Provisions of health care reform spark lawsuits, divide state leaders, and encourage release of federal guidelines to curb ED visits by newly insured patients

A Mixed Bag for Ongoing ACA Legal Battles

If you thought the legal wrangling over the Affordable Care Act (ACA) might finally slow down in 2014, think again. In January alone, several major court cases yielded victories for supporters and opponents alike. In one closely watched case, a federal judge blocked a Missouri law that would have required navigators or others providing information about the ACA’s health care plans to be licensed by the state.

Meanwhile, a District of Columbia federal judge dismissed a lawsuit brought by a group of business owners and individuals in six Southern states who had sued to prevent IRS tax credits to low- and moderate-income people buying insurance through the federal exchange. The Obama administration successfully argued that a bit of sloppy language left in the law that seemingly applied subsidies only to plans in state exchanges was meant to apply to both state and federal exchanges. The case, Halbig v. Sebelius, had been viewed as a significant threat to the ACA, though it’s not quite over: The plaintiffs are appealing the decision, and similar lawsuits are pending.

The administration received a setback of its own when the Supreme Court extended an injunction for a Denver-based Catholic charity, Little Sisters of the Poor Home for the Aged. The court decision temporarily exempts the nonprofit organization from several requirements of the ACA, including birth-control coverage, while the case is heard in the 10th Circuit Court of Appeals. The Catholic Church and other groups have vigorously opposed the birth-control coverage mandate on religious grounds.

More States Considering Medicaid Expansion

Few provisions of the ACA have divided states more than the question of whether to expand Medicaid. By the end of 2013, the states were equally split: 25 (plus the District of Columbia) had agreed to expand coverage, while the other half were either undecided or actively opposed.

That dynamic is changing, according to the nonpartisan Pew Charitable Trusts.

An additional nine states are now considering expansions of their own, including Utah, where Republican Gov. Gary Herbert announced his support in January. Officials in several other nonexpansion states have fretted over recent reports suggesting that they may lose out on billions of dollars in matching federal funds.

Another driving factor in the recent warming trend toward some form of expansion may be the growing use of waivers to craft state-specific versions of the federal program. Arkansas and Iowa have already used an alternative called the “private option” to enroll beneficiaries in private insurance plans. The Obama administration has given the Department of Health & Human Services leeway to grant these waivers to states wanting to experiment with health-care delivery methods as long as their Medicare modifications meet minimum standards and remain cost neutral.