Beyond King v. Burwell -

Beyond King v. Burwell

March 4, 2015 by Adam Levenson

Our health care system current ascends the result of King v. Burwell. The US Supreme Court landmark concerns an essential element of the Affordable Care Act (ACA) tax credits that give millions of Americans in low and middle income and ability to pay for health coverage . This year 11.4 million people subscribed to the private health insurance through exchanges of state and federal. If the Supreme Court of the United States strike the provision on the tax credit, approximately 8.2 million people in 34 countries at risk of losing their insurance coverage. As a result, premiums are likely to increase for those who are insured while an estimated $ 22 billion lower spending uninsured patients could support the entire health care system. Oral arguments in King v. Burwell begin today, March 4, and a decision is likely by the end of June.

King v. Burwell, however, are not the sole directors of the case of health should follow. Below, we have summarized the other important cases before the Supreme Court of the United States this session. To provide context and additional analysis, Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Law and Health Policy at the Milken Institute School of Public Health at George Washington University, weighs to explain the possible implications for the community of health administration.

King v Burwell

Background :. available tax credit of ACA allows low-income subsidies and those who purchase health insurance on the exchanges state-run middle income. The federal government has set up exchanges in states that have failed to create their own. To accommodate the residents of these states, the extended tax credit eligibility IRS to people who buy insurance on federal contracts. The US Supreme Court will decide whether the IRS is authorized to make a decision that affects the viability of large-scale ACA

Take Professor Rosenbaum: . Nearly all the people who are registered through an exchange receive subsidies and a decision in favor of the plaintiff would mean that millions of people would lose their subsidies. If they lose their subsidies, they would not be able to afford coverage. Insurance companies would immediately have to increase their rates by almost 50 percent just to stay solvent, and, of course, nobody would buy these higher rates. The insurance industry would withdraw from states that do not have subsidies, and literally disappear in the insurance market. There would be no individual left the insurance market.

For health care providers, the results would be catastrophic, particularly for hospitals that have seen an extraordinary relief in the wake of the Affordable Care Act. If, suddenly, there was no expansion of Medicaid and no subsidies markets, then all the gains of these hospitals have seen would be reversed. And the same is true for other types of vendors: for medical offices, health centers and the pharmaceutical industry. Any part of the health care industry that depends on the insurance as a payment mechanism looks at this case and includes the enormous gravity of it

Armstrong v Exceptional Child Center

.. Background: the federal Medicaid Act requires states to pay suppliers Medicaid reasonable rates for their services. Idaho cited budgetary reasons for refusing to raise Medicaid reimbursement rates despite acknowledging that the reimbursement rates are lower than the suppliers incur costs for treating Medicaid eligible patients. The Supreme Court will decide whether the supremacy clause of the US Constitution, which gives federal law precedence over state law, provides suppliers the right to sue the state Medicaid program under the federal law.

Take Professor Rosenbaum: What is at stake here is the ability of health care providers, hospitals, nursing homes and rural health centers to go to the court. When all else fails and a health care provider can not obtain the agency or the state legislature to address the issue and the federal government does not do anything, can the health care provider to court to have the matter reviewed? It is not a promise that the health care provider will win. It's just the fundamental question: are the doors of the courthouse open for you

It is possible that the court will say that the Congress did not specify ability of a supplier to go court, and the provider will be left potentially with no recourse. It is not known how low Medicaid payment rates could fall state, and it is also unclear whether the suppliers begin to sue the federal government over. If this happens, they argue that the federal government has essentially allowed an illegal contact to take place and fails to meet its obligations for implementing the federal law. But getting the federal government to enforce the law is difficult because of a principle known as prosecutorial discretion. The government has a lot of latitude to decide whether or not to apply a law or how to go about enforcing it. This could leave the providers and recipients no real cure in the case of Medicaid payments to standards. At a time when we have 70 million people on Medicaid, this is a real problem.

For health care providers, the results would be catastrophic, particularly for hospitals that have seen an extraordinary relief as a result of the Affordable Care Act

Council in North Carolina dental examiners v Federal Trade Commission

Background: .. the Office of dental examiners North Carolina State is a state agency that has the statutory authority to stop individuals from practicing dentistry without a license. The board has sent cease and desist letters to several non-dentists who offered teeth-whitening services in spas and shopping center kiosks, which have had the desired effect of banning everyone but dentists to offer these services whitening teeth profit. The Federal Trade Commission (FTC) accused the council of unfair competition, and the board argued that it was exempt from antitrust laws. The Court of the United States ruled that the appeal board is managed by market participants - dentists elect other dentists on the board - it is considered a private actor is governed by the federal antitrust laws. The Supreme Court of the United States decided that the shares in the company amounted to illegal suppression of competition

Take Professor Rosenbaum :. This is a very interesting case, and there are people who say it is the most important case of the term because of its long-term consequences for health care and health policy.

So, what is the consequence of the decision? Just because the licensing boards have the ability to regulate medical practice in a state does not mean they can do what they want. They must act in order to continue the clear interest of the state as expressed by the state. For example, a State Council introduced restrictions on hospital practices that are made in the name of quality (but redacted melts through a regulatory process), or going after some hospitals for violating standards board 'administration. Without a strong regulatory framework, a medical provider can not assume that this advice comes with the action of the state. So in essence, this case gives a very high bar for public councils acting with the imprimatur of a state. If you are a Council of State, it is better to pay attention to this case and the way you conduct your business. It must be open, transparent, subject to the regulatory process and subject to the monitoring process. You can not take your competitors

A Look Ahead :. Preparing the Aftermath

Although the decision for the Council of North Carolina Dental Examiners v Federal Trade Commission has been decided on. Spells reimbursement rates Affordable Care Act and Medicaid in the balance in King v. Burwell and Armstrong v. Exceptional Child Center. With the means to treat millions of people and operate thousands of health care facilities on the line, it is essential that health care administrators understand these cases and plan for the coming storm.