Adjusted Community Rating under PPACA is explained here, what Employers and Individuals need to know.
Archive for category Employee Benefits
This is an overview of the Penalties, Taxes, Fees, and other items that need to be considered and calculated by individuals and businesses as it relates to the Provisions and mandates under the Patient Protection and Affordable Care Act PPACA.
Today, the Supreme Court issued an opinion related to health care reform. A divided Supreme Court upheld the constitutionality of the Obama administration’s health-care law. The court said Congress was acting within its powers under the Constitution when it required most Americans to carry health insurance or pay a tax. Chief Justice Roberts’ vote saved the ACA.
The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
The bottom line is that the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is limited.
Please see below for a detailed overview of each opinion.
- The individual mandate survives as a tax. The only effect of not complying with the mandate is that you pay the tax. The Court holds that the mandate violates the Commerce Clause, but that doesn’t matter b/c there are five votes for the mandate to be constitutional under the taxing power. The Court holds that the Anti-Injunction Act doesn’t apply because the label “tax” is not controlling.
- The Medicaid provision is limited, but not invalidated. A majority of the Court holds that the Medicaid expansion is constitutional but that it will be unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the expansion provisions. Another way to think about Medicaid is that the Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program.
Original Posted by Rick Lindquist on Thu, Jun 28, 2012 @ 09:15 AM
From the beginning of the Chief’s opinion: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”
Posted @ Thursday, June 28, 2012 10:03 AM by Rick Lindquist
FOR IMMEDIATE RELEASE
June 28, 2012
CAHI Deeply Disappointed by Supreme Court Decision to Uphold the Affordable Care Act
November elections are the next battleground
Alexandria, VA — The Council for Affordable Health Insurance (CAHI) is deeply disappointed that the U.S. Supreme Court validated a massive expansion of federal power over Americans’ most personal decisions — those impacting their health and the health of their families — by letting stand the federal health care reform law (ACA). “CAHI members believe a one-size-fits-all approach does not produce the best health care delivery system for our nation,” stated CAHI’s interim Executive Director, Marianne Eterno. “Because the federal law has not been struck down in its entirety, we remain concerned about the future of health care in America.”
“This law does nothing to tackle one of the fundamental problems with our health care system: costly mandates have driven health insurance premiums out of the reach of millions of American consumers. Instead, the ACA will add millions of dollars to the nation’s deficit, while taking important decisions out of the hands of consumers and handing them to Washington bureaucrats,” warned Victoria Craig Bunce, CAHI Research and Policy Director.
“The November elections will be the next battleground on which the fate of the health care reform law is decided,” explained Roy Ramthun, CAHI Director of Federal Affairs. Republicans will most likely try to repeal the law legislatively, but chances of success are diminished by the Supreme Court’s unwillingness to strike it down.”
Ramthun added, “Just because you have health insurance doesn’t mean you can get health care — as millions living in countries with government-run health care systems know all too well. When a government controls the health care system, people get one choice: whatever the government chooses to provide. In government-run systems, no one knows what health care costs — nor do they care. As a result, consumers are held hostage by the government’s cost-benefit analysis. And patients only have access to what the government decides is cost effective care. ”
About the Council for Affordable Health Insurance
Since 1992, CAHI has been the principled, free-market voice protecting and promoting access, affordability and choice in American health care. CAHI’s membership includes health insurers, small businesses, physicians, actuaries, insurance producers and brokers and consumers. It’s your health; it’s your choice.
Council for Affordable Health Insurance
phone: 703-836-6200, x702