U.S. health plans to keep some reforms, however court rules

(Reuters) - Three major U.S. health insurers that provide coverage to millions of Americans said they would keep some protections included in President Barack Obama's healthcare overhaul regardless of how the Supreme Court rules on the law.

The Supreme Court is expected to decide later this month whether to strike down all or portions of the law, Obama's signature domestic policy achievement that was passed in 2010.

UnitedHealth Group Inc, the largest health insurer by market value, announced its intention early on Monday to preserve some of the provisions that have already taken effect. Rivals Aetna Inc and Humana Inc made similar pledges later in the day.

All three said they would still offer coverage for dependents up to age 26 under their parents' plans. The companies will also continue to offer certain preventive healthcare services without out-of-pocket cost-sharing.

"The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs," UnitedHealth Chief Executive Officer Stephen Hemsley said in a statement. "These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue."

The law, known as the Affordable Care Act, represented the biggest overhaul to the $2.6 trillion U.S. healthcare system in nearly 50 years. The three health insurers committed to maintaining some of the provisions that are already in place, although many of the more sweeping changes are due to take effect in 2014.

The law is designed to expand coverage to more than 30 million uninsured Americans, by establishing insurance exchanges and broadening the Medicaid program for low-income people.

Shares of UnitedHealth, Aetna and Humana fell about 1 percent, in line with a decline for the broader Standard & Poor's 500 Index

KEEPING POPULAR POLICY IN PLACE

The provision allowing children to stay on their parents' plans up to age 26 is perhaps the law's single most popular component. It has already helped about 6.6 million young adults to join their parents' health insurance plans last year, according to The Commonwealth Fund, a non-profit organization that analyzes healthcare issues.

Should the law be struck down, Republican lawmakers who opposed Obama's health reform efforts may seek to reinstate the extension of young adults dependent coverage.

The three insurers also said they will maintain a provision that provides clear ways for members to appeal coverage claim decisions.

UnitedHealth and Humana said they will keep two other provisions: forgoing lifetime dollar coverage limits on policies and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud.

It was not immediately clear where Aetna, the No. 3 health insurer, stood on those provisions.

Cigna Corp, another large national insurer, said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."

UnitedHealth, which serves more than 38 million members, said the protections are effective immediately and will be available to current and future plan members.

At the heart of the Supreme Court case is a requirement in the law that individuals buy health insurance coverage or face a penalty, known as the individual mandate. In return, health plans will have to provide coverage to patients with pre-existing medical conditions that would have disqualified them in the past.

Should the mandate alone be struck down, and the companies are still required to cover people regardless of health status, the insurers have said people will buy insurance only when they become ill, causing premiums to rise.

The law already bars insurers from denying coverage to children up to age 19 with pre-existing medical conditions.

UnitedHealth said it recognized the value of this provision, but said "one company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage."

The ban on denying coverage to those with pre-existing conditions will apply to adults starting in 2014, under the law.

DeAnn Friedholm, director for health reform at Consumers Union, said if a single company "declared they would take any comers, and their competitors do not, then they will immediately attract the sickest population, which would disadvantage them in trying to compete on prices."

"It requires a level playing field so that all the companies have to play by the same rule," Friedholm said.

(Reporting by Lewis Krauskopf in New York; Editing by Michele Gershberg and Tim Dobbyn)

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What happens after the Supreme Court rules on health care?

This week, we had six leading legal experts debating the Supreme Court’s upcoming health care ruling. So what did the group say about the next steps after the court rules?

balkinbarnett Jack Balkin and Randy Barnett

For now, the consensus in the media is that the Supreme Court will issue a decision on the Affordable Care Act on Monday, June 25, the last day before its recess. (The actual ruling has been known by the court internally but not made public.)

Our session on Wednesday at the National Constitution Center included Jack Balkin of Yale Law School and Randy Barnett of Georgetown University Law Center, moderator John Hockenberry, and expert guests Stephanos Bibas (University of Pennsylvania Law School), Jamal Greene (Columbia Law School), Ilya Shapiro (Cato Institute) and Neil Siegel (Duke University School of Law). The event was presented by the Center’s Peter Jennings Project and The Constitutional Sources Project (ConSource).

