King vs. Burwell: Not the only PPACA court game around

Eternal World Television Net Inc. has filed one of the many other birth control benefits mandates suits that are still open in the U.S. District Court for the South District of Alabama, and Catholic Benefits Association LCA has filed a similar case in the U.S. District Court for the Western District of Oklahoma. Many of the employers filing those cases have won injunctions keeping HHS from acting against them, and the Supreme Court required HHS to create an alternative system for the for-profit employers while the cases work their way through the system.

Plaintiffs in some cases argue that, because all health plans in their states cover elective abortions, requiring those plaintiffs to buy health coverage to avoid a tax penalty forces them to help pay for other people’s abortions. 

Alan Lyle How Jr. makes that case in Howe vs. Burwell et al., a suit filed against Burwell and other federal agencies and officials in January, in the U.S. District Court in Vermont. ”John Doe, an individual resident of Rhode Island,” who is poor and has HIV, has filed a similar suit in January in Rhode Island.

“To avail himself of any of those subsidies and avoid the draconian penalties defendants would impose, Doe must … pay specifically for others’ elective abortions,” lawyers say in a complaint filed on Doe’s behalf. “Doe is Catholic, a pro-life activist, and objects to being forced to pay for the killing of human beings through abortion.”

2. Exchange administration suits

Some active cases involve questions about how state governments and other entities are implementing PPACA.

In Missouri, St. Louis Effort for AIDS and other nonprofit groups are suing the insurance commissioner and the Missouri Association of Insurance Agents to prevent the state from imposing what the nonprofit groups believe are unreasonable requirements on certified application counselors. The agents, in turn, have argued that giving the plaintiffs what they want would “have the effect of creating a separate class of people who perform the same functions and duties similar to those of licensed insurance producers for health lines. However, this new class of persons is not subject to the regulation or review of the state.”

Meanwhile, in a state court in Clark County, Nev., Lawrence Basich and other Nevada exchange users are moving ahead with efforts to sue the Silver State Health Insurance Exchange and its contractors over problems with the enrollment system the exchange used in 2014. The court recently rejected a motion to dismiss a contractor from the case.

3. Product regulation suits

Some suits focus on efforts by insurers and other organizations to keep HHS from imposing new requirements on the products they sell.

In the U.S. District Court for the District of Columbia, Central United Life Insurance Company and Senior Security Benefits Inc. sued in November 2014 to block HHS, the Centers for Medicare & Medicaid Services (CMS) and the agencies’ top officials from interfering with insurers’ efforts to sell “fixed indemnity plans.”

HHS wants to require sellers of fixed indemnity plans to verify that the buyers of the products have PPACA-compliant major medical coverage, or “minimum essential coverage.”

See also: HHS sets complicated fixed indemnity rules

The plaintiffs argue that federal regulators are exceeding their regulatory authority. The HHS rule will “result in losses of revenue and investments, customer base and goodwill, and the ability to compete fairly with others in the marketplace,” the plaintiffs say.

In January, HHS asked the court to dismiss the case.