Both sides poised for healthcare ruling
Source: thehill.com/blogs/healthwatch
By Sam Baker
Lawmakers and interest groups don’t know how the Supreme Court will rule on President Obama’s healthcare law, but they’re ready to respond as soon as the decision is released.
The court is expected to issue its decision shortly after 10 a.m. Thursday. Once the ruling is announced, the courthouse steps and the Capitol, just across the street, will become circuses of spin.
House Republicans will likely hold multiple press conferences throughout the day. The party leadership will likely want to address the ruling, especially if the court strikes down all or part of the law.
The GOP’s Doctors’ Caucus is also planning a news conference Thursday afternoon. And Rep. Michele Bachmann (R-Minn.) reportedly reserved space outside the Capitol to hold her own event.
President Obama is scheduled to be in meetings at the White House all day Thursday. A White House spokesman would not say whether he will have any public comments in the wake of the court’s ruling on his signature domestic achievement.
A spokeswoman for Mitt Romney’s presidential campaign did not respond to a question about Romney’s schedule Thursday.
The healthcare case has greater short-term political implications than any case since Bush v. Gore, which decided the 2000 presidential election.
A victory at the Supreme Court would be an enormous boon to either side, yet pundits and strategists from both parties have also suggested that the losing side might gain a political upper hand by using the decision to rally its base.
Speaker John Boehner (R-Ohio), however, warned his caucus last week not to “spike the football” if the court strikes down the healthcare law. Excessive celebration could detract from the party’s focus on the economy, he said.
Rep. Tom Price (R-Ga.), a physician, said focusing on healthcare as an issue doesn’t have to cross the line into cheering the demise of the Affordable Care Act (ACA).
“The reason this isn’t a cause for celebration is that the status quo is unacceptable,” Price told The Hill in an interview.
Even if the court upholds the ACA, Republican leaders plan to press ahead with another vote to repeal the law.
Sen. John Thune (R-S.D.) said at a press conference Tuesday that if the court leaves any of the law standing, Republicans will try to repeal it and replace it with “step-by-step reforms” of their own.
A Senate Republican leadership aide would not provide specifics about the party’s plans following Thursday’s decision or say whether Minority Leader Mitch McConnell (R-Ky.) has delivered the same message as Boehner about “spiking the football.”
Democrats, meanwhile, aren’t especially thrilled that the decision will come just before the weeklong July 4 recess — meaning healthcare will dominate the headlines following Thursday’s ruling and will then be back in the news once Congress returns and House Republicans move on to their repeal vote.
“If we were here, then we could then move rapidly to get something on the agenda, something in the hopper, to respond to this in a way that the American people would understand that we’re going to move ahead on this,” said Sen. Tom Harkin (D-Iowa), the chairman of the Health, Education, Labor and Pensions Committee.
Harkin and his staff have been working on contingency plans in case the court strikes all or part of the law, but they will have to hold on to those options until after the July 4 holiday.
“As it is, we have these 10 days off,” he said. “I’m just wondering if the politically motivated Supreme Court didn’t plan it that way.”
Democrats will still get in on the initial reaction, however.
Reps. Raúl Grijalva (D-Ariz.) and Keith Ellison (D-Minn.), the leaders of the House Progressive Caucus, are planning a rally just outside the Supreme Court immediately following the decision.
The plaza outside the court has been slowly filling with protesters and interested onlookers as the healthcare ruling draws nearer. Although protests Thursday aren’t expected to rival the sea of activism that surrounded the court during oral arguments, protesters had amassed a respectable presence Monday amid the crush of TV crews camped out in front of the court.
Four Scenarios for Thursday’s Ruling on Health Care
Source: blogs.wsj.com/washwire
By Brent Kendall and Peter Landers
WASHINGTON–The Supreme Court’s eagerly awaited ruling on the 2010 federal health-care law is expected on Thursday, when the court will announce its final opinions of the term.
The high court announced two decisions on Monday. Three more, including the health-care case, remain pending.
Chief Justice John Roberts announced from the bench that Thursday will be the court’s final session before it takes a summer break. The chief justice said all remaining opinions will be announced then.
