U.S. Supreme Court hears arguments in challenge to California's Reproductive FACT Act A California law that requires specified facilities providing pregnancy-related services and counseling to disclose information about the availability of comprehensive reproductive health care services is currently being challenged before the United States Supreme Court. At issue in this case—NIFLA v. Becerra—are efforts by the State of California to ensure that patients receive accurate information about the availability and accessibility of free and low-cost comprehensive reproductive health services. Passed in 2015, the California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act requires licensed health-care centers to notify patients of the availability of free or low-cost health care services, including contraception, prenatal care, and abortions, through state programs. The law additionally requires that unlicensed health care centers—for example facilities that provide primarily counseling services—to inform women that there are no licensed medical providers on staff. The issue before the U.S. Supreme Court is whether the disclosures required by the FACT Act violate the Free Speech Clause of the First Amendment. The California Medical Association (CMA) joined the American College of Obstetricians and Gynecologists, American Academy of Pediatrics – California, American Society for Reproductive Medicine and other health care provider organizations to file an amicus brief in support of California’s FACT Act. CMA's brief explained that requiring licensed facilities to inform women of the availability of comprehensive free or low-cost reproductive health care reduces delays in care that can pose significant risks to maternal and fetal health. “Women’s pregnancy-related health care services are highly time-sensitive, and unnecessary delay can pose significant risks to maternal and fetal health,” CMA’s brief said. Additionally, the brief argues that requiring unlicensed medical facilities to inform women that there are no licensed medical providers on staff allows women to make informed decisions about the pregnancy-related services that they receive and prevents such facilities from misleading women into believing that the services being offered are medically necessary or beneficial. CMA’s brief explains that “patients can neither fully consent nor make fully informed decisions about their health care if they are not meaningfully informed about the care they are receiving or the qualifications and expertise of the individual who will be providing the care.” Oral arguments in this case were heard in the U.S. Supreme Court on March 20, 2018, and a decision is expected by the end of June. April 5, 2018 General Amicus Briefs, Legal Advocacy, United States Supreme Court, Women's Health 0 0 Comment Read More »
Supreme Court sends contraceptive coverage under ACA case back to lower court On May 16, 2016, the U.S. Supreme Court issued an unsigned unanimous opinion announcing that it would not rule on the merits of the case regarding the contraceptive coverage requirement under the Affordable Care Act (ACA). The move is seen as an effort to avoid a four-to-four deadlock. The Court instead vacated the judgments of the lower courts and instructed the courts to afford the parties an opportunity to arrive at compromise. The opinion instructs the courts to allow the parties sufficient time to resolve any outstanding issues between them that would accommodate religious exercise while ensuring that women "receive full and equal health coverage, including contraceptive coverage." In February, the California Medical Association (CMA) filed an amicus brief with the Supreme Court in support of the contraceptive-coverage provision for group health plans under the ACA. CMA joined the American College of Obstetricians and Gynecologists, Physicians for Reproductive Health and American Academy of Family Physicians, as well as other state medical associations and health care provider organizations, in filing the brief. The issue in this case, Zubik v. Burwell, is whether the Religious Freedom Restoration Act of 1993 (RFRA) not only entitles religiously-affiliated non-profit corporations to opt out of providing contraceptive coverage themselves, but also prevents the government from arranging for third parties to provide separate coverage to their employees. Under the ACA, employers with more than 50 full-time equivalent employees must provide health coverage for their employees or face fines in the form of a tax. The ACA also requires group health plans to cover certain preventative services at no cost to patients, including a full range of contraceptive coverage. Religious institutions, including churches, temples and mosques, are exempt from the ACA's contraceptive coverage requirement. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, are not automatically exempted from the requirement; rather, they are afforded an accommodation that requires them to notify the health plan or the U.S. Department of Health and Human Services of their religious objections. Such a notice then triggers independent birth control coverage for employees, students and their dependents who want it. After the U.S. Supreme Court’s 2015 decision in Burwell v. Hobby Lobby Stores, Inc., this accommodation was also extended to closely held for-profit entities that object to providing contraceptive coverage based on their owners’ religious beliefs. The religiously-affiliated non-profit corporations in this case seek a complete exemption from the ACA’s contraception coverage mandate, rather than an accommodation. They contend that by providing notice of their objection they are facilitating the provision of insurance coverage for “morally objectionable” contraceptive services, which violates their rights under