Back Story for Nurses New to This Column

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), a sweeping package of provisions we know as “healthcare reform.” Provisions go into effect during the next four years, with most changes taking place in 2014. Enactment of the law is complicated by mounting legal challenges.    

Stay tuned as we guide working nurses through the twists and turns, and provide an answer to the question: “What is going on with healthcare reform?”

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Supreme Court Holds Hearings

From March 26-28, the Supreme Court held six hours of oral arguments on the Patient Protection and Affordable Care Act (PPACA), often referred to as “Obamacare.” These much anticipated and historic hearings brought a swell of supporters and protestors alike to Washington D.C.  Pundits, politicians, and the public-at-large all took turns parsing the various questions posed by the Justices and the responses from attorneys from both sides. In the end, the decision rests with the nine Supreme Court justices, who are expected to rule on the constitutionality of the PPACA in June.  This link provided by the Supreme Court (www.supremecourt.gov/docket/PPAACA.aspx) provides a comprehensive look at the hearings as they occurred, along with various documents relatec to the case.

California Forges Ahead

Governor Brown has announced that regardless of whether the PPACA is upheld or struck down by the Supreme Court, California is poised to move forward with implementation of its own affordable care act plan.  More on this as it develops. 

The Supremes to Decide Before Election

In September, the Obama Administration filed a petition with the Supreme Court asking for a speedy ruling on the constitutionality of the Affordable Care Act (ACA). This request almost guarantees that the Court will hear at least one of the cases challenging the healthcare reform law before next year’s election. Which should make 2012 a very interesting year indeed.

Long-Term Care Too Costly

The Community Living Assistance Services and Support (CLASS) Act, a key component of the ACA, has fallen apart due to actuarial unsoundness. The CLASS Act would be funded by premiums and would pay enrollees $50 or more per day if they became too disabled to perform normal daily activities like eating and bathing.     

Employers who chose to participate would sign up their employees, who would then have the ability to opt out. The cash benefits could be applied to nursing-home care, but in an effort to encourage enrollees to stay in their own homes, payouts could cover such things as wheelchair ramps and wages for home healthcare aides.      

The CLASS Act was required by law to remain financially self-sustaining. However, the Health and Human Services Department was unable to devise a means of implementation that could both attract healthy participants and pay the minimum level of benefits.

Final Rules for ACOs Released

The Obama Administration released the final rules for Accountable Care Organizations (ACO). ACOs are partnerships of healthcare providers formed to reduce the cost of caring for Americans on Medicare while also boosting quality. ACOs that achieve these goals could share in any savings with the Medicare program. The model outlined by the Obama Administration would require participating groups of doctors, clinics and hospitals to take responsibility for managing the care of at least 5,000 Medicare patients.

Appeals Court Dismisses Virginia’s Challenge to Health Care Law

In a unanimous decision, the 4th U.S. Circuit Court of Appeals has overturned a lower court’s decision to declare the law unconstitutional, ruling that the state doesn’t have a right to bring a lawsuit.

This is the second appellate court ruling in favor of the government’s right to require individuals to buy health insurance or pay a penalty.  However, the court stopped short on ruling whether the individual mandate in the healthcare law is constitutional; it strictly examined Virginia’s right to sue. The court also dismissed a second lawsuit from Liberty University for the same reasons.

Another Court Ruling Against ACA

On Friday, August 12, the 11th Circuit Court of Appeals panel struck down the individual mandate, siding with 26 states that sued to block the law. The decision penned by Chief Judge Joel Dubina and Circuit Judge Frank Hull, found that “the individual mandate contained in the Act exceeds Congress’s enumerated commerce power. What Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.” However, in the same ruling the justices did not invalidate the entire overhaul as unconstitutional.

New Rules for Birth Control and Other Women’s Health Services

This month, the Dept. of Health and Human Services  unveiled wide-ranging changes regarding healthcare  services for women. Under these new provisions, women will soon be able to get birth control pills, breast pumps, HIV tests and five other categories of preventive services without incurring a co-pay or other out-of-pocket insurance charges. The new guidelines go into effect by 2012. Federal officials estimate that as many as 34 million women 18 to 64 years old aren’t presently covered by such services.

The Supreme Court Will Rule Next Year

The Thomas More Law Center for Ann Arbor, Michigan, filed a suit, stating that Congress overstepped its authority in requiring Americans to purchase health insurance or pay financial penalties. Currently the Supreme Court is in recess and will not meet again until early fall. Thus the earliest this case (or other challenge to the Affordable Care Act) may be heard would be early in 2012. 

