Carter's Benefits

eNewsletter Volume 5, Issue 04 April 2012

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Supreme Decision ...

The Supreme Court convened for 3 days to listen to testimony from both sides of the health care debate on March 28, 2012. Friday March 30, 2012 a decision was made votes were cast. What happened?

Unfortunately we won't know the outcome until late June when the Supreme Court adjourns. Until then, all we have to go on is the highlights of the proceedings as listed below in items 1, 2, and 3.

Recent News

  1. Justices meet Friday to vote on health care case.
  2. Court Mulls Severability Concerns On Third Day Of Healthcare Reform Hearings.
  3. Healthcare Law's Fate Uncertain After Sharp Questioning From Supreme Court Justices.
  4. Healthcare Law Said To Increase Cost Of Insurance For Young Workers.
  5. HHS Deems Rate Hikes In Nine States "Unreasonable."
  6. Women Still Pay More Than Men For Same Health Insurance.
  7. Survey: Employer-Sponsored Insurance Declined Between 2007 And 2010.
  8. Administration Releases Insurance Exchange Guidelines For States.
  9. Healthcare Reform Provisions To Impact Consumers In 2012.
  10. Author Advocates For End-Of-Life Planning.

Justices meet Friday to vote on health care case
The votes are cast and now we wait. Friday March 30, 2012 the Supreme Court met to vote on the constituionality of the Patient Protection and Affordable Care Act or PPACA.

The Associated Press (3/29) WASHINGTON (AP) -- While the rest of us have to wait until June, the justices of the Supreme Court will know the likely outcome of the historic health care case by the time they go home this weekend.

After months of anticipation, thousands of pages of briefs and more than six hours of arguments, the justices will vote on the fate of President Barack Obama's health care overhaul in under an hour Friday morning. They will meet in a wood-paneled conference room on the court's main floor. No one else will be present.
In the weeks after this meeting, individual votes can change. Even who wins can change, as the justices read each other's draft opinions and dissents.

But Friday's vote, which each justice probably will record and many will keep for posterity, will be followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer.

The late William Rehnquist, who was chief justice for nearly 19 years, has written that the court's conference "is not a bull session in which off-the-cuff reactions are traded." Instead, he said, votes are cast, one by one in order of seniority.

The Friday conference also is not a debate, says Brian Fitzpatrick, a Vanderbilt University law professor who worked for Justice Antonin Scalia 10 years ago. There will be plenty of time for the back-and-forth in dueling opinions that could follow.

"There's not a whole lot of give and take at the conference. They say, `This is how I'm going to vote' and give a few sentences," Fitzpatrick said.

It will be the first time the justices gather as a group to discuss the case. Even they do not always know in advance what the others are thinking when they enter the conference room adjacent to Chief Justice John Roberts' office.

By custom, they shake hands. Then Roberts will take his seat at the head of a rectangular table. Scalia, the longest serving among them, will be at the other end. The other seven justices also sit according to seniority, the four most junior on one side across from the other three.

"They generally find out how the votes line up at the conference," said Orin Kerr, a George Washington University law professor who worked for Justice Anthony Kennedy nine years ago.

The uncertainty may be especially pronounced in this case, where the views of Roberts and Kennedy are likely to decide the outcome, Kerr said in an interview Thursday. "I don't think anyone knows. I'm not sure Justice Kennedy knows."

No one's vote counts more than the others', but because they speak in order of seniority, it will become clear fairly quickly what will become of the health care overhaul.

That's because Roberts speaks first, followed by Scalia, then Kennedy. If the three men hold a common view, the Obama health care overhaul probably is history. If they don't, it probably survives.

If Roberts is in the majority, he will assign the main opinion, and in a case of this importance, he may well write it himself, several former law clerks said. If Roberts is a dissenter, the senior justice in the majority assigns the opinion.

The court won't issue its ruling in a case until drafts of majority opinions and any dissents have circulated among the justices, changes have been suggested and either accepted or rejected.