RFRA. The RFRA provides that the government “shall not substantially burden a person’s exercise of religion” unless that burden is the least restrictive means to further a compelling governmental interest. CMA's brief stressed the importance of widespread access to contraception as an essential component of health care for women of child-bearing age. The brief also argued that decisions concerning contraceptive use, like all health care decisions, should be made by patients in consultation with their health care professionals based on the best interests of the patient. This is best accomplished when contraceptive coverage is provided within the same overall framework as a woman’s other health care services in consultation with a woman’s chosen provider. The accommodation accomplishes this, while at the same time respecting an employer’s sincerely held religious objections to contraception. For a copy of CMA's brief, click here. June 8, 2016 General Contraception, Legal Advocacy, United States Supreme Court, Affordable Care Act 0 0 Comment Read More »
Supreme Court to hear ACA challenge by religious nonprofits The U.S. Supreme Court announced last week that it would hear another group of court cases that challenge the Affordable Care Act (ACA) requirement that health plans provide a full range of contraceptive coverage to women at no cost. Under the law, religious institutions, including churches, temples and mosques, are automatically exempt from the ACA's contraceptive coverage requirement and do not have to file any paperwork. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, must notify the health plan or the U.S. Department of Health and Human Services (HHS) of their religious objections. Such a notice then triggers independent birth control coverage for employees or students who want it. The nation's high court accepted seven cases from around the country (3rd, 5th, 10th and D.C. circuit appellate courts), including one challenge involving the Roman Catholic Archdiocese of Washington and one from a religious order called the Little Sisters of the Poor, which runs homes for the aged. The groups argue that notification "accommodation" offered by the Obama administration is not good enough because the opt-out notification itself makes them complicit in providing the coverage. The Obama administration counters that refusing to submit a notification is essentially vetoing the rights of others who do not hold the same beliefs. The government argues that meeting these requirements does not impose a burden on these groups and that the court should not disregard the interests of employees who may not share their employers’ religious beliefs. The cases accepted include Zubik v. Burwell; Priests for Life v. Department of HHS; Roman Catholic Archbiship v. Burwell; Texas Baptist University v. Burwell; Little Sisters of the Poor v. Burwell; Southern Nazarene University v. Burwell; and Geneva College v. Burwell. Oral arguments are expected to be held in March 2016. November 19, 2015 Managed Care Affordable Care Act, Contraception, United States Supreme Court, ACA 0 0 Comment Read More »
Supreme Court upholds ACA subsidies In a major victory for the Obama administration, the U.S. Supreme Court upheld a key provision of the Affordable Care Act (ACA), reaffirming that 6.4 million people in 34 states can continue to receive subsidies to purchase health care insurance. The question in the case, King v. Burwell, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.” Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic appointees in the majority, affirming that Congress’ intent was to allow tax credits in all 50 states, not just the 16 that have authorized their own online insurance exchanges. Plaintiffs in the case said that that the language in the law forbids the federal government from providing subsidies to states that did not set up an exchange. Lawyers for the Obama administration said the balance of the law showed that Congress did not intend to limit subsidies. “Had Congress meant to limit tax credits to state exchanges, it likely would have done so in the definition of an ‘applicable taxpayer’ or in some other prominent manner,” Chief Justice Roberts wrote. “It would not have used such a winding path of connect-the-dots provisions about the amount of the credit.” "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter," Chief Justice Roberts also wrote. The case arrived at the Supreme Court after a 4th U.S. Circuit Court of Appeals panel in Virginia in July 2014 unanimously ruled in favor of the administration, saying subsidies should be allowed in all 50 states. This case marks the law’s third trip to the high court. In 2012, Chief Justice Roberts joined the four more liberal justices to uphold the constitutionality of the ACA, with four conservative justices dissenting. Earlier, Chief Justice Roberts and the four conservative justices carved out an exception to providing contraceptive coverage for employers who object on religious grounds. The case does not directly affect California, as it is among the 16 states that established its own insurance exchange. However, the Court’s affirmation of the ACA serves to bolster California efforts to fully implement federal health care reform. The landmark decision also affirms CMA’s policy and actions generally to stand behind the ACA while recognizing the law is not perfect and working towards fixing problems. June 26, 2015 General Affordable Care Act, United States Supreme Court, ACA 0 0 Comment Read More »