Federal Appeals Court Upholds Ruling

On June 29, a federal appeals court in Cincinnati upheld President Obama’s healthcare overhaul. This is the first ruling by a federal appeals court on the reform bill. The three-judge 6th U.S. Circuit Court of Appeals panel delivered an opinion, in which there were disagreements on some issues, but affirmed a Michigan federal judge’s earlier ruling that Congress can require Americans to have minimum insurance coverage.

Second Appellate Panel Hears Arguments

On June 1, three judges from the United States Court of Appeals for the Sixth Circuit in Cincinnati heard arguments on the second challenge to the healthcare reform law that has reached an appellate hearing.  The New York Times has reported that the randomly-selected Sixth Circuit panel includes two judges appointed by Republicans — Jeffrey S. Sutton, who was named by President George W. Bush, and Judge Graham, who was nominated by President Ronald Reagan to the Federal District Court in Ohio and is on temporary assignment to the appellate bench. The third judge, Boyce F. Martin Jr., was appointed by President Jimmy Carter, a Democrat.

States Request Waivers

Several states have requested waivers to parts of the ACA. In general, the requests have been to waive certain implementation requirements on the grounds that these requirements “may lead to the destabilization of the individual market.”  So far three states, New Hampshire, Maine and Nevada have been granted partial waivers. Five more states have waiver requests pending.

And while we’re on the subject of waivers. States haven’t been the only “entities” to request waivers from portions of the law.  According to the White House blog posting, 1,372 waivers have been granted to employers, health plans, and others in all 50 states. According the White House posting, these waivers apply only to annual limits; no other provision of the ACA is affected.  

Supreme Court Rejects Request

In late April, the U.S. Supreme Court rejected Virginia’s request that the Court to rule on the constitutionality of the ACA in an expedited hearing. Their ruling means that the lawsuit will move forward to the U.S. District Court for the Eastern District of Virginia. This appeal stems from a December ruling by a judge that the minimum coverage provision of the ACA is unconstitutional. That ruling has been put on hold, pending appeal.  

Rules Proposed for Acccountable Care Organizations (ACO)

On Thursday, March 31, the Obama Administration released rules for the much-anticipated Accountable Care Organization (ACO) models. ACOs are another way that groups of doctors and hospitals that enter into collaboration to treat Medicare patients will be reimbursed. ACOs are anticipated to save taxpayers hundreds of millions of dollars by helping patients stay healthier and avoid unnecessary complications.

There are fears that this new approach might provide an unfair advantage to larger systems — those that can afford computerized databases and other resources to coordinate care with hospitals and specialists for the management of care for at least 5,000 patients. To encourage participation, the federal government would the share savings that are generated from more coordinated care.

White House Appeals Decision

The Obama Administration has formally asked a federal appeals court in Atlanta to rule in favor of the sweeping healthcare reform law. The Justice Department filed its brief on Sunday, April 3 with the US Court of Appeals for the 11th Circuit over the key provision of the law that requires most Americans to obtain health insurance or face financial penalties. This is the provision that a Florida judge ruled unconstitutional on January 31, setting up the current appeal. A three-judge panel of the 11th Circuit will hear oral arguments on the case in June. 

 
States’ Rights

On Feb 28, 2011, President Obama announced that he supported changes to the 2010 healthcare law that would allow states to opt-out of certain provisions of the ACA. This new announcement appears to be a White House endorsement of a proposal introduced by a trio of senators late last year to offer increased flexibility to the nation’s governors.

The bill, sponsored by Senators Scott Brown (R-Mass.), Mary Landrieu (D-La.) and Ron Wyden (D-Ore.) would accelerate the provision in the law that would allow states to ask federal health officials for “innovation waivers.”

Congress must approve the change, and then Health and Human Services officials need to write rules defining specifically how states could meet the criteria for a waiver. Should Congress approve the change, states could apply for “innovation waivers” as early as 2014 instead of in 2017.

Recent Court Ruling

In the latest round, the controversial individual mandate is ruled constitutional. Senior Judge Gladys Kessler, U.S. District Court in Washington, D.C., threw out a lawsuit brought by five plaintiffs who were represented by the American Center for Law and Justice. So for those who are keeping track, that makes three courts that have upheld the ACA law (in whole or part) as constitutional, and two courts that have ruled the ACA law (in whole or part) unconstitutional.