"These justices aren't locked in. Minds have changed during the drafting process and minds have changed after opinions have been circulated," said Rick Garnett, associate dean and professor of law at Notre Dame Law School who worked for Rehnquist 15 years ago.

In one celebrated case decided in 1992, Rehnquist initially assigned Kennedy to write a majority opinion for five justices allowing prayers at public school graduations. In the end, Kennedy ended up writing the opinion for a different five-justice majority striking down the graduation prayers. According to several accounts, Kennedy simply changed his mind during the writing process.

No one will know precisely when decisions on particular cases will be coming, until perhaps Roberts ends a court session in late June by announcing the next meeting will be the last until October. Then it's a safe bet that whatever hasn't been decided will be on the last day. And decisions in the biggest cases very often aren't announced until that last day of the term.

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Court Mulls Severability Concerns On Third Day Of Healthcare Reform Hearings.
The Supreme Court's third day of hearings on the Affordable Care Act generated a great deal of coverage, but as has been the case all week, the topic had to compete with other high-profile stories for air time. None of the three networks led their newscasts with the healthcare story last night, though they did devote more than 13 minutes to their coverage of the hearings and the issue of healthcare reform in general. More than 2,000 local television stories were broadcast on the hearings, and nearly every report noted that Wednesday's arguments focused on whether the entire law can stand if the individual mandate is ruled unconstitutional.

Much of the reporting yesterday and this morning depicts the court as ideologically driven, and either implies or asserts that political considerations impel the court's five Republican-appointed justices to oppose the President. The AP Share to FacebookShare to Twitter (3/29, Sherman), in an article titled, "Court Appears Split By Ideology Over Health Care," reports, "A Supreme Court seemingly split over ideology will now wrestle in private about whether to strike down key parts or even all of President Barack Obama's historic health care law. ... Questions at the court this week days showed a strong ideological division between the liberal justices who seem inclined to uphold the law in its entirety and the conservative justices whose skepticism about Congress' power to force people to buy insurance suggests deep trouble for the insurance requirement, and possibly the entire law."

Legal Correspondent Savannah Guthrie, on NBC Nightly News (3/28, story 3, 1:10, Williams) reported, "Even some of the legal arguments that some have looked at as unserious, or legal long-shots, the justices were taking very seriously. So we're set up for a decision in June in the middle of a presidential election year, and don't think the justices are not aware of [the timing]."

Despite the widespread belief that the individual mandate, or even the whole ACA, will be overturned, there was a great deal of coverage that was positive in tone regarding the Administration's healthcare policy. For instance, ABC World News (3/28, story 4, 2:20, Moran) reported that the ACA has "a lot more" than the individual mandate, including "help people pay for prescription drugs, cover...pre-existing conditions," and "allow young Americans to stay on their parents' plan until they are 26." ABC added, "Today, conservatives argued that if the requirement that everyone has insurance is struck down, all that must go too."

The CBS Evening News (3/28, story 6, 2:50, Pelley) reported the ACA "was passed two years ago to help the nearly 50 million uninsured Americans." CBS added, "When the uninsured end the ER their costs are passed on to paying customers," and "that means insurance companies end up paying more so they raise rates and fewer people can afford health insurance."

Brian Williams, on NBC Nightly News (3/28, story 2, 3:50), said, "President Obama's healthcare law...might be on life support. Today's focus was this, how much of it can be salvaged if the court throws out the controversial requirement that all Americans be forced to buy health insurance?" Justice Correspondent Pete Williams added that if the mandate is found unconstitutional then "the justices seem to agree that more parts of the law should go with it, and many of them suggest tossing out most of it." Justice Scalia: "My approach would say, if you take the heart out of the statute, the statute is gone." According to Williams, "The best hope for the Obama Administration would be...that the justices would find it so hard to decide what to throw out and what to keep that they simply let the entire law stand, but...that seems a dim prospect."

