Appeals court rules against Obama administration on ACA contraception opt-out

The 8th US Circuit Court of Appeals has upheld two lower court rulings against the Obama administration, saying provisions that let employers opt out of the Affordable Care Act’s mandate that health plans cover contraception violate the employers’ religious freedom. Other federal appeals courts have said the opt-out provisions reasonably accommodate religious freedom. The conflicting ruling increases the likelihood that the issue will go to the Supreme Court. Reuters (9/17), Bloomberg (9/17)

Appeals Court “Cuts the Heart Out of the ACA”

In the case, Halbig v. Burwell, The U.S. Court of Appeals for the District of Columbia Circuit ruled that the Affordable Care Act’s (ACA) tax credits are only available to persons in state-run marketplaces. Elizabeth Taylor, executive director of The National Health Law Program (NHeLP) said, “Today’s ruling is misguided and, if not corrected, will cut the heart out of the ACA. Only 14 states established their own Marketplace.” As noted in the amicus brief filed by AARP Foundation Litigation and NHeLP, tax credits are crucial to achieving the law’s mission of providing near universal health care coverage. According to analysis by the Urban Institute, 7.3 million people could lose their subsidies. Jane Perkins, NHeLP legal director said, “If today’s decision stands…older adults, the chronically ill, and those with low to moderate incomes would feel the brunt. Without the financial help required by the ACA, quality coverage will be out of reach. These Americans will be too poor for private coverage, but not eligible for public programs — the very situation the ACA was designed to avoid.” The ruling does not immediately affect the availability of financial assistance in the federal Marketplace. The government is likely to petition the appeals court for review by the full 11 judge panel.

Appeals Court Says HMO Regulator Cannot Discriminate Against Autistic Children

In a complex opinion issued yesterday, the California Court of Appeal ended the Department of Managed Health Care’s (DMHC) discriminatory practice of allowing HMOs to deny treatment for autistic children of state employees and low-income families enrolled in the Healthy Families program on the basis that such treatment can only be administered through state-licensed providers.

The case was brought by the non-profit Consumer Watchdog and Strumwasser & Woocher LLP. The treatment at issue, known as Applied Behavioral Analysis (ABA), has been found to be the most effective treatment for autistic children. After the lawsuit was filed, the California Legislature agreed with Consumer Watchdog by passing a law in 2011 clarifying that HMOs and health insurers must provide coverage for ABA for children enrolled in private health insurance plans and that such treatment could be provided through providers who are certified by a national board, but not state-licensed. However, the Legislature did not include public employees and Healthy Families enrollees.

The remaining issue to be decided by the Court of Appeal was whether the DMHC could allow HMOs to deny ABA for children enrolled in public health plans if an ABA provider does not hold a state license.  As Consumer Watchdog and Strumwasser & Woocher LLP pointed out in the lawsuit, no state licensing currently exists for ABA therapists. For more information, visit http://www.strumwooch.com

Appeals court says wellness penalty does not violate ADA

The 11th U.S. Circuit Court of Appeals ruled that charging an employee a penalty for failing to complete a health risk assessment does not violate the Americans with Disabilities Act. The court said the Broward County, Fla., wellness program’s actions fell under the “safe harbor” provision of the ADA. Business Insurance (tiered subscription model) (8/28)

Last Updated 12/01/2021

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