On the health care law, here are the most likely four scenarios on how the court could rule, as first laid out by Law Blog last week, shown in order of how much of the law would be struck down:
Scenario #1: The entire law is upheld.
The high court may conclude—as the majority of lower courts did—that Congress was acting within its powers under the Constitution when it required most Americans to carry health insurance or pay a penalty. That provision was at the center of the two-year legal battle, and if it survives, the rest of the law is likely to stay as well.
Such a ruling would be a victory for Democrats and President Barack Obama, who had passed the biggest reworking to the health system since the creation of Medicare in the 1960s and faced the prospect of the court nullifying their effort. It would also avert disruption for hospitals, doctors and employers who have spent more than two years preparing for changes in the law.
Even in this case, however, the law would face an uncertain future. Republican presidential candidate Mitt Romney and GOP congressional leaders have pledged to repeal the law if they take control of Congress and the White House in November elections.
Scenario #2: The insurance mandate is struck down, but the entire rest of law stays.
This was the ruling of a federal appeals court in Atlanta last year, and the Supreme Court may choose to uphold it. In this scenario, the high court would conclude that Congress exceeded its powers with the requirement to carry insurance or pay a penalty. But it would judge that provision separable from the rest of the law.
This would be the worst-case scenario for insurance companies and set off a scramble for the Obama administration and supporters of the law to prove that it could still work. Unless Congress took further action, insurers would be required accept all customers starting in 2014–even those who are already sick–without imposing surcharges for pre-existing medical conditions. At the same time, the court’s ruling would mean people wouldn’t be required to carry health coverage. Insurers say that would lead to chaos in the market as people waited until they were sick to sign up for policies.
Scenario #3: The mandate and two related provisions are struck down but the rest of the law stays.
At Supreme Court arguments in March, the Obama administration, fearing the market chaos in scenario #2, argued that the insurance mandate was inextricably linked to two other provisions. Those provisions require insurers to accept all customers and restrict the insurers from charging more based on a person’s medical history. The administration said if the mandate were struck down, the other two provisions should go too.
If the court adopts that position, it would mean that the principal aim of the law—expanding coverage to tens of millions of Americans—would be unlikely to be achieved. Republicans would feel vindicated and push to repeal the rest of the law.
While not as disruptive as scenario #2 for health insurers, this scenario would still create broad uncertainty in the health business. Many parts of the law would remain, including those setting up new marketplaces in 2014 where consumers can shop for policies and get subsidies for coverage. Companies with 50 or more workers would have to start offering a set level of health benefits in 2014 or pay a fine.
Supporters of the law have said those provisions could still function, but questions would be sure to arise whether the marketplaces were workable without the core of the law.
Scenario #4: The entire law is struck down.
If the high court concludes that the insurance mandate is unconstitutional, it may agree with challengers that the only path is to invalidate the entire law.
Such a ruling would unravel all the work by the health industry and local governments preparing for the law. It would be a painful blow to Mr. Obama and Democrats who spent so much time and political capital on their health-care overhaul. Yet it would also put pressure on Republicans. They could no longer talk about repealing what they term ObamaCare but would have to figure out what, if anything, to bring before Congress to replace it. Gerald F. Seib discussed Republican challenges in the event of a negative ruling here.
Supreme Court to deliver healthcare ruling on Thursday
By Elise Viebeck - 06/25/12
Source: thehill.com/blogs/healthwatch
The final countdown has begun for the landmark decision on President Obama’s healthcare law.
The justices will render judgment on the controversial law on Thursday, ending months of speculation about a ruling that could have far-reaching implications for the 2012 election and beyond.
The ruling will come shortly after 10 a.m. Thursday, at the end of an action-packed week for lawmakers on Capitol Hill.
Anticipation grew over the weekend that the Supreme Court would issue the healthcare decision on Monday morning. Instead, the court ruled in the high-profile Arizona immigration case, while announcing that the remaining decisions for the term — including the health case, Florida v. Department of Health and Human Services — would not be issued until Thursday.
The three-day deferral left Washington in a state of nervous anticipation for the ruling, which will have election-year ramifications for Democrats and Republicans alike. Congressional offices have been preparing their responses for months, though no one outside the court knows what fate awaits Obama’s signature law.