White House Has "No Contingency Plan," Points To Romney's Mandate. According to Fox News' Special Report (3/28, lead story, Bream), "The White House is showing signs it's preparing a positive spin regardless of the outcome." Ed Henry reported, "While President Obama boasts about not paying attention to 'cable chatter,' his staff could not ignore the storm of criticism directed at his solicitor general, Donald Verrilli, for what many called a weak performance that may have helped put the President's signature domestic achievement on the brink." White House deputy press secretary Josh Earnest: "What Mr. Verrilli delivered was a very solid performance before the Supreme Court. That's a fact." Henry added, "White House aides insist the President is so certain of victory, he does not have a 'plan B.'"

The Hill Share to FacebookShare to Twitter (3/29, Parnes) also reports that the White House "has no contingency plans in place in the event the Supreme Court rules the healthcare law is unconstitutional. ... If the law is thrown out, there's 'no contingency plan in place'...Earnest said. ... 'We're focused on maximizing the benefits of this law.'" The Hill notes Earnest "said the healthcare law 'was originally a Republican idea' and was backed by 'the former governor of Massachusetts.'"

Potential Political Repercussions Assessed. The CBS Evening News (3/28, story 2, 3:20, Pelley) reported, "If the Court throws it out, it will be the first time since the New Deal that the court has struck down a major domestic program proposed by the President and passed by the Congress."

The Washington Post Share to FacebookShare to Twitter (3/29, Gardner), in an article titled, "Supreme Court's Health-care Ruling Could Deal Dramatic Blow To Obama Presidency," also reports that the White House is "refusing publicly to consider that the law might be struck down or to discuss contingency plans," but "other Democrats" are "surmising that a backlash against Republicans could follow a ruling against the law." However, according to the Post, "Supporters argue that on a substantive level, the results would be devastating" because "it was Obama who, at every turn during the original health-care debate, pressed for a more ambitious package that required Americans to purchase insurance. A nullification would serve as a dramatic rebuke of that decision as well as the judgments Obama and his advisers made about the legality of the law."

The Los Angeles Times Share to FacebookShare to Twitter (3/29, Memoli, West) reports that the Obama's campaign has "begun targeting key voter groups that might be most affected by a loss." The Times adds that "analysts in both parties say that under some scenarios, he could gain politically by losing judicially. ... A ruling against the law would mean 'that one of the most unpopular parts of the Obama record is obliterated without an election,' said Republican pollster Whit Ayres."

Justices Exhibit Ideological Split On States' Medicaid Expansion Challenge. The Boston Globe Share to FacebookShare to Twitter (3/29, Jan) says "several" justices "indicated skepticism that making states expand Medicaid coverage to more low-income individuals under President Obama's health care law amounts to coercion, as states suing the federal government argued." Paul Clement, "the lawyer representing 26 states opposing the 2010 law, argued that the Medicaid expansion is unconstitutional because Congress ties federal funding for the program with the condition that states enroll millions of new individuals who did not previously qualify. ... Why is a big gift from the government – 'a boatload of federal money' -- coercive, asked Justice Elena Kagan less than a minute into Clement's opening argument. 'It doesn't sound coercive to me, let me tell you,' she said."

Mandate's Role In Keeping Premiums Down Detailed. According to Terry Moran, on ABC World News (3/28, story 4, 2:20, Sawyer), "Under the Obama healthcare law, we will all pay for each other," but the "liberal justices" noted that currently "the uninsured still get care from the emergency room and the rest of us pay." Justice Ginsburg: "The people who don't participate in this market are making it much more expensive for the people who do."

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Healthcare Law's Fate Uncertain After Sharp Questioning From Supreme Court Justices.
Media reports and analyses last night and this morning portray the Supreme Court as leaning towards ruling against the constitutionality of the Affordable Care Act. Yesterday's hearing generated widespread coverage on both TV and print. However, only the CBS Evening News, among the three network newscasts, led with the court hearing.

According to Brian Williams, on NBC Nightly News (3/27, story 2, 3:05), "A lot of the experts have been predicting that the law would probably stand, but after today, all bets are off." On the CBS Evening News (3/27, lead story, 4:40, Pelley) Jan Crawford said, "The healthcare law is considered President Obama's signature achievement, appeared a majority of the Justices were ready to describe the individual mandate another way -- unconstitutional."

