This term, which officially begins Monday, the justices will hear a case with potential implications for insurers and state efforts at healthcare reform. Another Affordable Care Act case is also likely to grab the justices' attention,this time over the law's contraceptive mandate. Here are a few cases that are likely to keep pundits talking:
Contraception, data-sharing among issues expected on Supreme Court docket
This case, so far, is the one to watch for those in healthcare. It has potential ramifications for self-funded insurers and states eyeing healthcare reform.
The case will decide whether the third-party administrator for self-funded insurer Liberty Mutual Insurance Co. should have to turn over certain data—such as claims, member eligibility and other issues—to the state of Vermont. The state argues it needs the data to improve the cost and effectiveness of healthcare. Liberty Mutual, however, says that the federal Employer Retirement Income Security Act, known as ERISA, protects it and its administrator from having to share the information.
If the Supreme Court sides with the insurer, that could hinder healthcare reform efforts in the states, said Dana Berkowitz, a partner at Stris & Maher, which is representing the state of Vermont in the case.
“It would basically stifle the states' abilities to be laboratories of innovation in the healthcare field,” Berkowitz said.
Nicholas Bagley, a law professor at the University of Michigan, called the case “a big deal.”
“If those pretty modest informational demands are impermissible under ERISA, that suggests a fairly limited scope of state power to undertake future reforms to the healthcare systems in their states,” he said.
The American Hospital Association and the American Medical Association have filed briefs in the case supporting the state of Vermont.
Liberty Mutual, however, has argued in court documents that states will still have enough data to consider healthcare reforms even without information from self-funded insurers. It has also argued that ERISA was meant to protect such plans from “the burdens of complying with conflicting state laws.”
Steve Wojcik, vice president of public policy with the National Business Group on Health, said employers will be closely watching the case.
“This will be hopefully a good case that strengthens ERISA pre-emption of state requirements put on self-funded employer plans,” Wojcik said. But if Vermont is successful, he said, “It could encourage other states to do a similar type of thing, to place administrative burdens on employer plans, asking them for data or reporting of other information.”
Oral arguments have not yet been scheduled, but Berkowitz said they will likely happen in December or January.
This case hasn't grabbed much attention, but it presents some interesting issues that could affect insurers.
The case centers on this question: If a plan's beneficiary wins money in court for an injury but then spends it, should the beneficiary still have to reimburse his or her insurance plan for the medical expenses it paid?
The beneficiary in the case, Robert Montanile, argues that forcing him to reimburse his insurer for money he won for a car accident is unfair because he's already spent it on living expenses for himself and his daughter. His health insurance administrator, however, says that's part of the deal, and allowing beneficiaries to skip such reimbursements could affect plan affordability.
“Health plans reasonably do not want to spend their limited resources paying medical bills that could, and should, have been paid by the actual wrongdoer,” according to a brief filed with the Supreme Court on behalf of the insurer.
Plans make more than $1 billion a year under such reimbursement provisions, according to the health plan.
But Berkowitz, whose firm also represents Montanile, said if the Supreme Court sides with the insurer, it could have a ripple effect for many consumers.
The Supreme Court is scheduled to hear oral arguments in the case Nov. 9.
This case has implications for home healthcare workers and the industry, though it's not yet clear whether the Supreme Court will agree to hear it.
Home healthcare industry groups are challenging a new federal Labor Department rule that would mean higher wages for many home healthcare workers. For decades, home healthcare agencies haven't had to pay minimum wage or overtime to companionship workers who provide “fellowship, care and protection.”
The rule, however, would significantly narrow the definition of companionship workers to those who spend no more than 20% of their time providing actual care, such as feeding and bathing. It would also no longer exempt companionship workers employed by third parties, such as home healthcare providers, from wage protections.
The Labor Department says the new rule is needed to ensure fair wages. Industry groups, however, say the rule could make home care unaffordable for many and destabilize the industry.
A federal appeals court recently upheld the rule. Industry groups responded by saying they will likely take the matter to the Supreme Court.
“This affects millions of people who receive the care. It affects state Medicaid programs that finance the care. It affects thousands of companies that provide the care, and it affects 1 to 2 million workers,” said William Dombi, co-counsel for the industry in the case and a vice president at the National Association for Home Care and Hospice. “We have a significant public policy issue here.”
Those on the other side of the case, however, believe its chances of reaching the high court are slim.
“We do not expect the Supreme Courtto take up this case,” said Robert Espinoza, vice president of policy at the Paraprofessional Healthcare Institute, which represents home health aides and other healthcare workers.
The plaintiffs in seven separate but similar cases have petitioned the Supreme Court to hear arguments about why they believe religious not-for-profits shouldn't have to notify insurers or the government when they want to opt out of the Affordable Care Act's requirement that employers cover birth control for their employees.
The Supreme Court has not yet said whether it will hear any of the cases, but not all circuit courts agree on the issue, making a hearing likely.
Instead of directly providing coverage to employees, the Obama administration has said not-for-profit religious organizations may submit a form to their third-party administrators, or provide information to HHS, so the government can arrange contraception coverage. The religious not-for-profits, however, say submitting those forms or notifying HHS would make them complicit in providing birth control, a violation of their religious beliefs.
It's not clear which of the seven cases the court might take. The most prominent of the cases so far has been Little Sisters of the Poor v. Sebelius. But the Obama administration is urging the Supreme Court to a hear different case on the issue, Roman Catholic Archbishop of Washington v. Burwell, saying it presents a fuller range of issues and health coverage arrangements that could be affected. Unlike King v. Burwell, none of the cases presents a threat to the future of the ACA overall. The cases do, however, speak to religious-freedom issues.
“It will tell us a lot about how hard the government has to work to accommodate religious beliefs, even religious beliefs that strike nonbelievers as sort of finicky,” the University of Michigan's Bagley said.
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