“We’re keeping a close eye on it. Absolutely. We’re having a war room every day — every Monday and Thursday,” Rep. Diana DeGette (D-Colo.) recently told The Hill.
The wealth of possible outcomes means that outside groups have also taken pains to prepare.
The pro-reform group Families USA, for example, already has eight statements pre-written about the decision. The advocacy group is hoping that one will match the final conclusion and enable the group to respond immediately.
By some estimates, between 50 and 100 people at or associated with the court already know the outcome in the healthcare case.
The court's customary practice is to meet in a private conference following oral arguments, discuss the case in order of seniority, then take an initial vote on how to rule — meaning the nine justices and their clerks have probably known the decision since the oral arguments in March.
But the court is a master of keeping decisions under lock and key, and hasn’t suffered a leak for ahead of a scheduled announcement for decades.
On Monday, the court did rule on one major case — striking down three out of four provisions of Arizona's controversial immigration law.
According to SCOTUSblog, journalists in the court chambers Monday knew no healthcare decision was imminent after a comment from Chief Justice John Roberts.
"Justice [Anthony] Kennedy has our second and final decision of the day, inArizona v. United States," Roberts reportedly said.
At that point, nearly 90,000 people were watching SCOTUSblog, a specialized site that has become the go-to resource for court-watchers in Washington.
Since Kennedy authored the majority opinion in the Arizona case, Roberts will “almost certainly” be the author of the majority opinion on healthcare reform, according to SCOTUSblog.
Health Care Reform: Four Companies That Are Leading Change
By Kathy Gersch
Source: Forbes.com
This week, Kathy Gersch, my Kotter International colleague, highlights four companies in the health care sector that are not waiting for a Supreme Court decision to transform their businesses.
The Supreme Court is set to rule on key provisions of the Affordable Care Act before the end of this month. With so much uncertainty around the future of the U.S. health care system, many companies have long been frozen, taking a “wait-and-see” approach to change, choosing to sit tight until the future becomes clearer.
But in a rapidly changing world, sitting tight can spell disaster.
“A leader of a large health care organization’s challenge is to play offense, not defense,” John Kotter wrote on this blog last summer. “If I were running a hospital… I would be focused on how do we make some significant change to take advantage of the opportunities that are going to be inevitable with this swirling, difficult, changing environment in health care.”
John is exactly right. And in the last few weeks alone, a number of hospitals and other health care providers have heeded his call and are taking drastic action.
The New York Times recently profiled one hospital in Brooklyn, New York — Maimonides Medical Center — whose leaders echoed John’s sentiments: “Win, lose or draw in court, administrators said, the policies driving the federal health care law are already embedded in big cuts and new payment formulas that hospitals ignore at their peril. And even if the law is repealed after the next election, the economic pressure to care differently for more people at lower cost is irreversible.”
With “value-based purchasing” programs mandated by the Affordable Care Act, where hospitals will be judged based on both cost and quality of care, Maimonides is taking major steps to boost patient satisfaction. As the Times reported, Maimonides “asked labor-management teams in every unit to invent their own improvement projects. In one initiative, nurses are making hourly rounds to offer patients extra help.” The hospital also provides valet parking and free Wi-Fi — certainly not business as usual.
Elsewhere in New York City, two of the largest hospital systems — NYU Langone Medical Center and Continuum Health Partners — are joining forces to boost their bargaining power with insurance providers and to cut costs, partly as a result of efficiency mandates outlined in the health care reform bill. Again, this is an example of medical organizations taking matters into their own hands and transforming the dynamics of the health care system, rather than allowing change to simply happen to them.
Insurance companies are also changing. As Aetna CEO Mark Bertolini explained to the Wall Street Journal last week, “If the Affordable Care Act were to go away tomorrow, we still would be better off as an organization, because who can argue with getting a lower health care delivery cost, more streamlined administrative structure, making yourself simpler and less complex to do business with? If that all happened and then health care reform went away, we would be better off and so would our customers.”
The leaders of UnitedHealthcare seem to agree. They made news recently when they pledged to keep popular coverage provisions mandated by the Affordable Care Act in place, regardless of the Supreme Court’s decision. The company said it would continue offering policyholders no-copayment preventative services and third-party appeals for cases where treatments are denied. They also vowed, among other things, not to cancel policies retroactively, except when fraud had taken place. These are marked shifts in the way insurance companies typically operate.