According to the Washington Post Share to FacebookShare to Twitter (3/28, Fahrenthold, Aizenman), "By the end of Tuesday's long-awaited oral arguments, the individual mandate...seemed to be in trouble." Adam Liptak, in a front-page article for the New York Times Share to FacebookShare to Twitter (3/28, A1, Subscription Publication), also says "the available evidence indicated that the heart of the Affordable Care Act is in peril." Liptak continues, "If the indications from Tuesday's arguments are correct...the ruling may undo parts or all of the overhaul of the health insurance system, deal Mr. Obama a political blow in the midst of the presidential election season, and revise the constitutional relationship between the federal government and the states."

Justice Kennedy gets the lion's share of the attention, and "skeptical" is, by far, the adjective most often used to describe the tone of his questioning. A Los Angeles Times Share to FacebookShare to Twitter (3/28, Savage, Levey) headline reading "Skeptical Kennedy Signals Trouble For Obama's Healthcare Law" is a concise summation of the day's analysis.

In an analysis touted on the Drudge Report Tuesday, The Hill Share to FacebookShare to Twitter (3/27, Strauss) reported New Yorker legal analyst Jeffrey Toobin, on CNN (3/27, 12:07 PM EST), described the hearing as a "trainwreck for the Obama administration," and Kennedy as "enormously skeptical." Toobin added, "This law looks like it's going to be struck down. ... All of the predictions, including mine, that the justices would not have a problem with this law were wrong." Toobin also claimed Solicitor General Donald Verrilli "did a simply awful job," characterizing Verrilli as "nervous," and "not well spoken."

On NBC Nightly News (3/27, story 2, 3:05, Williams), NBC's justice correspondent Pete Williams reported, "It does seem the majority of the justices are skeptical that Congress has the power to pass such a sweeping law."

David Leonhardt, in an analysis for the New York Times Share to FacebookShare to Twitter (3/28, Subscription Publication), says, "Many legal scholars, including some conservatives, have been predicting that the Supreme Court will uphold" the ACA, but "after Tuesday's arguments, when several justices asked skeptical questions about the heart of the law, a political lens seemed relevant, too. ... Skeptical questions from the bench are often an indicator of how justices will ultimately vote -- and many court experts expressed surprise at the apparent agreement among the conservatives, including" Kennedy.

Bill O'Reilly, in his opening monologue for Fox News' The O'Reilly Factor (3/27), said "most of the justices" were "openly skeptical about the power needed to impose Obamacare." O'Reilly added that "the consensus is" Verrilli "did not make a strong argument."

Roll Call Share to FacebookShare to Twitter (3/28, Dennis, Drucker, Subscription Publication) quotes Senate minority leader Mitch McConnell as saying, "It was noteworthy that the four more liberal members of the court were mainly peppering the plaintiffs and the other five were mainly peppering the government, leading us to hope this awful law will be overturned." Sen. Ron Johnson added, "I was encouraged that they were asking the right questions."

Fox News' Special Report (3/27, lead story, Bream) reported Kennedy "unleashed an unexpectedly candid assessment of the individual mandate today that has supporters terrified the Affordable Care Act could be toast."

The Wall Street Journal Share to FacebookShare to Twitter (3/28, Kendall, Subscription Publication), in an article titled, "Kennedy Leaves Both Sides Hopeful," says some liberal analysts are still hopeful that Kennedy will side with the Administration.

NBC's Pete Williams, on CNBC's The Kudlow Report (3/27), said, "It's quite clear the four conservatives...believe this law is unconstitutional, and it's equally clear that the four liberal members of the court...would vote to uphold it. ... But tonight I think the future of the healthcare law is very much in doubt." Williams, on MSNBC's Hardball (3/27, Matthews), added, "It wasn't a great day for the administration. ... It's quite clear they didn't pick up any of the conservatives," which means "the question comes down to" Kennedy, and "for most of the questioning...he showed great skepticism."

