals for the Fourth Circuit in Richmond Virginia dismissed two challenges to the new health care law. For more information on this matter, please see our item dated 5/17/11 below.
In a unanimous opinion, a three-judge panel found that Virginia Attorney General Ken Cuccinelli lacked legal standing to bring his challenge. Mr. Cuccinelli, a Republican had argued that the state of Virginia had passed a law saying that the state's residents could not be required to carry health insurance. He also argued that the Commerce Clause of the Constitution prevented the federal government from imposing such a burden on the state's residents.
The three judges on the panel had all been appointed by Democratic presidents. Judge Diana Gribbon Motz wrote the opinion, as well as another opinion, in which the judges voted 2 to 1 to dismiss a case brought by Liberty University of Lynchburg, Va., on a different set of technical grounds.
The majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
(8/17/11)- The U.S. Court of Appeals for the 11th Circuit in Atlanta, in a 2 to 1 vote, ruled that the provision requiring Americans to buy health insurance or face tax penalties was not unconstitutional.
The court found that Congress exceeded its powers to regulate commerce when it decided to require people to buy health insurance, under the provision in the law known as the "individual mandate". The court did however hold that while this provision was unconstitutional, the rest of the law could stand.
Thus the scoreboard now stands one appellate court upholding the constitutionality of the law, while another appellate court denied the constitutionality of the provision requiring individuals to purchase health insurance by the year 2014, or face tax penalties.
For more on the ruling of the U.S. Court of Appeals for the Sixth Circuit in Cincinnati which upheld the constitutionality of the law, please see our item dated 7/1/11 below.
The majority opinion for the 11th Circuit's ruling was written by Chief Judge Joel F.Dubina, who was appointed by the first George Bush, and Judge Frank M.Hull, who was named by President Bill Clinton. Judge Stanley Marcus, another Clinton appointee, wrote the dissenting opinion.
(7/31/11)- Slowly but surely the constitutionality of the health care law of 2010 is wending its way through the legal system as it heads to the Supreme Court. In the most recent development, a petition was submitted to the Supreme Court appealing the ruling of the U.S. Court of Appeals for the Sixth Circuit in Cincinnati upholding the constitutionality of the law as we discussed in our item dated 7/1/11 below.
In that ruling, Judge Jeffrey S. Sutton, who had served as a law clerk to Justice Antonin Scalia, and who had been appointed to the bench by a Republican president, George W. Bush, voted in favor of the constitutionality of the law.
(7/29/11)- Federal administrators will soon take over the review of health insurance premium rates in 10 states where it says state officials do not adequately regulate premiums for insurance sold to individuals or small businesses.
Starting September 1, federal and state officials will begin to scrutinize proposed rate increases of more than 10% to determine if they are justified.
Obama officials state that in publicizing excessive, unreasonable health insurance premium rate increases, they are protecting consumers under the new health care act.
Seven states- Alabama, Arizona, Idaho, Louisiana, Missouri, Montana and Wyoming-do not have effective rate review programs for either individuals or small-health-group insurance premium increases.
In three other states- Iowa, Pennsylvania and Virginia- the federal government will review proposed premium increases for small groups and will allow states to review individual rates.
(7/1/11)- The U.S. Court of Appeals for the Sixth Circuit in Cincinnati has upheld the constitutionality of the Patient Protection and Affordable Care Act of 2010. The ruling came in a 2-1 vote, with one of the judges who was appointed by a Republican president joining to form the majority with a judge appointed by a Democrat.
Opinions are expected shortly from panels in the Fourth Circuit in Richmond, Va., and the 11th Circuit in Atlanta. The majority consisted of Judge Jeffrey S. Sutton, an appointee of President George W. Bush, a Republican and Judge Boyce F. Martin Jr., a Democrat appointed by President Jimmy Carter. The dissenting jurist was Judge James L. Graham, a Republican appointed by President Ronald Reagan.
The appeal had been filed by the Thomas More Law Center, a conservative public interest firm in Ann Arbor, Mich., from the decision rendered by Judge George C. Steeh in the Federal District Court in Michigan. For more on this case please see our item dated 6/3/11 below.
(6/27/11)- Obama administration officials announced that they would postpone until January 1, 2012 the requirement, contained in the 2010 health care act, that insurance companies offer an explanation when they refuse to pay a claim and grant consumers an internal and external review of the denial.
States are expected to handle the review, and if they don't, the federal government will step in to do so.
(6/16/11)- It is only a matter of time before the U.S. Supreme Court will decide upon the new health care law's constitutionality. It will fall on the solicitor general to defend the law's legality, and so the appointment and confirmation in the Senate by a vote of 72 to 16 of Donald Verrilli Jr. is going to have huge ramifications at the trial.
