Supreme Court to Hear Health Reform Arguments

The Supreme Court said on November 14th it will hear arguments next March regarding President Barack Obama’s health care overhaul.

Their final ruling could shape the outcome for Obama’s re-election as this decision to hear arguments in the spring sets up an election-year showdown over the White House’s main domestic policy achievement.

The justices announced they will hear an extraordinary five-and-a-half hours of arguments from lawyers on the constitutionality of a provision at the heart of the law and three other related questions about the act. The central provision in question is the requirement that individuals buy health insurance starting in 2014 or pay a penalty.

It is possible that whatever the Court decides, the debate may not end.  It may possibly take more time to determine if the final responsibility for health care lies with the individual or government.

Even if the court upholds the law, Republican leaders say “repeal and replace” remains their slogan. “Job-killing tax hikes on families and small businesses may well be constitutional — that doesn’t mean we would support them,” said Senate Republican Leader Mitch McConnell of Kentucky.

The 2010 health care overhaul law aims to extend insurance coverage to more than 30 million Americans, through an expansion of Medicaid, the requirement that individuals buy health insurance starting in 2014 or pay a penalty and other measures. The court’s ruling could decide the law’s fate, but the justices left themselves an opening to defer a decision if they choose, by requesting arguments on one lower court’s ruling that a decision must wait until 2015, when one of the law’s many deferred provisions takes effect.

D.C. Court of Appeals Upholds Health Care Reform Requirement

      The District of Columbia  Circuit Court of Appeals today upheld the health care reform law’s         requirement that nearly all Americans buy insurance by 2014 or face penalties.    This ruling comes   just days before the Supreme Court is expected to consider whether to take up the  issue. That decision could come as soon as Thursday, when the justices will hold a private conference to discuss what cases to take this term.

The D.C. Circuit is now the second appeals panel to uphold the health reform law’s individual mandate. The law’s supporters are declaring victory because the opinion was written by a conservative judge, Laurence Silberman, who was nominated by former President Ronald Reagan. Silberman and Senior Judge Harry Edwards, who was nominated by former President Jimmy Carter, upheld a lower court ruling that the law was constitutional.  Judge Brett Kavanaugh, who was appointed by former President George W. Bush, dissented.

The D.C. Circuit Court is the fourth appeals panel to consider a lawsuit challenging the health reform law. The 6th Circuit upheld the law, the 11th Circuit struck the mandate and the 4th Circuit ruled that the Anti-Injunction Act which says Americans have to pay a tax before they can challenge it in court barred it from ruling on the mandate until at least 2014.

2012 Health Care Reform Checklist

Anthem Blue Cross of California has recently provided a checklist of key items employers may need to to make sure they are on target with Health Reform Rules.  This list can be found at:

Please contact our office at (888) 474-6627 to verify what you may need to do as an employer to stay in compliance.

copyright Anthem 2011 used with permission.

An Employer COBRA Quiz!

Since one of my favorite game shows is Jeopardy, it stands to reason that I just love quizzes.  Since I know that many of you also love Jeopardy, lets play round one with the only subject being COBRA.  You do not need to answer in the form of a question.

Q:. Can Continuants receive the same benefits they had while an active employee?

A: Continuees can have the the same benefits that are available to active workers. If an employer decides to change for active workers, then the new offerings must also be available to COBRA particpants.

Q: Can the COBRA spouse of a participamt continue on COBRA after divorce?

A: No.  If the husband was not on the active coverage, and he was added to COBRA after it started, then he is not eligible for a second qualifying event.

Q:  What are some common COBRA mistakes?

A:  They can include:

*Not sending the Initial Right Notice

*Not sending the Qualifying Event notice

*Not maintaining accurate archives

*Making a decision simply because it “feels right”

*Making exceptions

*Not maintaining an accurate, up to date policy and procedure manual

*Overlooking the COBRA continuants at annual enrollment

Q: Should an HR Manager answer an inquiry regarding COBRA prior to obtaining all the facts and answers?

A:  No.  This one is a trick question.  Anything the HR/benefits manager says before reviewing the worker’s COBRA files may be inaccurate, and that’s a compliance liability for the employer.  Many things changed in the COBRA world in 2004, especially with coverage election and general notice letters. The new regulatory guidelines improved, in part, how an employee was required to notify an employer about a qualifying event, such as a divorce or a child who is no longer eligible for coverage as a dependent.

For more information, please refer to or contact our office at (888) 474-6627.

Thank you for playing!



2011 California Legislative Actions

Recent 2011 California legislative actions include:

ABX1 21 – designed to fund a large chunk of the Healthy Families budget by extending by a year a tax on Medi-Cal managed care organizations;

AB 922 – designed to expand and move the Office of the Patient Advocate. It took on an amendment that also moves its parent agency, the Department of Managed Health Care. Those agencies currently reside under the Department of Business, Transportation and Housing.

SB 946 -  require private insurers to cover treatment for autism.

These bills now moves to Gov. Jerry Brown’s desk for review.



Proposed Rules for Summary of Coverage Available

In follow up to our post from August 18, 2011, the departments of Labor and Health and Human Services (with the
Treasury) laid out the new proposed rules for the “uniform summary of coverage” that is required under PPACA.   Health insurers and group health plans have to provide consumers with clear, consistent and comparable information about their health plan benefits and coverage starting in 2012.

All health plans and issuers would provide a summary of benefits and coverage, along with a glossary of terms to employees before enrollment.  Health plans and issuers will also provide notice at least 60 days before any significant modification is made in the plan or coverage during the plan or policy year.  The summary of benefits coverage would be some simple standard boxes for comparison shopping. If the exchanges are in place by 2014, this would allow an employee to compare employer sponsored coverage against other market-available options.

As these are merely proposed, there is nothing final and employers do not have to immediately act, nor can then act until the proposed
uniform definitions are drafted. But employers and plan sponsors should keep this information handy as a reference point for developing a long-term compliance strategy.

For more details about the proposed regulations, please go to the dol website at