Poll shows people want Congress to act to make all states eligible for ACA subsidies A new poll has found that nearly six in 10 people believe that Congress or states should act to restore health insurance subsidies if the U.S. Supreme Court strikes them down when it rules on King v. Burwell, a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The poll, conducted by the Kaiser Family Foundation in early January, found that 64 percent wanted Congress to act to make all states eligible for federal aid if the court rules that subsidies should be only available in states with their own markets. Those favoring congressional action included 82 percent of Democrats, 40 percent of Republicans and 63 percent of independents. Fifty-nine percent of those residing in states that use the federal market place said their own state should create its own marketplace if the court invalidates subsidies. The Court has scheduled oral arguments for March 4, 2015, and will release its final decision in June. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. If the subsidies are struck down, some 5.4 million Americans who signed up for coverage in 2014 through the federal exchange, could be left holding the bag for much higher than anticipated premiums, threatening the future of the ACA in the affected states. California is one of 14 states (and the District of Columbia) that are fully running their own exchanges. The other states rely on the federal government for some or all of their exchange operations. The poll also found that many of those at risk of losing subsidies aren’t aware of it. Only a third of those in federally run states knew their exchange was run by the federal government, while 39 percent incorrectly thought their state ran its own exchange. A Rand Corporation study published last month found that of the 5.4 million people who signed up for health insurance on federal-run exchanges last year, 87 percent of them received subsidies. According to the Rand study, without the subsidies, premiums would be 43.3 percent higher on average in the individual market in 2015, while enrollment would drop by 68 percent. The King v. Burwell case arrived at the Supreme Court after a 4th U.S. Circuit Court of Appeals panel in Virginia in July unanimously ruled in favor of the administration, saying subsidies should be allowed in all 50 states. This case marks the law’s third trip to the high court. In 2012, Chief Justice John Roberts joined four more liberal justices to uphold the constitutionality of the ACA, with four conservative justices dissenting. Earlier this year, Chief Justice Roberts and the four conservative justices carved out an exception to providing contraceptive coverage for employers who object on religious grounds. January 29, 2015 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
Supreme Court to hear ACA subsidy case Last Friday, the U.S. Supreme Court unexpectedly said it will hear King v. Burwell—a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The decision to hear the case comes just one week before the second exchange open enrollment period begins on November 15. Consumer uncertainty could affect whether those that are eligible, enroll. If the subsidies are struck down, some 5.4 million Americans who signed up for coverage in 2014 through the federal exchange, could be left holding the bag for much higher than anticipated premiums, threatening the future of the ACA in the affected states. California is one of fourteen states (and the District of Columbia) that are fully running their own exchanges. The other states rely on the federal government for some or all of their exchange operations. A Rand Corporation study published last month found that of the 5.4 million people who signed up for health insurance on federal-run exchanges last year, 87 percent of them received subsidies. According to the Rand study, without the subsidies, premiums would be 43.3 percent higher on average in the individual market in 2015, while enrollment would drop by 68 percent. The King v. Burwell case arrived at the Supreme Court after a 4th U.S. Circuit Court of Appeals panel in Virginia in July unanimously ruled in favor of the administration, saying subsidies should be allowed in all 50 states. This case marks the law’s third trip to the high court. In 2012, Chief Justice John Roberts joined four more liberal justices to uphold the constitutionality of the ACA, with four conservative justices dissenting. Earlier this year, Chief Justice Roberts and the four conservative justices carved out an exception to providing contraceptive coverage for employers who object on religious grounds. Many had speculated that the court would wait to hear King v. Burwell until after the full U.S. Circuit Court of Appeals for the District of Columbia Circuit issues a decision in a separate but similar case, Halbig v. Burwell. Oral arguments in that case are scheduled for Dec. 17. Arguments at the high court in King v. Burwell are likely in March, with a decision expected before July. November 14, 2014 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
CMA files a petition with the Supreme Court to block the 10 percent physician reimbursement cut The California Medical Association (CMA) filed a petition today asking the United States Supreme Court to review the Ninth Circuit Court of Appeals ruling that cleared the way for the State of California to implement a 10 percent cut to Medi-Cal provider reimbursement rates. Federal law requires that Medi-Cal patients have the same access to physicians and other health care providers as the general insured public. Despite this law, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011. Previously, a district court enjoined the cuts, finding that they would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the case requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied. The brief filed today argues that the Centers for Medicare & Medicaid Services (CMS) did not specify the rules that a state must follow to show that its proposed reimbursement rates are sufficient to meet the standard that was set by the Congress in