The post has been vacant since Elena Kagan left it to become a member of the Supreme Court last August. Mr. Verrilli has been the deputy counsel to President Obama. Before that, he was an associate deputy attorney general. He clerked for former Justice William J. Brenner Jr.
(6/10/11)- Blue Shield of California, one of the largest health insurers in the nation said it would refund $167 million to policyholders as part of its plan to limit its profits to no more than 2% of its revenue. The company also went on to announce that it had already planned to return $180 million, the profit the company said it made above the 2010 target.
On average, this means that the typical policyholder would receive a 30% credit towards one month's premiums. Hospitals and doctors that participate in programs aimed at better coordinating care for patients would receive $10 million, California lawmakers are considering legislation that would give state regulators the authority to approve insurers' rate increase requests before they go into effect. Please also see our item dated 5/25/11 below.
(6/3/11)- A three-judge panel of the Sixth U.S.Circuit Court of Appeals heard 90 minutes of oral arguments in the matter of the constitutionality of the new health care law. A Republican president appointed two of the 3 judges on the panel, while a Democratic president appointed the 3rd member of the panel.
Judge Jeffrey S. Sutton was appointed by ex-president George W. Bush, while ex-president Ronald Reagan appointed District Court Judge James L. Graham of Ohio, who is temporarily assigned to the appellate bench. The Democratic appointment on the panel is Royce F. Martin Jr. who was appointed by ex- President Jimmy Carter.
Neal K. Katyal, the acting United States solicitor general defended the constitutionality of the law for the federal government. The challenge to the law had been filed by the Thomas More Law Center, a public interest law firm in Ann Arbor, Michigan. Robert J. Muise argued the case for the Law Center.
A hearing on the constitutionality of the health care law will be held before the 11th Circuit in Atlanta next week.
(5/25/11)- Under the terms of the new health care law, federal and state officials will review health insurance premium increases in the individual and small group insurance market to insure that any increases are not excessive.
Federal officials do not have the authority to block rate increases, even if they find them to be excessive, but many state authorities do have the power to block the increase.
Kathleen Sebelius, the secretary of health and human services issued a final rule that established procedures for federal and state insurance experts to scrutinize the increases. Federal officials had proposed a 10% maximum increase in December, and that figure was finalized under the new rulings.
"Health insurance companies have recently reported some of their highest profits in years and are holding record reserves, " Ms Sebelius said. "Insurers are seeing lower medical costs, as people put off care and treatment in a recovering economy. But many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification."
Starting in September 2012, the federal government will set a separate threshold for each state, reflecting trends in insurance and health care costs in that state. Under the terms of the new health care law, the federal government will provide the states with the financing to strengthen their capacity to oversee the rate increase in their state.
The new rule states that a rate increase is unreasonable if it is excessive, unjustified or " unfairly discriminatory." An increase is deemed excessive if it is "unreasonably high in relation to the benefits provided."
(5/17/11)- Since the enactment of The Patient Protection and Affordable Care Act (PPACA), 31 lawsuits have been filed to challenge it, according to the Justice Department. Nine are awaiting action by Courts of Appeals, and nine are pending in federal district courts. The others have been dismissed.
The United States Court of Appeals for the Fourth Circuit is presently holding hearings on 2 lower court contradictory decisions from within its jurisdiction. On June 1, the Court of Appeals for the Sixth Circuit in Cincinnati will hear the appeal of a ruling in favor of the law. On June 8, the Court of Appeals for the 11th Circuit in Atlanta will review a Florida judge's ruling that held the law to be unconstitutional.
Neal K. Katyal, the acting solicitor general, will represent the Obama administration in each of the appellate cases.
(4/28/11)- The U.S. Supreme Court turned down a petition for expedited review from Virginia of the state's challenge to the new health care law. There were no noted dissenting votes, nor was any reason given for the refusal.
3 federal district courts have upheld the constitutionality of the law and 2 have declared the law to be unconstitutional. The case questioning the constitutionality of the law is now expected to reach the Supreme Court in the term that starts in October.
The first of the appeals will be heard starting with oral arguments in the United States Court of Appeals for the Fourth Circuit, in Richmond, Virginia in Virginia's challenge and a companion case on May 10.
Virginia's Attorney General Kenneth T. Cuccinelli II filed for the expedited review before the U.S. Supreme Court in February, citing the large expense that the state was undergoing in carrying out the terms of the law. The filing also stated that in all likelihood the matter would have to be decided by the Supreme Court in light of the conflicting decisions.
