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Life Health > Health Insurance > Your Practice

Officials: 11th Circuit PPACA Ruling Clouds Benefits Picture

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WASHINGTON BUREAU — The 11 U.S. Circuit Court of Appeals ruling on the Patient Protection and Affordable Care Act of 2010 (PPACA) ensures that the U.S. Supreme Court will be the ultimate arbiter of the law’s constitutionality, but it also further muddies the water as to what benefits employers will have to provide to their employees, industry officials said.

A 3-judge panel of the court, based in Atlanta, rejected the individual health insurance ownership mandate provision in PPACA but upheld the other provisions.

Ed Fensholt, director of the health reform advisory practice at the Lockton Benefit Group, Kansas City, Mo., said the constitutionality of the individual mandate is an issue that the Supreme Court was almost certainly going to take up anyway in the coming months but that the Friday decision “virtually guarantees it.”

“More than anything else, employers need certainty in order to focus on their core business mission,” said James Klein, president of the American Benefits Council, Washington.

“Whether the question is tax rates, funding obligations for their pension plans or the future of the nation’s health care system, clear answers are essential,” Klein said. “At least with regard to the constitutionality of the health law, only the Supreme Court can provide that clarity.”

He added that while the 11th Circuit has now ruled the mandate unconstitutional, a panel of the 6th U.S. Circuit Court of Appeals recently found the mandate to be a valid exercise of the Commerce Clause.

“The fact that the 11th Circuit’s decision upheld the rest of the law, while striking down the mandate, does not make the situation any clearer,” Klein said.

“Employers are working hard to implement the new law, Klein said, noting that significant proposed regulations regarding employer responsibilities were issued by the Obama administration Aug. 12.

“Knowing whether people must obtain health coverage is critical for individuals and for the employers from whom most Americans get their coverage,” Klein said. “Citizens, employers and all stakeholders deserve the clarity that only the Supreme Court can provide.”

Ira Loss and Beth Mantz Steindecker, of Washington Analysis, Washington, a public policy analysis firm, expressed similar views in a note to investors.

They said the 2-1 decision rejected the individual mandate from the PPACA but upheld the Medicaid eligibility expansion.

“Not only did the panel retain the rest of the law, unlike the lower federal district court from which it took the case, but it also found that the insurance market reforms, particularly guaranteed issue and the prohibition on denials for preexisting conditions, could also stand, despite the loss of the individual mandate,” Loss and Steindecker said.

Were the Supreme Court to render a similar decision within the next 12 to 15 months, Loss and Steindecker explained, it would present a dire scenario for the health care sector, as insurers, drug makers, providers, pharmacy benefit managers, and distributors would still be subject to the statutory excise fees and reimbursement cuts but would not enjoy the increased demand associated with the newly insured via the mandate.

“This is especially true if the insurance market reforms were retained and the cost of insurance continues to increase,” Loss and Steindecker said.

If the next election is a Republican sweep, the point would be moot, as the analysts would expect to see a broad repeal of health care reform in conjunction with passage of a serious alternative for expanding health insurance coverage.

Other PPACA repeal coverage from National Underwriter Life & Health:


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