The Courts

Separating eligibility determinations from the rest of state health insurance exchange functions could be the future of marketplace operations, exchange experts said this week at a National Health Insurance Exchange Summit.

Some opponents of the Affordable Care Act were elated on Monday (April 27) by a court ruling that brought them a step forward in their fight against the contraception mandate, as a separate decision last week dismissed claims that the health reform law's individual and employer mandates are not valid because the law was improperly drafted.

As Republicans begin rolling out their efforts to repeal and replace the Affordable Care Act this year, congressional committee staffers say the insurance industry is warming to the idea of overturning the individual mandate -- a major component of GOP health reform outlines pitched so far.

The Supreme Court ruled Tuesday (March 31) that providers can't sue states over Medicaid rates, in part because HHS handles rate setting and the law on rate setting is too broad for federal courts to take up.

Health insurers are working on their own contingency plans in preparation for a potentially disastrous U.S. Supreme Court ruling in King v. Burwell, while the Obama administration has more regulatory options that would help mitigate effects of an insurance “death spiral” than HHS Secretary Sylvia Burwell and other officials are publicly willing to admit, industry leaders said Thursday (March 12).

Stakeholders who are hopeful the Supreme Court will rule IRS overstepped its boundaries in allowing exchange subsidies to flow through Healthcare.gov back up their view by pointing to a 2012 letter that a group of state health reform officials sent to HHS as proof that, despite what 23 state Attorneys General claim, there were serious questions surrounding HHS' authority to run an exchange.

A former administration official and former Senate finance staffer both see merit in a proposal floated by web-broker eHealth that would allow states to certify and rely upon private exchanges to enroll consumers into health plans should the Supreme Court rule that subsidies cannot flow through the federal exchange.

In the course of oral arguments in King v. Burwell at the U.S. Supreme Court on Wednesday (March 4), justices and lawyers alike suggested past litigation that could serve as precedents in shaping how the high court ultimately rules.

U.S. Supreme Court Justice Anthony Kennedy suggested Wednesday (March 4) that it would be a drastic step for the high court to say that the Internal Revenue Service can make its own call on how to distribute billions of dollars in federal funds to subsidize health insurance premiums, if the justices do end up deciding that language at the core of the Affordable Care Act's greatest legal threat is ambiguous.