the Medicaid Act. Congress mandated that each state’s Medicaid program set payment rates that “are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographical area.” Lacking any guidance from CMS, the Ninth Circuit deferred to CMS, who approved the cuts despite the fact that the California Department of Health Care Services (DHCS) did not review cost data with respect to most of the services that would be subjected to rate reduction. Had it done so, CMA believes that the new payment rates for many services would be found to be below a providers’ own costs to provide that care. This case presents a straight forward but important legal question of agency deference that has sharply divided the courts of appeals. In other words, what level of deference must a court give to informal agency interpretations of statutes made outside the context of a formal rulemaking. In this case, the Ninth Circuit Court of Appeals applied Chevron deference, meaning that it deferred to the federal agency ruling without question. Without a full review of the facts, CMA and the other plaintiffs – California Hospital Association, California Dental Association, California Pharmacists Association , National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response – believe that reducing California's already dismal Medi-Cal rates will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system under the Affordable Care Act (ACA). Despite the fact that no statistical evidence of the effect of a 10 percent cut was presented by DHCS or CMS, the court, in its deferral to the federal agency, has condemned Medi-Cal beneficiaries in the state of California to second-class health care under the ACA. The petition argues that under these circumstances, the U.S. Supreme Court should review this case to determine if the Ninth circuit court was right to defer to CMS or whether CMS should have examined the potential effects of the 10 percent cuts and made a determination with the facts in hand. On August 14, 2013, the California DHCS announced that it would begin implementation of the 10 percent Medi-Cal physician payment rate reduction on January 9, 2014. If these cuts are allowed to stand, access to care will be devastated, not only for the existing Medi-Cal patients, but also the millions of patients that will be newly eligible for Medi-Cal under the Affordable Care Act in 2014. The California Medical Association (CMA) filed a petition today asking the United States Supreme Court to review the Ninth Circuit Court of Appeals ruling that cleared the way for the State of California to implement a 10 percent cut to Medi-Cal provider reimbursement rates. Federal law requires that Medi-Cal patients have the same access to physicians and other health care providers as the general insured public. Despite this law, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011. Previously, a district court enjoined the cuts, finding that they would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the case requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied. The brief filed today argues that the Centers for Medicare & Medicaid Services (CMS) did not specify the rules that a state must follow to show that its proposed reimbursement rates are sufficient to meet the standard that was set by the Congress in the Medicaid Act. Congress mandated that each state’s Medicaid program set payment rates that “are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographical area.” Lacking any guidance from CMS, the Ninth Circuit deferred to CMS, who approved the cuts despite the fact that the California Department of Health Care Services (DHCS) did not review cost data with respect to most of the services that would be subjected to rate reduction. Had it done so, CMA believes that the new payment rates for many services would be found to be below a providers’ own costs to provide that care. This case presents a straight forward but important legal question of agency deference that has sharply divided the courts of appeals. In other words, what level of deference must a court give to informal agency interpretations of statutes made outside the context of a formal rulemaking. In this case, the Ninth Circuit Court of Appeals applied Chevron deference, meaning that it deferred to the federal agency ruling without question. Without a full review of the facts, CMA and the other plaintiffs – California Hospital Association, California Dental Association, California Pharmacists Association , National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response – believe that reducing California's already dismal Medi-Cal rates will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system under the Affordable Care Act (ACA). Despite the fact that no statistical evidence of the effect of a 10 percent cut was presented by DHCS or CMS, the court, in its deferral to the federal agency, has condemned Medi-Cal beneficiaries in the state of California to second-class health care under the ACA. The petition argues that under these circumstances, the U.S. Supreme Court should review this case to determine if the Ninth circuit court was right to defer to CMS or whether CMS should have examined the potential effects of the 10 percent cuts and made a determination with the facts in hand. On August 14, 2013, the California DHCS announced that it would begin implementation of the 10 percent Medi-Cal physician payment rate reduction on January 9, 2014. If these cuts are allowed to stand, access to care will be devastated, not only for the existing Medi-Cal patients, but also the millions of patients that will be newly eligible for Medi-Cal under the Affordable Care Act in 2014. September 20, 2013 Medi-Cal Advocacy, Medi-Cal, Medi-Cal Cuts, United States Supreme Court, Access to Care, Medi-Cal Lawsuit 0 0 Comment Read More »