Acting Solicitor General Neal K. Katyal represented the federal government in opposing the expedited hearing petition in the case, Virginia v.Sebelius, No.10-1014. Supreme Court Justice Elena Kagan, who joined the Supreme Court in August, after serving a year as the United States solicitor general did not recuse herself in turning down the petition, leading legal experts to conclude that she will not recuse herself from hearing the case when it comes before them during the regular fall session of the court.
(4/20/11)- Missouri's Democratic attorney general filed a "friend of the court" brief in the United States Court of Appeals for the 11th Circuit, in Atlanta, in support of the attorneys general from 26 states opposing the constitutionality of the new health care law.
The filing of the brief by Attorney General Chris Koster, a onetime Republican state legislator who switched to the Democratic party in 2i007 did not mean that he was joining with the other 26 states as a plaintiff in the action.
The only Democratic state attorney general who is a plaintiff in the action is Attorney General Buddy Carswell of Louisiana, who switched to the Republican party in February.
Three lower court judges have upheld the constitutionality of the law, while two have declared the law to be unconstitutional.
(3/15/11)- The Justice Department filed a notice of appeal of the decision by Judge Roger Vinson of the U.S. District Court for the Northern District of Florida, who declared that the new health care law was unconstitutional. The Justice Department said it was asking the Court of Appeals for the 11th circuit in Atlanta to provide an "expedited review" of the decision.
(3/9/11)- Judge Roger Vinson of the U.S. District Court for the Northern District of Florida granted a stay to his January ruling (please see our item dated 2/1/11 below) provided that the Justice Department files an appeal of his decision within 7 days of this ruling.
Tracy Schmaler, a spokesman for the Justice Department said a request for an expedited appeal would be "promptly" filed with the Court of Appeals for the 11th circuit in Atlanta.
The United States Court of Appeals for the Sixth Circuit, in Cincinnati and the United States Court of Appeals for the Fourth Circuit, in Richmond, Va. will be hearing appeals in connection with the constitutionality of the new health care law within the next few months.
It is clear that ultimately the U.S. Supreme Court, sometimes within the next year to year and a half, will be the arbitrator-of-last-resort in this matter.
(3/4/11)- Let the scoreboard now read 3 to 2 in favor of upholding the constitutionality of the new health care law. U.S. District Court Judge Gladys Kessler in Washington, D.C. became the third judge ruling in favor of the constitutionality of the law. It is no coincidence that the judges who have ruled in favor of the constitutionality of the law were all appointed by Democratic presidents, while those how have ruled that the law is unconstitutional have been appointed by Republican presidents.
According to Judge Kessler, who was appointed to her position by former President Bill Clinton, "Congress had a rational basis for its conclusion that the aggregate of individual decisions not to purchase health insurance substantially affects the national health insurance market."
She went on to say that those who do not purchase insurance " will ultimately get a 'free ride' on the backs of those Americans who have made responsible choices to provide for the illness we all must face at some point in our lives."
Five individuals represented by the American Center for Law and Justice, a conservative Christian group filed the District of Columbia case.
In her 64-page opinion Judge Kessler also tossed out a claim that the law restricted the plaintiffs' exercise of religious freedom because the mandate to buy health insurance conflicted with their belief that G'd would provide for their well being.
(2/22/11)- As noted in our item dated 2/1/11 below, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida ruled that the Patient Protection and Affordable Care Act of March 23, 2010 was unconstitutional, since its provisions violated the commerce clause of the Constitution.
While the judge did not specifically enjoin the act from being enforced, he used the language that his ruling should be treated as the "functional equivalent" of an injunction.
The U.S. Justice Department has asked the judge to clarify his decision in regards to the governments ability to continue to implement the terms of the law while the ruling was being appealed.
Judge Vinson's decision is in the process of being appealed to the United States Court of Appeals for the 11th Circuit. The government's filing indicates those provisions of the law that it feels have already taken effect,, such as tax credits for small business, increased Medicare payments to providers, antifraud measures, high-risk insurance pools and grants to the states, and asks if his ruling intends for each to be suspended.
(2/18/11)- The United States Court of Appeals for the Sixth Circuit, in Cincinnati, announced that it would hear oral arguments during a term that stretches from May 30 to June 10th of the decision of Judge George C. Steeh of the Federal District Court in Detroit, Michigan that upheld the constitutionality of the health care law. For additional information on this case please see our item dated 10/15/10 below.
The United States Court of Appeals for the Fourth Circuit, in Richmond, Va., had already announced that it will hear arguments in mid-May in the Obama administration's appeal of the decision by Judge Henry E. Hudson of the U.S. District Court in Richmond, Va. declaring a central provision of the law unconstitutional.
More than 70 House Democrats in Washington have come out stating that Justice Clarence Thomas should recuse himself when the case reaches the Supreme Court, since his wife has been a paid lobbyist for conservative groups opposed to the law.