In each of these examples, leaders are refusing to let complacency set in. They are not resting on their laurels, being myopic or tricking themselves into thinking that the old way of doing things will suffice in the future. The world is changing quickly, and those who fail to change with it are sure to be left behind. The winners will be in front of the transformation instead of behind the curve trying to catch up when things become “clear”. One thing is certain – change in healthcare will continue, and it’s accelerating. There is no point of perfect clarity.
5 things health reform supporters don’t want you to know
By Joanna Antongiovanni
Source: ifawebnews.com
As the Supreme Court of the United States will likely rule on health reform soon, conversations about the bill’s constitutionality are once again resurfacing. Aside from this debate, there are several flaws within the bill that contribute to its inability to best protect consumers from increasing rates and provide them with affordable coverage. Below are five things that supporters of health reform don’t want you to know.
A lack of focus
The bill is more focused on insurance costs and does not adequately address the main reason health care costs go up: the actual cost of care. This is a big problem because it overlooks what could really make a difference and solve some of the health care issues in our country. The Kaiser Family Foundation report predicts that the health care rebates employers can expect to receive is minimal, an average of $127 compared to premiums of $5,400 a year for an individual and $15,100 for a family. If these predictions are close to the actual rebates, it proves the bill’s insurance reforms and current medical loss ratios do not address the true cause of increasing premiums in our country.
One size doesn’t fit all
As health reform stands now, it fails to address the unique needs of each state. One of the mostly unpublicized outcomes of the medical loss ratio (MLR) requirements has been that carriers have opted to exit specific unprofitable markets or exit health group products altogether to concentrate on lines of business not affected by health reform.
In some states this has created an unfair advantage for the one or two carriers that remain.
Other plans have eliminated specific products such as “child only policies” citing the inability to cover the cost of the additional mandates placed on these policies at an affordable cost. In addition, doctors and hospitals in wealthy areas are more likely to pass along those costs to consumers in those areas, increasing health insurance costs in those regions.
What was originally intended to increase coverage to the uninsured and lower health insurance costs has in fact done the opposite. In addition, many states that are struggling to balance their budgets following the burden of Medicaid expansion are seeing red and increasing deficits. These states are looking for alternative ways to save money and state-funded programs like education are at risk for budget cuts.
The current exchanges don’t fit
One major oversight of the bill is that there is no exchange that exists today that would satisfy health reform’s exchange requirements. An exchange is a government manufactured insurance marketplace for individuals not covered for health insurance by their employers to shop for health insurance at competitive rates. None of the current exchanges that exist for health care work under the new bill, the health reform exchange is two parts Massachusetts exchange, one part Utah exchange and one part “other”.
It’s debatable if either the Massachusetts or Utah exchanges accomplishes what they are set out to do, that is, to provide a market for people to purchase affordable insurance.
The creation of the exchange itself did not make health insurance affordable as it never addressed the cost of care. This is an obvious problem as individuals that are not covered by their employer need to have an affordable alternative for health care. Instead of looking to examples of what would work, the exchange dreamed up by health reform is a conglomeration of different ideas hastily combined.
Pennies on the dollar
Did you know that health insurance companies only make 3 cents to 6 cents on the dollar for health insurance premiums?
Health reform’s misplaced blame on insurance companies will only result in more difficulty for employers and individuals to get the specific insurance policies that they need. If the insurance companies continue to be attacked, they will lose more money and have fewer agents who will be able to help consumers find a policy that meets both their financial and health needs. Again, the cost of care resurfaces as the larger influencer on health insurance premiums.
All bark and no bite
There is only one thing worse than a mandate…a mandate without teeth. The bill mandates individuals to purchase health insurance but the consequences for not purchasing insurance is so weak it begs the question about how serious lawmakers were about actually making people purchase insurance. As the law is written now, it will accelerate the destruction of the insurance industry as people, after they have done the math, will opt to pay the penalty rather than pay for coverage.
Only time will tell the Supreme Court’s final decision regarding health reform. Regardless, so long as the legislation fails to address the above issues, the bill will be ineffective in solving the health care conundrum in our country.