The CBS Evening News (3/27, lead story, 4:40, Pelley) reported that the Administration "says the mandate will make sure that everyone has health care, while keeping insurance affordable, but opponents say it is a dangerous new power for the government, forcing citizens to buy a product." CBS's Jan Crawford added, "The conservative Justices and Kennedy, a moderate, expressed concerns the law gave Congress broad new powers to dictate behavior," while "all four of the Court's liberal Justices defended the law."

McClatchy Share to FacebookShare to Twitter (3/28, Doyle, Lightman) reports that the justices "cast serious doubts on the Obama administration's signature health care law Tuesday, emboldening the Republicans who now are eagerly campaigning to kill it." According to McClatchy, Solicitor General Verrilli "stressed...that the 40 million uninsured Americans posed what he called 'an economic problem' that Congress is empowered to fix." McClatchy adds, "In a potentially sobering sign for the Obama administration, even [Kennedy] the justice most commonly considered to be a swing vote made pointed observations about the insurance-buying mandate."

The Washington Post Share to FacebookShare to Twitter (3/28, Barnes, Aizenman) says Kennedy "suggested" that the Affordable Care Act "invoked a power 'beyond what our cases allow' the Congress to wield in regulating interstate commerce." Paul Clement, "the former George W. Bush administration solicitor general representing 26 states challenging the law, picked up on that theme, saying the government was defending an 'unprecedented' act by Congress with no limiting principle."

The Los Angeles Times Share to FacebookShare to Twitter (3/28, Savage, Levey) notes Kennedy "described it as 'unprecedented' for the federal government to impose an 'affirmative duty' on people to buy a product." According to the Times, "In his closing argument, Verrilli urged the justices to defer to the choices made 'by the democratically accountable branches of government,'" but "the court, which has five Republican appointees, did not sound as though it was inclined to do so."

Mike Sacks, in the Huffington Post Share to FacebookShare to Twitter (3/28), reports, "From the very start, things did not go well for the government's argument that" the mandate is "constitutional." Sacks says Verrilli "began his argument not with his usual calm and clear delivery, but rather with a case of coughs that seemed to take him off his game. And just as he was starting to recover his composure," Kennedy "asked, 'Can you create commerce in order to regulate it?'" which "adopted the framing of the case put forward by those challenging the mandate."

The Wall Street Journal Share to FacebookShare to Twitter (3/28, Bravin, Subscription Publication) notes Justice Scalia said the Administration's argument was akin to saying: "Everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market. Therefore, you can make people buy broccoli."

USA Today Share to FacebookShare to Twitter (3/28, Wolf, Heath) says the "conservative justices suggested they might be willing to send lawmakers back to the drawing board just months before a presidential election. ... Inside the courtroom...the most significant law signed by Obama came under sharp attack by justices appointed by his Republican predecessors. Outside, hundreds of demonstrators packed onto the sidewalk in front of the marble courthouse, shouting over each other."

According to Politico Share to FacebookShare to Twitter (3/27, Brown, Gerstein, Haberkorn), "Before the arguments, many court watchers said they expected the law would be upheld, and a few even predicted that as many as eight justices would back the constitutionality of the mandate." But "after the session, court watchers said a 5-4 decision along partisan lines striking down the mandate was a distinct possibility -- harkening back to other politically divisive, sharply divided rulings from the court, such as Bush v. Gore in 2000."

Sam Baker, in a post for The Hill Share to FacebookShare to Twitter (3/27), wrote, "The sense of a possible election-year defeat in the courtroom for the president's signature domestic achievement was unmistakable."

However, on NBC Nightly News (3/27, story 3, 1:30, Williams), legal correspondent Savannah Guthrie said, "Oral arguments are not always an indicator of where the court will come out," and noted that in "the DC circuit, very conservative judges grilled the government's lawyers," but, "ultimately those conservative judges were in the majority upholding the healthcare law."

