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October 26, 2011 at 08:13 AM
America’s Health Insurance Plans (AHIP) today asked the U.S. Supreme Court to require the Department of Health and Human Services to defend its position on the 2014 insurance market reforms, or find them invalid on their own if the Court rules the individual mandate itself to be unconstitutional.
The difference between developing measures to implement a Patient Protection and Affordable Care Act with market reforms intact but no individual mandate versus implementing the PPACA without some or many of those market reforms is night and day, AHIP stated.
The AHIP amicus brief, known as National Federation of Independent Business et al. vs. Kathleen Sebelius,Secretary of HHS et al. asked the Supreme Court to accept the 11th Circuit Court of Appeals case that struck down the individual mandate as unconstitutional, but in its ruling, include a decision on the 2104 market reforms.
Some PPACA provisions have already taken effect. Court cases involving efforts to have the High Court declare PPACA to be unconstitutional now have Supreme Court docket numbers. PPACA opponents are working to get Congress to repeal parts or all of PPACA and they also are trying to persuade the U.S. Supreme Court to overturn the act.
The Appeals Court did not consider the other related provisions of the law, including the 2014 insurance market reforms. However, the reforms and the individual mandate are inextricably linked, according to AHIP, which has not taken a position on the individual mandate itself.
The 2014 market reforms will transform the way that insurance contracts are written, priced and sold, especially in the individual and small group markets, with provisions requiring insurers to issue and renew health care coverage for any individual who applies, and a “community rating” system that prohibits health plans from adjusting premium prices based on an applicant’s health status. Traditional underwriting guidelines will give way to rules that sharply limit the degree to which premium rates can be varied on the basis of age and tobacco use. Because PPACA’s market reform provisions eliminate many risk management tools used by insurers for decades, the individual mandate uncoupled from market reforms could have unintended, negative effects, according to the brief.
AHIP noted that “each of the eight states that had enacted market reforms without a mandate experienced severe market disruptions in the form of higher premiums, lower enrollment and a general failure to achieve (goals.)”