(2/11/11)- Even though the Court of Appeals for the Fourth Circuit in Richmond, Virginia has agreed to hear the appeal by the Justice Department of the decision by Judge Henry E. Hudson of the U.S. District Court in Richmond, Va. that struck down the constitutionality of the Patient Protection and Affordable Care Act of 2010 (PPACA), Kenneth T. Cuccinelli II, the attorney general of Virginia said that he would seek an expedited review of the case by the U.S. Supreme Court. Please see our item dated 1/29/11 and 12/17/10 below.
As we have noted in this article, two federal courts have upheld the constitutionality of the law, while 2 other federal courts have declared the act to be unconstitutional.
It is quite rare for the Supreme Court to hear a case speedily under the expedited review process.
The Obama administration will oppose the expedited review, since the provisions of the law remain in effect, unless enjoined from doing so by a lower court, Thus the provisions of the act are constitutional unless the U.S.Supreme Court rules otherwise.
In November 2010, the Supreme Court refused to review another challenge to the act that had been dismissed by a California judge on the groungs that the plaintiffs did not have standing to sue.
(2/1/11)- Judge Roger Vinson of the U.S. District Court for the Northern District of Florida ruled that the Patient Protection and Affordable Care Act of March 23, 2010 was unconstitutional, since its provisions violated the commerce clause of the Constitution. For more background information on this case please see our items dated 10/19/10 and1/21/10 below.
The suit questioning the constitutionality of the law was brought by former Florida Republican Attorney General Bill McCollum, who was joined, as plaintiffs, by the nation's most influential small business lobby. Ultimately 26 states joined the suit as plaintiffs, 25 of who were from Republican states.
In addition to Florida the states joining the action as plaintiffs were: Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.
Although Judge Vinson did declare the law unconstitutional, he did not issue an injunction against the provisions of the act from being carried out.
Thus we now have 2 federal judges who were Democrats ruling in favor of the constitutionality of the law and 2 Republican federal judges ruling against its constitutionality.
The Justice Department announced that it would appeal Judge Vinson 78 page decision. Judge Vinson ruled that it was unconstitutional for the federal government to require American to buy health care insurance or else face being fined by the IRS in 2014, when that provision is due to go into effect.
It is inevitable that the ultimate determination of the constitutionality of the law will be decided by the U. S. Supreme Court within the next 1 year to 1 1/2 years.
(1/29/11)- The Court of Appeals for the Fourth Circuit in Richmond, Virginia announced that it would expedite its consideration of the lower court ruling that held the Patient Protection and Affordable Care Act of 2010 (PPACA) unconstitutional. Please see our item dated 12/17/10 below.
The appellate court will hear oral arguments between May 10 and May 13 on the Justice Department's appeal to overturn the ruling of Judge Henry E. Hudson of the U.S. District Court in Richmond.
Judge Hudson had ruled that Congress had exceeded the boundaries of the Commerce Clause of the Constitution by requiring Americans to obtain commercial health insurance. Judge Hudson did allow the law to remain in effect while the appeal is pending.
(1/21/11)- Six more states have joined the lawsuit questioning the constitutionality of the Patient Protection and Affordable Care Act that is now pending before Judge Roger Vinson of the U.S. District Court for the Northern District of Florida. For additional details on this lawsuit please see our item dated 10/19/10 below.
The six from Iowa, Kansas, Maine, Ohio, Wisconsin and Wyoming all have Republican attorneys general. Thus, of the 26 states involved in this legal action attacking the constitutionality of the law, 25 are from states with Republican attorneys general.
The U.S. House of Representatives voted 245 to 189 to repeal the act. Three Democratic senators voted along with 242 Republicans in favor of repealing the act.
Democratic Senate leaders who control the Senate said that they will not act on the repeal measure.
(1/19/11)- Beginning in July of this year, the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 gives federal regulators the right to review health premium increases by insurance companies greater than 10%, if a state does not have sufficient procedures of its own in this area.
David Jones, the recently appointed health commissioner of California raised questions about the premium increases assessed by some of the health care insurance companies in that state. On January 6, he called on Blue Shield of California to delay premium increases of up to 59%.
He also called on Aetna Inc. and units of WellPoint Inc and UnitedHealth Group Inc. to postpone their price increases as he reviews them
California is the biggest market for insurance purchased by individuals, accounting for 15% of the national figure. About 2 million Californians bought individual policies in 2009, more than double the number in Texas (907,717), the state with the second largest individual market, according to the Kaiser Family Foundation.
Florida had 893,765 single health-care policies purchased by its residents and New York had 740,539 single purchaser policies.
The California insurance commissioner does not have the power to reject the increases, but he can review the applications for rate increases and ensure that they are in compliance with the state law.