The Washington Times Share to FacebookShare to Twitter (3/28, Cunningham) reports, "The justices also posed rigorous questions to...Clement and Michael Carvin, attorneys for the National Federation of Independent Businesses and 26 states, probing for answers to why they say the government can't require Americans to buy coverage ahead of time to pay for their own health care. ... 'When you are born, and you don't have insurance, and you will in fact get sick, and you will in fact impose costs, have you perhaps involuntarily -- perhaps simply because you are a human being -- entered this particular market?' Justice Stephen Breyer asked Mr. Carvin."

Also reporting on the hearing are the AP Share to FacebookShare to Twitter (3/28, Sherman), Roll Call Share to FacebookShare to Twitter (3/28, Dennis, Drucker, Subscription Publication), the National Journal Share to FacebookShare to Twitter (3/28, Khan, Friedman, Subscription Publication), CQ Share to FacebookShare to Twitter (3/28, Norman, Subscription Publication), NPR Share to FacebookShare to Twitter (3/28, Totenberg) "Shots" blog, the Huffington Post Share to FacebookShare to Twitter (3/28, Young), Forbes Share to FacebookShare to Twitter (3/28, Fisher), the Detroit Free Press Share to FacebookShare to Twitter (3/28, Spangler), HealthDay Share to FacebookShare to Twitter (3/28, Esposito), Medscape Share to FacebookShare to Twitter (3/28), MedPage Today Share to FacebookShare to Twitter (3/28), WebMD Share to FacebookShare to Twitter (3/28, Lowes), and Modern Healthcare Share to FacebookShare to Twitter (3/28, Subscription Publication).

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Healthcare Law Said To Increase Cost Of Insurance For Young Workers.
In the Forbes Share to FacebookShare to Twitter (3/23) "Apothecary" blog, Avik Roy says, "In 2009, during the height of the debate over Obamacare, the law's architect, MIT economist Jonathan Gruber, was all over the op-ed pages, talking about how the bill would reduce the cost of health insurance." Now Gruber "is quietly telling state governments that the law will significantly increase the cost of insurance," especially "for young Americans: the ones who most struggle to find affordable health coverage." Roy goes on to say "that Obamacare forces insurers to charge their eldest beneficiaries no more than 3 times what they charge their youngest ones" under "a policy known as 'community rating,'" which according to his sources "was a favor that Democrats did for the AARP," even though the group "actually wanted Obamacare to have a community rating ratio of 2:1."

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HHS Deems Rate Hikes In Nine States "Unreasonable."
CQ Share to FacebookShare to Twitter (3/23, Bunis, Subscription Publication) says HHS' Center for Consumer Information and Insurance Oversight Director Steve Larsen deemed as "unreasonable" health insurance premium hikes proposed by the John Alden Life Insurance Company and Time Insurance Company -- an announcement that covers nine states, including Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming. Hike requests ranged from 12% in Louisiana to 24% in Wisconsin. Meanwhile, HHS also released a report Thursday on "what has happened to rate increases since the rate review authority took effect. Larsen said that in the last quarter of 2011, premium increases dropped by about 4.5 percent." Of that drop, Larsen said, "We absolutely think the [federal] scrutiny this is bringing to the process is a contributing factor."

MedPage Today Share to FacebookShare to Twitter (3/23, Frieden) says the HHS statement did not mention the insurance companies by name, but it deemed the rates unreasonable "because the insurer would be spending a low percentage of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions." The report also quotes a statement from Secretary Sebelius, who said, "Thanks to the Affordable Care Act, consumers are no longer in the dark about their health insurance premiums. ... It's time for these companies to immediately rescind these unreasonable rate hikes, issue refunds to consumers, or publicly explain their refusal to do so." The latter quote was run by the Huffington Post Share to FacebookShare to Twitter (3/23), which also noted that the HHS statement did not mention insurance companies by name.

Similarly, the AP Share to FacebookShare to Twitter (3/23) notes HHS, after completing its monitoring of rate increases under new federal guidelines, singled out states where insurers sought excessive premium hikes. Although Sebelius didn't name the two Idaho companies with excessive increases, the agency website shows Blue Cross of Idaho "has proposed increases of 13 and 14%, and divisions of Assurant Health, including John Alden Life Insurance Co. and Time Insurance Co., have proposed 16% rate hikes."