Tensions rise as justices kick healthcare ruling to next week
By Sam Baker and Elise Viebeck
Source: thehill.com
The Supreme Court did not rule on President Obama's healthcare law Thursday, raising tensions before a decision next week.
The ruling was possible Thursday but not expected. The court traditionally holds its biggest decisions until the last day of the term, and the healthcare case is among the most highly anticipated decisions in decades, overshadowing the current term.
The next possible day for a decision is Monday, but justices will add more days to the schedule later next week.Television camera crews set up outside the court Thursday just in case a decision on the healthcare law was released. There is also great interest in an expected court decision on Arizona's controversial immigration law. Tha Arizona decision also was not released Thursday.
Interest in the court's docket was also reflected at the Scotusblog, which said it had 22,000 visitors on Thursday morning.
The court's public information office implemented new protocols starting Thursday in order to accomodate the vast interest surrounding the healthcare decision.
The Obama administration took the opportunity to praise one provision of the health law just an hour before 10 a.m., when the ruling might have been issued.
Health and Human Services Secretary Kathleen Sebelius said that Americans will receive $1.1 billion in rebates from insurers this summer as a result of the law's medical loss ratio (MLR). This will average about $151 per insured family, the agency estimated.
The MLR that insurers spend roughly 80 percent of all premiums on healthcare rather than marketing, executive bonuses or other administrative costs.
The Obama administration continues to talk up provisions of the law as they are implemented. Polls show that, as a whole, the Affordable Care Act remains unpopular with the public.
Legal insiders believe the justices will strike down all or part of the healthcare law, according to a survey released Wednesday.
Obama administration touts health law an hour before possible ruling
By Elise Viebeck
Source: The Hill
Federal health officials touted a popular provision of the healthcare law — which would result in $1.1 billion in insurance rebates to consumers — just an hour before the Supreme Court could issue its ruling.
A ruling could happen Thursday at 10 a.m. After that, the next possible decision date is Monday, June 25.
The Obama administration continues to talk up provisions of the law as they are implemented. As a whole, the Affordable Care Act remains unpopular with the public.
Health and Human Services (HHS) Secretary Kathleen Sebelius said Thursday morning that 12.8 million Americans will receive $1.1 billion in rebates from insurers this summer as a result of the law. This will average about $151 per insured family, the agency estimated.
The rebates will stem from the law's medical loss ratio, which mandates that insurers spend roughly 80 percent of all premiums on healthcare rather than marketing, executive bonuses or other administrative costs.
"The 80/20 rule helps ensure consumers get fair value for their health care dollar," Sebelius said in a statement.
Materials from HHS said that consumers will likely see a rebate check in the mail, a lump sum reimbursement to the account they use to pay premiums or a reduction in their future payments. Insurers must issue checks by Aug. 1, unless the law is struck down in the next two weeks.
Poll: Healthcare reform must stay on Washington's agenda
Americans strongly support further efforts to reform the healthcare system if the Affordable Care Act is declared unconstitutional, a new poll finds.
The overwhelming desire for a new reform effort — supported by more than 75 percent of the public — was comprised of backers and opponents alike of the law known as "ObamaCare," according to The Associated Press-GfK poll.
Neither party is expected to launch a comprehensive reform effort if the court strikes down the law in the next two weeks. Republicans in the House have said they will immediately repeal whatever portions of the law are left standing and approach other reform attempts step by step.
The White House, meanwhile, is expected to continue implementing any parts of the law that remain.
The poll found that even among Tea Party supporters — the most vocal objectors to the original healthcare law — nearly 60 percent said they want Washington to continue some kind of healthcare reform effort. This represented the lowest level of support found by the poll, according to the AP.
Overall, 47 percent opposed the law, including only 21 percent of independents, and just over a majority said the 2012 presidential contest will have a big effect on the healthcare system.
The poll was conducted June 14-18 and had a margin of error of 4 points.
Bigger Changes May Be in Store for FSAs
A recent IRS clarification regarding contribution limits for some health flexible spending accounts (FSAs) comes at a time when the agency and Congress are seriously rethinking some of the other constraints to the accounts.
