Supreme Court con­sid­ers cases on abor­tion and con­tra­cep­tion … an­other chal­lenge to the ACA … state all-payer data­bases

Modern Healthcare - - NEWS - By Lisa Schencker

Some had thought 2016 would be a quiet le­gal year for health­care af­ter last year’s frenzy over the pre­mium sub­si­dies case in the U.S. Supreme Court. Not likely.

This year, the Supreme Court will tackle abor­tion, con­tra­cep­tive cov­er­age, and a bat­tle be­tween states and self-in­sured em­ploy­ers over health­care data. In ad­di­tion, there’s a pend­ing chal­lenge to the Af­ford­able Care Act in a lower court that wor­ries ACA supporters.

The high court will de­cide Gobeille v. Lib­erty Mu­tual In­sur­ance Co., a case in­volv­ing whether an in­sur­ance com­pany with a self-funded em­ployee health plan must share data such as med­i­cal claims with the state of Ver­mont for its all-payer health­care data­base. The case is be­ing closely watched be­cause it has im­pli­ca­tions for more than a dozen states with sim­i­lar data­bases.

The in­sur­ance com­pany in Gobeille ar­gues that the fed­eral Em­ployee Re­tire­ment In­come Se­cu­rity Act pro­tects it from hav­ing to share that in­for­ma­tion, spar­ing it and other self-in­sured em­ploy­ers from be­ing sub­ject to dif­fer­ent state laws. The state, how­ever, says it needs the in­for­ma­tion for health­care re­form ef­forts. If the in­surer wins, “th­ese all-payer claims data­bases will be hol­lowed out,” said Ni­cholas Ba­gley, a Univer­sity of Michi­gan law pro­fes­sor.

The high court also will de­cide ma­jor cases on abor­tion and con­tra­cep­tive cov­er­age. In Whole Woman’s Health v. Cole, abor­tion providers al­lege that a Texas law makes it too dif­fi­cult for women to get abor­tions, abridg­ing their con­sti­tu­tional rights. The law re­quires, among other things, that doc­tors at abor­tion clin­ics have ad­mit­ting priv­i­leges at lo­cal hos­pi­tals.

The con­tra­cep­tion cases in­volve chal­lenges brought by re­li­gious not-for-profit groups that op­pose hav­ing to play any part in pro­vid­ing birth con­trol to employees. Those groups are chal­leng­ing an Obama ad­min­is­tra­tion pol­icy that says if they want to opt out of the ACA’s con­tra­cep­tion cov­er­age man­date, they must no­tify their third-party ad­min­is­tra­tors or HHS so the gov­ern­ment can ar­range cov­er­age. A de­ci­sion likely will come near the end of the court’s term in June.

Mean­while, in U.S. House of Rep­re­sen­ta­tives v.

Bur­well, House Repub­li­cans al­lege that the Obama ad­min­is­tra­tion il­le­gally funded the ACA’s cost-shar­ing sub­si­dies for lower-in­come ex­change plan mem­bers. Those sub­si­dies, which are re­ceived by a large per­cent­age of ex­change plan mem­bers, make it more af­ford­able for them to use their plans to ob­tain med­i­cal ser­vices.

It’s pos­si­ble that U.S. Dis­trict Judge Rose­mary Col­lyer, a Ge­orge W. Bush ap­pointee who sounded sym­pa­thetic to the plain­tiffs’ ar­gu­ments in an ear­lier hear­ing, will de­cide the case soon. If she rules against the ad­min­is­tra­tion, “it will throw a wrench in the works,” Ba­gley said.

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