Modern Healthcare Share to FacebookShare to Twitter (3/23, Daly, Subscription Publication) notes the premium hikes will impact more than 42,000 policyholders. "Despite the lack of authority to directly affect the health insurance rates, HHS credits the review program with 'helping to moderate rate increases' since it launched." But critics argue the excessive determinations "still routinely allow large double-digit rate hikes, including the 10 such increases approved for plans offered by Blue Shield of California Life and Health Insurance Co. since January."

The Milwaukee Journal Sentinel Share to FacebookShare to Twitter (3/23, Boulton) says CMS data show that the proposed rate increase in Wisconsin would impact 694 people. Federal healthcare reform "requires companies that sell health insurance to individuals and small employers to spend 80% of premiums on medical bills and quality initiatives or refund money to their customers. Assurant said its rates are based on that threshold." The Coeur d' Alene (ID) Press Share to FacebookShare to Twitter (3/22) also covers this story.

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Women Still Pay More Than Men For Same Health Insurance.
The New York Times Share to FacebookShare to Twitter (3/19, Pear, Subscription Publication) reports, "Women still pay more than men for the same health insurance coverage, according to new research and data from online brokers." Although the federal "health care law will prohibit such 'gender rating,' starting in 2014," disparities are still evident in the majority of states. A new "report to be issued this week" by "the National Women's Law Center, a research and advocacy group, says that in states that have not banned gender rating, more than 90 percent of the best-selling health plans charge women more than men."

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Survey: Employer-Sponsored Insurance Declined Between 2007 And 2010.
Modern Healthcare Share to FacebookShare to Twitter (3/16, Evans, Subscription Publication) reports, "Employer-sponsored insurance declined across all income categories between 2007, the year the Great Recession began, and 2010 among nonelderly Americans, newly released survey results show."

CQ Share to FacebookShare to Twitter (3/16, Subscription Publication) reports, "The study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR) found that the proportion of people younger than 65 with no workers in the family jumped 10 percentage points to 31.6 percent in 2010." This "was the key driver of the decline in employer health coverage, accounting for about three-quarters of the drop since 2007, according to findings from HSC's 2010 Health Tracking Household Survey, a nationally representative survey with information on 13,595 non-elderly people." But in addition to this factor, "some workers forced to take part-time work didn't then get access to employer-based insurance, and rising health costs have led to fewer companies offering coverage and fewer workers signing up as premiums and co-pays increased."

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Administration Releases Insurance Exchange Guidelines For States.
The release of new rules Share to FacebookShare to Twitter for states regarding the implementation of health insurance exchanges sparked moderate coverage. Sources noted mixed reaction to the rules among state leaders and consumer advocates. The Washington Times Share to FacebookShare to Twitter (3/13, Cunningham) reports, "The Obama administration released more than 600 pages of guidance on Monday outlining a flexible framework for how states should go about enrolling uninsured Americans in new insurance exchanges under the president's health-care overhaul." HHS Secretary Kathleen Sebelius remarked, "These policies give states the flexibility they need to design an exchange that works for them." Reaction from state officials was "mixed," as "some complained that the administration is leaving too many questions unanswered...while others applauded the agency's approach."

The Washington Post Share to FacebookShare to Twitter /Kaiser Health News (3/13, Appleby) reports, "Responding to thousands of comments on earlier proposals, the administration made some changes, including setting a requirement that governing boards have at least one voting consumer representative." In addition, the announcement "included some 'interim' rules, which could be tweaked after a 45-day public-comment period," covering "issues such as how quickly states must determine whether an applicant is eligible for Medicaid or the Children's Health Insurance Program, and the role insurance brokers will play in helping low- and middle-income people apply for federal subsidies to buy coverage."

CQ Share to FacebookShare to Twitter (3/13, Reichard, Subscription Publication) reports that Sebelius emphasized in a news release "that the regulation provides states 'the guidance and certainty they need' to structure exchanges in two key areas. One is 'establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.' The other is the standards for establishing the exchanges, including exchanges for small business, and certifying plan participation."

