health insurance

In Moda Health Plan v. United States the Supreme Court will decide whether Congress may enact appropriations riders restricting the sources of funding available to pay health insurers for losses incurred that were supposed to be paid per federal law.

The Affordable Care Act’s (ACA) risk corridor program provided that if a health insurance plan participating in the exchange lost money between 2014-2016 it would receive a payment from the federal government based on a formula defined in the statute. If it made money the plan had to pay the federal government based on a formula. The purpose of the program was to induce health insurance companies to offer plans on the exchange despite the fact they didn’t have reliable data to price the plans.

The Government Accountability Office (GAO) identified a particular funding source the federal government could use to make payments. Congress passed appropriations riders for all three years disallowing that funding source to be used to make risk corridor payments.

In December 2018 a federal district court declared the Affordable Care Act (ACA) individual mandate unconstitutional. It also declared the remaining provisions of the act “inseverable,” meaning also invalid. The court didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.

In the district court litigation the Department of Justice (DOJ) didn’t defend the individual mandate. But it did argue that other provisions of the ACA, excluding the guaranteed-issue and community-rating requirements, which were intended to provide affordable health insurance for those with pre-existing conditions, were severable. Now DOJ has informed the Fifth Circuit that it has changed course and agrees with the lower court that the entire ACA was properly invalidated.

CSG Midwest
Residents living in more than half of the nation’s counties have only one insurer to choose from on their state’s Affordable Care Act health insurance exchange. This lack of options is most prevalent in rural areas: 41 percent of enrollees in non-metro counties vs. the overall rate of 21 percent, according to the Kaiser Family Foundation.
Could the creation of agricultural cooperative health plans help fill insurance gaps, offer more choices for consumers and lower costs?

If a collective bargaining agreement contains a general durational clause, retiree health insurance benefits last the duration of the agreement and aren’t vested for life the Supreme Court held in a per curiam (unauthored) opinion in CNH Industrial N. V. v. Reese.

CNH Industrial N.V. agreed to a six-year collective bargaining agreement providing those who retired under the pension plan health insurance but no other insurance benefits. The Sixth Circuit concluded the agreement was ambiguous as to whether retiree health insurance vested for life because it “carved out certain benefits” like life insurance “and stated that those coverages ceased at a time different than other provisions.” Extrinsic evidence supported lifetime vesting.

CSG Midwest
A trip to the doctor, and treatment, without a co-pay?