Insurance Coverage and Medical Care

In a unanimous decision the U.S. Supreme Court held in Rutledge v. Pharmaceutical Care Management Association that states may regulate the price at which pharmacy benefit managers (PBMs) reimburse pharmacies for the cost of prescription drugs without violating the Employee Retirement Income Security Act (ERISA).  

PBMs act as an intermediary between prescription-drug plans and pharmacies. When a pharmacy fills a prescription the PBM reimburses...

Today the Supreme Court heard oral argument in California v. Texas. In this case it is possible the Supreme Court could rule that a portion of the Affordable Care Act (ACA) is unconstitutional and strike down the entire law.

Predicting the outcome of Supreme Court cases based on oral argument is a risky proposition. Nevertheless, it appeared at...

In a 7-2 decision in Little Sisters of the Poor v. Pennsylvania the Supreme Court held that religious employers and employers with moral objections may be exempted from the Affordable Care Act’s (ACA) contraceptive mandate.

The State and Local Legal Center (SLLC) filed an amicus ...

Indiana has received federal approval of a first-of-its-kind program that helps individuals transition from Medicaid to employer-based health coverage or a plan in the individual marketplace. The new “workforce bridge” builds on the Healthy Indiana Plan (HIP), which is used by the state to expand Medicaid to cover low-income adults.

Each HIP participant has $2,500 placed in an account each year to use for health care expenses. But what happens when someone no longer qualifies for HIP, due to a new job or other factors that cause his or her income to rise above eligibility thresholds?

Previously, participants lost the ability to use any funds in their state-funded account. However, with implementation of the HIP Workforce Bridge, members leaving the Healthy Indiana Plan can continue to use up to $1,000 from their account for up to 12 months in order to pay premiums, deductibles, co-payments and co-insurance during their transition to other types of coverage.

Amy Howe at SCOTUSblog aptly describes Maine Community Health Options v. United States as “relatively low-profile but super-high dollar!” In this case the Supreme Court held 8-1 that health insurance plans can sue the federal government to recover unpaid Risk Corridors payments under the Affordable Care Act (ACA).

The Risk Corridors program was designed to...

Screening mammograms are used to check for breast cancer in women who have not yet shown any signs or symptoms of the disease. Diagnostic mammograms, on the other hand, are used when additional images are needed after the screening mammogram discovers possible indicators of breast cancer.

These indicators include lumps and dense breast tissue; the latter is an important indicator because women with extremely dense breasts are four to six times more likely to develop cancer than women with fatty breasts, according to Densebreast-info, Inc., an online educational resource. Additionally, it is often hard to detect cancer via routine screening mammograms in higher-density breasts, thus necessitating further tests.

Beyond more in-depth X-ray diagnostic mammograms, other detection tests include ultrasounds (sonograms) and magnetic resonance imaging (MRIs). Since 2010, under the Affordable Care Act, insurance providers must cover screening mammograms once a year for women ages 40 to 74 with average risk for breast cancer, and once every two years for all other women. However, insurance providers are not required to cover diagnostic tests under federal law.

Today the Supreme Court heard oral argument in its first abortion case since Justice Kennedy left the bench and was replaced by Justice Kavanaugh. The outcome of this case is likely to come down to Chief Justice Roberts and Justice Kavanaugh.  

In June Medical Services v. Russo the Supreme Court will decide whether Louisiana’s law requiring physicians performing abortions to have admitting privileges at a local hospital is...

In Texas v. California and California v. Texas the Supreme Court will decide whether the Affordable Care Act’s (ACA) individual mandate is unconstitutional. More importantly, if the Court holds that it is, it will decide whether the individual mandate is severable from the ACA. It is possible the Court will conclude it isn’t and that the entire law is...