The National Journal Share to FacebookShare to Twitter (3/13, McCarthy, Subscription Publication) reports that in a conference call, Tim Hill, the deputy director in the Centers for Medicare and Medicaid Services insurance-regulation office, explained to reporters, "The concept here is the eligibility for determining the premium tax credit is going to be done by the exchange.... But it is also the case that ... a Web-based broker or a small-business broker or agent [would be allowed] to interact with [consumers on] the exchange in an automated way." He "said the federal government would not regulate how insurance brokers or other companies that crop up to guide consumers onto the exchanges charge and collect fees."

In story carried by more than 310 news sources, the AP Share to FacebookShare to Twitter (3/13) calls the rules "ambitious," and notes that "experts say it's anybody's guess how the national rollout will go." The piece continues, "For things to go smoothly, state and federal officials must work together to verify private personal and financial details for millions of people, make sure that consumers are enrolled in the right health plan, and accurately calculate how much government aid, if any, each household is entitled to." According to Sebelius, "she expects the court to uphold Obama's Affordable Care Act and thinks states will move quickly once the court has ruled."

In a separate story carried by at least 85 publications, the AP Share to FacebookShare to Twitter (3/13, Alonso-Zaldivar) reports that "Democratic state officials are praising the flexibility in federal rules issued Monday." Montana's insurance commissioner, Monica Lindeen, remarked, "Allowing states to continue to regulate their insurance industry and protect consumers is critically important. States have 150 years of experience regulating insurance. The more states' rights are maintained, the better off consumers will be." In turn, "Republicans say the health care law still amounts to a power grab by Washington." Virginia Gov. Bob McDonnell (R) commented, "Once again, the Obama administration has overpromised, oversold and under-delivered."

Bloomberg News Share to FacebookShare to Twitter (3/13, Wayne) quotes Thomas Barker, the former acting general counsel of the U.S. Department of Health and Human Services under President George W. Bush, who said, "It looks like they tried to be as accommodating to states as they possibly could." He added that "the flexibility may be aimed at getting states moving on building exchanges, and 'to try to tone down some of the criticism' of the health law." Also reporting this story are the Los Angeles Times Share to FacebookShare to Twitter (3/13, Levey), The Hill Share to FacebookShare to Twitter (3/13, Pecquet) "Healthwatch" blog, Reuters Share to FacebookShare to Twitter (3/13, (Morgan), Politico Share to FacebookShare to Twitter (3/13, Feder), the Huffington Post Share to FacebookShare to Twitter (3/13), CQ Share to FacebookShare to Twitter (3/13, Subscription Publication), MedPage Today Share to FacebookShare to Twitter (3/13, Frieden), Modern Healthcare Share to FacebookShare to Twitter (3/13, Daly, Subscription Publication), and Government Health IT Share to FacebookShare to Twitter (3/13, Mosquera).

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Healthcare Reform Provisions To Impact Consumers In 2012.
The Washington Post Share to FacebookShare to Twitter /Kaiser Health News (3/13, Andrews) lists the "major new provisions that will affect consumers this year" with implementation of the healthcare overhaul. These include required coverage, rebates for consumers, and a shrinking doughnut hole

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Author Advocates For End-Of-Life Planning.
Author Susan Jacoby writes in the New York Times Share to FacebookShare to Twitter (3/31, Subscription Publication), "A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do -- and do not -- want by writing living wills and appointing healthcare proxies. ... I consider it my duty, to myself and younger generations, to follow the example my mother set by doing everything in my power to ensure that I will never be the object of medical intervention that cannot restore my life but can only prolong a costly living death."

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How does Carter's Benefits help ?
We continue to stay on top of changes in this industry. In a consultative role, Eddie Carter has begun hosting live seminars to update employers and Human Resource Managers on these changes. If you would like to host a meeting with your local community or civic organization, please contact me for details.

Eddie Carter, Consultant Eddie Carter,
Benefit Consultant
If you have questions or would like more information please give us a call or send us an email.  Our email address is Questions@CartersBenefits.Com

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