Last year, WellPoint sought a 39% increase in California, which was eventually decreased to a 14% increase.
Federal regulators would also not be able to reject increases, but the hope is that by publicly requiring the insurance companies to justify the increases, the insurance companies will be held accountable by the public.
(1/4/11)- The first major beneficiaries of the new Patient Protection and Affordable Care Act of 2010 will be those Medicare Part D plan members who fall into the "doughnut hole". Enrollees whose total drug costs for the year fall between $2,840 and $6,448 will get a 50% discount of branded prescription drugs and 7% discount on generic drugs.
Those who fell into the hole in 2010 received a $250 rebate in 2010 to offset the cost of paying for those drugs out-of-pocket.
Medicare beneficiaries with annual incomes above $85,000 for individuals and $170,000 for couples will get a smaller subside for Medicare Part D prescriptions.
The pharmaceutical industry will face a $2.5 billion levy in that their profit margins will be reduced by the lower prices for drugs falling into the "doughnut hole".
About 20 preventive health services, including colorectal cancer screenings, mammograms and smoking cessation services will be free for Medicare beneficiaries.
(12/29/10)- The $250 billion stop-gap funding measure that was recently passed by Congress does not contain the needed financing for the Patient Protection and Affordable Care Act of 2010. The Internal Revenue Service needs additional funding to enforce the requirement that most Americans carry health insurance by 2014.
Republicans are also looking to cut funds for the law's expansion of the Medicaid insurance program for the poor, and for subsidies to offset the cost to buying insurance for lower income individuals and families. There would not be financing for the new board that will recommend Medicare spending reductions, and for parts of the law tied to abortion coverage services.
The Department of Health and Human Services has the power to redirect money from other operations to cover some of the gaps in the new law, but a battle certainly will develop over these matters when the new Congress comes into session.
(12/17/10)- The Justice Department announced that it would appeal the decision of Judge Henry E. Hudson of the U.S. District Court in Richmond, Va.,that declared the Patient Protection and Affordable Care Act of 2010 (PPACA ) unconstitutional, . The Richmond case was filed by Virginia's attorney general, Kenneth T. Cuccinelli II, a Republican, and all but one of the 20 attorneys general and governors who filed a similar case before Judge Roger Vinson in Pensacola, Fla, are Republicans.
The two previous rulings that upheld the constitutionality of the act are already before the midlevel courts of appeal, with the Detroit case in the Sixth Circuit in Cincinnati., and the Lynchburg case in the Fourth Circuit in Richmond, which is the same circuit court where Judge Hudson decision will be appealed. Lynchburg is only 116 miles from Richmond, even though the decisions are on opposite sides of the issue.
(12/14/10)- Federal Judge Henry E. Hudson in Richmond, Virgina, as expected, ruled against the constitutionality of the Health-Care Reform Act of 2010. Thus he became the first federal jurist to rule against the constitutionality of the law, as opposed to the two prior rulings that had upheld the law as constitutional.
For more information on these cases please see our items directly below this one.
The next judge to rule on this issue will be Judge Roger Vinson of the U.S. District Court for the Northern District of Florida. Please see our item dated 10/19/10 below.
Judge Hudson based his ruling on the fact that Congress had exceeded its constitutional power to regulate commerce by penalizing individuals who, by their "inaction", failed to obtain health insurance as required by the law. In his opinion, "inaction" is not covered by the commerce clause of the Constitution.
There is no doubt that whichever side wins in these cases, it will be the U.S. Supreme Court that will have the final say on the matter.
(12/7/10)- A second federal court judge has upheld the constitutionality of the new health-care law in dismissing a lawsuit brought by Liberty University in Lynchburg, Virginia. In doing so, the judge, Norman K. Moon upheld the law as being within the constitutional power of Congress to regulate interstate commerce.
Judge George C. Steeh of the Federal District Court in Detroit had also upheld the constitutionality of the law as noted in our item dated 10/15/10 below. President Bill Clinton had appointed both Judge Steeh and Judge Moon.
Two other federal court judges are expected to rule on the constitutionality of the law within the next two months. For more details on the case pending before Judge Roger Vinson, of the U.S. District Court for the Northern District of Florida please see our item dated 10/19/10 below.
The other judge who is expected to rule on the constitutionality of the law is Judge Henry E. Hudson in Richmond, Virgina. Republican presidents appointed Judge Vinson and Judge Hudson.
The item in the law causing most of the lawsuits is the requirement for individuals to buy health insurance by 2014. Even though the law provides for subsidies to be paid for the poor in getting the insurance, opponents of the law argue that this violates the Interstate Commerce clause of the Constitution..
