DOJ Seeks Speedy Resolution to Obamacare Ruling

On Wednesday, April 10, the 5th Circuit Court granted the Trump administration’s request for an expedited hearing, meaning all arguments will be heard in the first week of July.

The Trump Department of Justice (DOJ) on Monday urged the 5th U.S. Circuit Court of Appeals to hear all arguments in the appeal of a judge’s ruling that the Affordable Care Act (ACA, or Obamacare) is unconstitutional during the week of July 8.

doj-seeks-expedited-aca-tiralThe DOJ filed a motion to expedite oral arguments with the court and indicated that this timeline is unopposed by others in the case, including attorneys general from 16 Blue States and the District of Columbia, who are arguing in favor of the keeping the ACA intact.

On. Dec. 14, U.S. District Judge Reed O’Connor ruled that the entire ACA is unconstitutional because the individual mandate is no longer valid as a tax since the fine for not having health insurance has been reduced to zero dollars.

In 2012, Chief Justice John Roberts negotiated a compromise 5-4 vote in the U.S. Supreme Court by ruling the law was constitutional under Congress’s authority to levy taxes, in this case, the ACA’s individual mandate. With the tax gone, Judge O’Connor ruled, the ACA is no longer constitutional.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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HHS Releases Additional Funding to Fight Opioid Crisis

The Department of Health and Human Services (HHS) has released an additional $487 million to supplement first-year funding through its State Opioid Response (SOR) grant program. The awards to states and territories are part of HHS’s Five-Point Opioid Strategy and the Trump administration’s tireless drive to combat the opioid crisis.

hhs-opioid-programTogether with the $933 million in second-year, continuation awards to be provided under this program later this year, the total amount of SOR grants to states and territories this year will total more than $1.4 billion.

This funding will expand access to treatment that works, especially to medication-assisted treatment (MAT) with appropriate social supports.

“One year ago this week, President Trump launched his national opioid initiative, which called for expanding access to compassionate, evidence-based treatment, including MAT. This week’s funding awards to states were possible because of legislation Congress passed and President Trump signed since then,” said HHS Secretary Alex Azar. “Our strategy is beginning to produce results, thanks to so many Americans working on the ground, in their own communities, to turn the tide on this crisis.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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DOL Proposes Revised Joint Employer Definition

The Department of Labor (DOL) today announced a proposed rule to revise and clarify the responsibilities of employers and joint employers to employees in joint employer arrangements. The department has not meaningfully revised its joint employer regulation since 1958.

whd-issues-opinion-on-fmla-leaveThe Fair Labor Standards Act (FLSA) allows joint employer situations where an employer and a joint employer are jointly responsible for the employee’s wages. This proposal would ensure employers and joint employers clearly understand their responsibilities to pay at least the federal minimum wage for all hours worked and overtime for all hours worked over 40 in a workweek.

“This proposal will reduce uncertainty over joint employer status and clarify for workers who is responsible for their employment protections,” said Secretary of Labor Alexander Acosta. “Providing public notice and comment is the best way to move forward with another significant deregulatory proposal.”

In 2017, the department withdrew the previous administrations sub-regulatory guidance regarding joint employer status that did not go through the rulemaking process that includes public notice and comment.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Judge Strikes Down Expansion of Association Health Plans (AHPs)

In the same week that the Trump administration doubled down on its legal opposition to Obamacare, a federal judge Thursday blocked as an “end-run” around the requirements of the Affordable Care Act (ACA, or Obamacare) the expansion of Association Health Plans (AHPs) sought by the administration.

U.S. District Judge John Bates sided with the arguments brought in a lawsuit by 11 Blue States and the District of Columbia against the plan unveiled in a June 2018 rule from the Department of Labor (DOL). AHPs under the rule do not have to adhere to the essential benefits and other requirements of the ACA.

The judge had strong language for the administration’s effort, calling the regulatory change a “magic trick” that allowed for “absurd results” undermining the intent of Congress.

The ruling comes just three days after the Department of Justice (DOJ) withdrew all support for the ACA in the review by the 5th U.S. Circuit Court of Appeals of a federal judge’s ruling that the entire health care law is unconstitutional.

And it comes one day after a federal judge in Kentucky blocked the implementation of Medicaid work requirements for able-bodied recipients in both Kentucky and Arkansas.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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DOL Proposes Changes in Calculating What Comprises Rate of Pay

The Department of Labor (DOL) today announced a proposed rule to clarify and update the regulations governing regular rate requirements for the first time in more than 50 years.

dol-schedules-overtime-rule-public-sessionsRegular rate requirements define what forms of payment employers include and exclude in the “time and one-half” calculation when determining workers’ overtime rates.

Under current rules, employers are discouraged from offering more perks to their employees as it may be unclear whether those perks must be included in the calculation of an employees’ regular rate of pay.  The proposed rule focuses primarily on clarifying whether certain kinds of perks, benefits, or other miscellaneous items must be included in the regular rate. Because these regulations have not been updated in decades, the proposal would better define the regular rate for today’s workplace practices, according to the proposal’s announcement.

“The regular rate proposal would provide clarity for employers to allow them to add more benefits to their employees without unknown overtime consequences or litigation,” said Keith Sonderling, acting administrator for the department’s Wage and Hour Division (WHD). “This proposed rule offers a positive path forward to employers and employees alike.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Same Judge Blocks Same Medicaid Work Requirement — Again

UPDATE: Arkansas has asked the Trump administration to appeal the judge’s ruling, and Indiana is proceeding nonstop to implement Medicaid work rules without regard to the rulings in Kentucky and Arkansas.