In late May, the IRS released a notice that clarified that the $2,500 annual contribution limit to FSAs that was imposed by the Patient Protection and Affordable Care Act (PPACA) is effective for plans that begin in 2013 -- meaning noncalendar-year plans in 2012-2013 do not have to comply, according to a post on the E is for ERISA website.
That change, however, may do little good for proactive employers with noncalendar-year plans that already made adjustments. The notice does not contain guidance about changing the contribution limit midyear, so it appears that employers that made changes to the contribution limits at the start of the 2012-13 plan year must stick with them, according to ftwilliam.com, a division of Wolters Kluwer.
This adjustment could be the first in a number of significant changes to rules governing FSAs. The IRS is considering a change to the "use-it-or-lose-it" rule, which requires participants to spend their FSA balance annually or lose the money, according to a report in Business Insurance. The report notes that the IRS acknowledges that the cap under PPACA "limits the potential for using health FSAs to defer compensation," and so a rework of the use-it-or-lose-it rule likely is due.
The U.S. House of Representatives also is stepping into the debate, as legislators recently passed a bill that would ease the use-it-or-lose-it rule, according to Business Insurance. The House bill allows workers to withdraw up to $500 in unused balances from the accounts, although the funds would be taxable.
The bill also abolishes an unpopular rule that restricts the purchase of over-the-counter medications with FSA money. Under the PPACA rule, tax-advantaged health accounts, including FSAs and health savings accounts, cannot be used to purchase over-the-counter medications without a prescription. The bill strikes that provision from the law, the Business Insurance report said.
However, the Obama administration already has pledged to veto the bill if it makes it through the Senate because the legislation also would eliminate a tax on makers of medical devices -- a tax that the administration sees as vital to funding the health care reform law, according to a Workforce online report.
Preparing for the SCOTUS ruling
By Brian M. Kalish
June 18, 2012
Industry groups are being proactive in preparing their membership for the Supreme Court’s ruling on health care reform — which is expected at any time — as they know no matter the ruling, the business has changed forever.
At the National Association of Health Underwriters they have readied their membership by covering the topic across numerous mediums, including weekly e-newsletters, town halls and web seminars, says Jessica Waltman, NAHU’s SVP of government affairs.
After the decision comes out, NAHU members will want to know what will happen, Waltman says, adding she believes the ruling may come out during the organization’s annual convention, which begins June 24 in Las Vegas, so they are making plans to have plenty of time to discuss it.
“We need to inform our membership, so we have a variety of information tools that we are preparing that cover the eventualities as far as we can see them,” she says. “We believe no matter the ruling; [our] members will start receiving calls from their clients. … Our goal is to have tools at the ready so they can best assist their clients.”
The Council of Insurance Agents & Brokers is taking a similar approach, and has already had discussions with its membership about the potential impact of the ruling, says Scott Sinder, partner, Steptoe & Johnson LLP, and The Council’s general counsel.
The Council and its attorneys at Steptoe & Johnson LLP “have folks anxiously awaiting and ready to read the opinions,” and the organization intends to send notice to its members within hours of the ruling that reports on “the big picture,” which will be followed up with more in depth analysis within 24-28 hours.
A series of web seminars, including an initial one for its membership and a second one for members to share with their clients, will follow.
One broker, who says he started his business expecting health care reform, says he’s enjoyed watching the buildup to the ruling. “In the last three to four months it’s been interesting to see brokers still holding onto that hope that we’re going to go back five or six years and broker commissions will go back up and we’re not going to have government involvement in health care. But I don’t see that scenario occurring,” says Reid Rasmussen, owner of Benefit Brainstorm, Inc, adding he believes 30% of brokers will leave the business in the next two years.
“That will open opportunity up to the insurance professionals that are still left figure out how to better serve their clients,” he says. “Smart agents are expanding their horizons and serving their client better than ever before. … It’s not going to make a difference in the end what the Supreme Court rules.”
Even so, Waltman says, NAHU cannot wait for the ruling to come out, as presently “it’s very difficult to plan anything and it affects a lot of our dealings [and] feelings. … It affects everything we are doing.”
“Just having the closure will be very helpful,” she adds. “I think we are looking for that and then we can plan accordingly. No matter what the Court does … there needs to be changes to market reform in the coming year.”