In effect opponents of the law argue that this requirement would amount to the regulation of inactivity. Judge Moon disagreed with this argument when he stated: "Far from 'inactivity', by choosing to forgo insurance, plaintiffs are making an economic decision t try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance."
(10/27/10)-Slowly but surely the cases arguing against the constitutionality of the Health-Care Reform Act of March 2010 are wending their way through the court system. In the latest case, where a hearing was held before U.S. District Judge Henry E. Hudson that took up almost 3 hours, the judge announced that he would announce his decision before the end of the year.
As our item dated 10/15/10 below reports, Judge George C. Steeh of the U.S. District Court in Michigan, whom Bill Clinton appointed upheld the constitutionality of the law. On the other hand Judge Roger Vinson of the U.S. District Court for the Northern District of Florida seemed to indicate that he doubted the constitutionality of the law. Please see our item dated 10/19/10 below.
Republican presidents appointed both Judges Hudson and Vinson.
It seems quite clear that at this point that no matter which side prevails in the lower court decisions, ultimately the Supreme Court will have to decide on the constitutionality of the law.
(10/19/10)- A federal court judge in Florida denied a government motion to dismiss an action brought by 18 Republican attorneys general, 2 Democratic attorneys general, two individuals and the National Federation of Independent Business (which represents small businesses) that questioned the constitutionality of the Health-Care Reform Act of 2010.
The judge, Roger Vinson of the U.S. District Court for the Northern District of Florida who will now proceed to hear the case went, on to say: "at this stage of the case, the plaintiffs have most definitely stated a plausible case." The case will now proceed to a full hearing on December 16th.
The plaintiffs also argued that the law's provision expanding Medicaid to 16 million Americans was unconstitutional because it would impose costs that the states could not afford.
Please see our item dated 10/15/10 below, where a federal judge in Michigan upheld the constitutionality of the law.
(10/15/10)- Judge George C. Steeh of the Federal District Court in Detroit, Michigan became the first jurist to rule on the constitutionality of the new health care law. The judge upheld the constitutionality of the law, stating: the provisions of the new law cover "activities that substantially affect interstate commerce".
The central question is whether the Commerce Clause of the Constitution gives Congress the authority to require citizens to obtain a commercial health insurance contract by 2014, when that provision goes into affect. There are about 20 other state lawsuits questioning the Constitutional legality of the provision, with the next hearing being held on October 18th in Virginia.
Judge Steen was appointed by President Bill Clinton who went on to say: "These decisions, viewed in the aggregate have clear and direct impacts on health care providers, taxpayers and the insured population who ultimately pay for the care provided to those who go without insurance."
(10/10/10)-Under present Medicare Part D coverage, seniors pay a $310 deductible, then 25% of their drug costs until they reach $2,830 in total prescription drug expenses for the year. After that, beneficiaries must pay for drugs out-of-pocket until expenses exceed $6,440. This is the so-called " doughnut hole". After reaching that expense level a beneficiary pays 5% of the drug costs for the rest of the year.
Under the new health-care reform bill beneficiaries will receive a 50% discount on brand-name drugs, and a 7% discount on generics when they reach the "doughnut hole" level. By the year 2020 the " doughnut hole" will be entirely eliminated.
Under the new health care law, most government subsidies that Medicare Advantage plans have received will be phased out by 2017. In 2011, the subsidies will be frozen at last year's level.
In 2011, open enrollment for Medicare Advantage plans will be from January 1 through February 15, instead of its present timeframe of January 1 through March 31. Under the old system Medicare Advantage plan participants could change insurers or go back to regular Medicare. Under the new law, a beneficiary will be allowed to only go from Medicare Advantage plans back to regular Medicare. You will not be allowed to switch from regular Medicare to Medicare Advantage.
(9/20/10)- The number of Americans without health insurance rose by 4.4 million to 50.7 million last year, the largest annual jump since the government began collecting comparable data in 1987, according to figures from the U.S. Census Bureau.
The percentage of Americans covered by private insurance in 2009, 63.9%, was the lowest since 1987,while the percentage of people covered by government programs, 30.6%, was the highest. The number of American with some form of health insurance dropped last year for the first time since 1987 to 253.6 million in 209 from 255.1 million in 2008.
The 50.7 million Americans who are uninsured is 16.7% of the population. The number of Americans with employer-sponsored coverage dropped by 6.6 million to 169.7 million last year from 176.3 million in 2008- the largest one time drop since 1987.
The total number of Americans with private insurance fell to 194.5 million from 201 million. The number of Americans covered by Medicaid increased to 47.8 million in 2009 from 42.6 million in 2008, and is now the largest percentage of the population on the program since 1987.