U.S. District Judge James Boasberg has blocked the implementation of work requirements for able-bodied Medicaid recipients in Kentucky and Arkansas. Nine months ago, the judge blocked Kentucky’s planned implementation, but Gov. Matt Bevin, a Republican, threatened to rescind Medicaid expansion in the state if the work requirement were not allowed.

cms-looks-to-sell-health-insurance-across-state-linesInstead, Kentucky applied for a second waiver from the Department of Health and Human Services (HHS) to implement the work rule, which was then granted, with the requirement set to commence this next Monday. However, in stepped Judge Boasberg to apply a second kibosh.

Boasberg ruled that the approval of work requirements by the Department of Health and Human Services “is arbitrary and capricious because it did not address … how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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McDonald’s Drops Opposition to Minimum Wage Hikes

McDonald’s Corp., which is involved in a lingering legal dispute over whether it is a joint employer, is now dropping its lobbying efforts against minimum wage hikes, an issue that led to its legal wrangle in the first place.

mcdonalds-faces-strike-over-harassment-claimsMcDonald’s unveiled its new position yesterday in a letter to the National Restaurant Association.

“We believe increases should be phased in and that all industries should be treated the same way,” Genna Gent, McDonald’s vice president of government relations, wrote in the letter. “The conversation about wages is an important one; it’s one we wish to advance, not impede.”

The corporation’s dispute with the National Labor Relations Board (NLRB) not coincidentally arose from a group of franchisee employees who marched for higher wages under the banner of “Fight for $15.” The group’s lawsuit against McDonald’s alleges the corporation as a joint employer is responsible for their treatment at the hands of franchise owners, who in many instances terminated them for their protests.

“Since day one, we’ve called for $15 and union rights and we’re not going to stop marching, speaking out and striking until we win both,” said Terrence Wise, an organizer for the movement.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Centene, WellCare Merger to Create Obamacare Behemoth

Centene, a major health insurer based in St. Louis, is paying $17.3 billion in cash and stock to purchase WellCare Health Plans, a provider of government-sponsored health care programs, including Medicaid.

The merger has been approved by both companies’ boards of directors and is expected to be completed in the first half of 2020. Together, the merged company will service about 22 million members with pro forma revenues of about $97 billion annually.

“With the addition of WellCare, we expect to bolster and diversify our product offerings, increase our scale and have access to new markets, which will in turn, enable us to continue investing in technology and better serve members with innovative programs designed to meet their needs,” said Centene’s chairman and CEO Michael Neidorff in a statement.

UnitedHealth Group, the nation’s largest insurer, serves 115 million members and takes in $226 billion annually, ranking it fifth on the Fortune 500 list of largest U.S. companies by revenue.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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DOJ Now Argues for Legal Dissolution of the ACA

The Department of Justice (DOJ) under new Attorney General William Barr has changed course and is now calling on the 5th U.S. Circuit Court of Appeals to strike down in its entirety the Affordable Care Act (ACA, or Obamacare).

doj-argues-aca-is-unconstitutional

U.S. Attorney General William Barr

This is in opposition to its previous position, which argued only for the unconstitutionality of the ACA’s individual mandate and its pre-existing conditions clause.

The appeals court is reviewing the decision rendered by U.S. District Judge Reed O’Connor on Dec. 14 that the entire law is unconstitutional. The filing of the motion yesterday by the Justice Department came just hours after 21 attorneys general from Blue States presented arguments in favor of the ACA.

The one-page filing said the department “has determined that the district court’s judgment should be affirmed.”

Judge O’Connor’s ruling came after Republicans zeroed out the tax penalty for not having health insurance, which the judge claimed not only invalidated the individual mandate but the rest of the ACA as well, ruling the legislation unconstitutional.

No date has been set for full courtroom arguments, but July has been rumored as the earliest opportunity. In the interim, the ACA will remain fully functional following a ruling by Judge O’Connor to keep his injunction in abeyance pending the appeals process.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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CMS Gives Grandmothered Health Plans Another Year of Life

In announcing the final tally for enrollment in Obamacare plans for 2019 through the exchanges, the Centers for Medicare and Medicaid Services (CMS) today also announced that health insurance plans that are not compliant with all new mandates but were “grandmothered” in 2014 are being given another year of non-compliant, grandfather status.

cms-to-crack-down-on-Medicaid-fraud

CMS Administrator Seema Verma

CMS today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirmswhat it calls another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases.

Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the exchanges began operations in 2014.

In addition to this report, as part of the administration’s commitment to ensure access to affordable coverage options, CMS is also issuing guidance extending for one additional year, the non-enforcement policy to allow issuers to continue certain health plans, often referred to as “grandmothered” plans, which do not meet all the many mandates and restrictions in the Patient Protection and Affordable Care Act (PPACA).

According to CMS, these plans can be more affordable for people who choose to renew coverage with them.  Extending these grandmothered policies will allow consumers to maintain more affordable coverage than they would have access to through PPACA plans.

“Not extending the grandmothered plan policy would cancel plans that are meeting people’s needs today and, as a result, force people to decide between buying coverage they cannot afford on the individual market or going uninsured,” said CMS Administrator Seema Verma. “By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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