(8/6/10)- U.S. District Judge Henry Hudson denied a motion by the U.S. Justice Department to dismiss the case brought by the Commonwealth of Virginia's Attorney General Ken Cuccinelli to declare the Health Reform Act of 2010 unconstitutional
The suit argued that the federal government does not have the authority under the Constitution's Commerce Clause nor the taxing power to require citizens to buy health insurance or pay a penalty. There are 21 states currently contesting the constitutionality of the Health-Care Reform Act of 2010
A further hearing on the matter will be held on October 18th.
The Virginia Health Care Freedom Act passed this year, declared that residents of the state cannot be forced to buy health insurance. The federal health-care legislation requires most U.S. residents to have health-care coverage or pay a penalty by 2014.
(7/29/10)- President Barack Obama's heath-care reform act that passed in 2010 allows the FDA to approve generic biologics to be marketed, with the FDA setting the rules as to how that approval can be granted
The FDA recently approved the first generic version of the blood thinner Lovenox (enoxaparin) to be sold in this country. Lovenox, is manufactured and sold by Sanofi-Aventis SA, while the generic version thereof will be marketed by a subsidiary of Novartis AG.
Sanofi's subsidiary, Momenta indicated it may bring legal action to prevent the generic version of Lovenox to be marketed because the drug is too complex to be copied safely. Lovenox is drawn from animal proteins, and is in the middle of the categorization of a traditional chemical drug and a biologic drug made from human proteins.
(7/17/10)- The Obama administration released the rules specifying which preventive services insurers must provide to consumers at no additional cost for new health plans that begin coverage after September 23, 2010, and to health plans that make significant changes after that date. The rules stipulate that no co-payments can be charged for the tests and screenings.
The administration does concede that as a result of these rules, premiums will be increased by about 1.5% on average. The rules arose as required under the new Health-Care Reform Act of 2010.
The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations/ prenatal care' and regular wellness visits for infants and children.
Counseling to help people stop smoking, screening and counseling for obesity; and test for infection with virus that causes AIDS must also be offered at no cost.
The administration is working on a supplemental list of free preventive services for women.
(7/11/10)- The new health-care reform law requires pharmaceutical companies and medical equipment manufacturers to report physician-payment data to the government, which the U.S. Department of Health and Human Services will consolidate and make available on a public Web site. This requirement for annual reporting is to begin in 2013.
(6/29/10)- There are about 1400 American corporations that have been receiving federal tax subsidies since 2003 to offset their costs for prescription drugs for their retirees who are covered under their health-care and benefits plans. This subsidy, which amounts to about $600 per eligible retiree was granted so that the corporations would continue to cover retirees' drug benefit costs, and not shift them onto Medicare.
Under the new health care legislation that was recently enacted, this subsidy will end, and not be available again until 2013.
Navistar International Corp. announced that it would drop prescription drug benefits for its approximately 38,600 retirees and their spouses, of whom, about 22,000 are 65 or older, thus in effect causing eligible retirees and spouses to apply for Part D coverage for their pharmaceutical needs..
The United AutoWorkers (UAW) union has petitioned the federal district court in Dayton, Ohio, to block this change.
(6/11/10)- The government will begin to mail $250 checks to seniors today, who belong to Medicare and fell into the so-called "doughnut hole". The "doughnut hole" is when prescription drug spending totaled between $2,831 to $6,440 in 2009, and thus no insurance coverage reimbursed them for any part of that expenditure.
In reality this means that about one in 10 individuals who are on Medicare will receive the check, or about 4 million people.
The bill cuts about $455 billion in Medicare spending over a decade from payments to hospitals and other health-care providers. About $136 billion of this cut will hit Medicare Advantage plans.
(6/6/10)- The new health-care reform act requires pharmaceutical companies to advise Congress as to how many free samples of their products they distribute.
Pfizer Inc. gave out 101 million drug samples worth $2.7 billion in 2007. Merck & Co. gave out 39 million samples worth $356 million and Eli Lilly & Co. gave out 33million samples worth $67 million.
The value of the drugs reported to Congress was based on either the market price or the wholesale cost for the drugs.
In addition to the free samples, Pfizer said it has helped six million patients receive more than 48 million Pfizer prescriptions, which was worth an estimated $5.7 billion as part of its program to help low income individuals receive low to no-cost drugs.
(5/29/10)- Kathleen Sebelius, the secretary of health and human resources announced that the federal government would soon begin sending $250 checks to Medicare beneficiaries who had prescription drug costs that hit the " doughnut hole" in 2009.
The first checks will go out June 10, and the government estimates that about 4 million Medicare beneficiaries will receive these checks by the end of the year. The government will automatically send out the checks and Medicare beneficiaries do not have to fill out any forms to get the checks.
(5/13/10)- According to the latest estimate from the Congressional Budget Office, the new-health care law could add at least $115 billion more to government health-care spending over the next 10 years.
The new estimate includes an additional $10 billion to $20 billion in administrative costs to the federal agencies carrying out the law, $34 billion for community health centers and $39 billion for Indian health care.
If Congress approves all the additional spending called for in the legislation, it would push the 10-year cost of the health-care reform above the $1 trillion mark that the Obama administration had set as the ceiling.
(5/10/10)- Under a temporary $5 billion program, that was a part of the Health-Care Reform Act of 2010, the federal government will reimburse employers for 80% of the cost of claims from between $15,000 to $90,000 a year for a retired worker who is 50 or older and not eligible for Medicare.
The program will run from June 1, 2010 to January 1, 2014, when many early retirees will be able to enroll in health plans offered through new state-based markets known as insurance exchanges.
The aim of this program is to help induce employers to keep health-care coverage for early retirees who are not eligible for Medicare, but earn too much, or have too much in assets to be eligible for Medicaid.
Kathleen Sebelius, the secretary of health and human services, predicted that 4,500 employers and early retirees would seek federal help under the program. The government could deny or stop accepting applications for the program if it appeared that the $5 billion would run out before 2014.
(4/12/10)- The parts of the new health-care reform legislation governing preventive care go into effect on September 23rd, 2010, which is six months after it was signed by the president. If Medicare covers you, the upgrades to preventive care go into effect January 1, 2011.
On September 23rd new health-care insurance plans, and plans that make changes, must start to offer free preventive care.
The preventive services will include those that the United Stated Preventive Services Task Force (USPSTF) has given their top A or B rating, like screening for HIV, depression, osteoporosis in postmenopausal women, as well as breast, colorectal and cervical cancer. The USPTF is a panel of outside medical experts under the Health and Human Services Department.
Children will receive free screenings for conditions including iron deficiency, sickle cell diseases and hypothyrodiism.
Immunizations recommended by the Centers for Disease Control and Prevention (CDC) will be covered, including vaccines for Hepatitis A & B, tetanus-diphtheria, seasonal flu vaccines and human papilloma virus for girls 9 to 26 years old.
(3/29/10)- When prescription drug coverage was extended to Medicare beneficiaries in 2003 as Medicare Part D, it was feared that many corporations would abandon drug coverage for their retirees, and thus force the retirees into Part D coverage.
To encourage corporate America to continue to offer prescription drug coverage for their retirees, beginning in 2006, companies have received a 28% federal subsidy, or up to $1,330 per retiree, tax-free.
In addition to receiving the subsidy, the company could deduct it from their taxes. Under the new law, companies will no longer be able to deduct the subsidy, but it remains tax-free. The change does not take effect under the new health-care reform law until 2013, but they have to take the charge now, to reflect the loss of the future tax deduction.
According to David Zion, an analyst at Credit Suisse, the S&P 500 companies will take a combined hit of $4.5 billion to first-quarter earnings.
It seems to us at therubins that corporate America is raising its voice in complaint about this change, when in all reality, the change is one that certainly is more equitable in eliminating a double benefit that corporate America should not have been entitled to in the first place.
For those making more than $200,000 or $250,000 for a couple, the new Act means a boost in the Medicare payroll tax beginning in 2013. That is the same year, the Act adds a tax of 3.8% on unearned income, which includes interest and dividends, above those same thresholds. The tax applies only to the income in excess of the limits.
Thus if a couple earned $200,000 in wages and $100,000 in capital gains, for a total of $300,000, $50,000 (the amount over the $250,000 mark for couples)would be subject to the new tax starting in 2013. If the top income tax rate returns to 39.6%, as President Obama has proposed, investors in the top bracket would pay a total of 43.4% rate on bond interest, including the proposed 3.8% investment tax.
It is estimated that the new tax would affect some four million couples and one million individual filers..
The amount you can put in a tax-free flexible spending account (FSA) will be limited to $2,500 a year starting in 2013. There is currently no legal cap on the amount that an employee can put into his/her flexible spending account, although many employers impose their own limits.
Those who pay for drugs in the "doughnut hole" coverage gap are eligible for a $250 rebate in 2010. In 2011, that group will get a 50% discount on brand-name drugs. The doughnut hole will be gradually eliminated by 2020. This loss of profit for drugs in the "doughnut hole" is where the drug companies came up with the $80 billion over 10 years that they lose as a result of the health-care reform act.
Starting next year, certain preventive care examinations will be free.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN
SELECTING A NURSING HOME SEE OUR ARTICLE "How
to Select a Nursing Home"
By Allan Rubin
updated December 11, 2013