Much of the discussion among the experts was on the merits of the case as it was presented in late March to the nine justices.

Full Video Replay:

Health Care Reform’?s Big Test: Commerce and the Constitution from National Constitution Center and National Constitution Center on FORA.tv

But the issue came up of what happens after June 25 (or another earlier day) when the court rules? The discussion yielded a lot of interesting points that extended beyond legal arguments.

Barnett of Georgetown Law said if the court rejects the Affordable Care Act and the controversial individual mandate to buy insurance, then it will have drawn a line about the growth of congressional power.

“If the mandate is struck down, it will be a very important case,” Barnett said. “The court will continue to draw a line beyond which Congress cannot go and that will be very, very important. But where they are going to draw that line is where the line existed in 2009 before this bill was passed.”

Audio: Barnett on Drawing a Line on Congressional Power

Barnett added if the court decides the entire ACA is constitutional, it would essentially give Congress unchecked powers in some cases.

Shapiro of the Cato Institute also said if the court rejects the ACA, it will take America back to the status quo on health care before President Obama and Congress passed the ACA.

Both Barnett and Shapiro thought the court’s ruling would be narrow and not applicable to other cases.

Greene of Columbia Law said if the court struck down the ACA, it would one of the most significant decisions since the Missouri Compromise and the Dred Scott case.

Balkin of Yale Law said the decision will have no effect, in the long run, on the public’s respect for the Supreme Court.

Audio: Why The Supreme Court Retains Respect

“It will have absolutely no effect on the court’s legitimacy,” Balkin said. “The military is the most admired and respected institution in American life, and the Supreme Court is next.”

Bibas of University of Pennsylvania Law said whatever the court rules against the ACA, it’s not a radical departure from recent acts to expand or contain the power of Congress. “Ours is a government of limited powers,” he said. “It’s not a radically new departure.”

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He also said the long-term benefit from the health care case is a public dialogue that is needed.

Audio: Health Care Will Spark a Broader Debate

Bibas said, “That conversation is going to be continued and many more chapters are going to be written by the Congress and the president before its ever comes back to the court. Rather than being pessimistic about all the negative possibilities that come out of it, why shouldn’t we be fundamentally optimistic about spurring a debate that maybe was long past due?”

Siegel of Duke University School of Law said the court’s ruling could affect other laws, depending on how the justices craft their opinion.

No one expected health care to fade away as an issue.

Barnett said if the law is struck down, health care will be at the center of the general election and the next Congress.

“If this gets struck down, there are going to be common sense health reforms that do not try to take over and rework and re-engineer one-sixth of the economy, which this monstrosity did,” he said.

Hockenberry couldn’t get a group opinion on the decision. Balkin said he had previously predicted the court would uphold the law by a 6-3 vote, but his predictions were “always wrong.” Barnett said he was sticking by a decision to not making any predictions, while the remaining four experts were split.

Audio: The Group’s Predictions

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Restaurant play-area health rules could loom

by Edythe Jensen - Mar. 4, 2012 09:28 PM
The Republic | azcentral.com

A Chandler mother's crusade against unsanitary restaurant playgrounds has prompted proposed changes to Maricopa County's health code.

"This is a giant step in the right direction," said Erin Carr-Jordan, 37, a mother of four with a Ph.D. in developmental psychology.

She has been working with Supervisor Fulton Brock and other county officials on the wording of the potential regulations, which would expand the county's oversight of restaurant-cleanliness inspections to include play areas. They also would require sanitized cleaning of those areas after every shift, detailed cleaning protocols, permanent signs encouraging children's hand washing before meals and immediate closure of the play areas "when vomiting and/or fecal accidents occur."

Woman fighting bacteria banned from McDonald's

But getting those changes into law isn't a sure thing. The approval process takes months, Brock is leaving office at the end of the year and a candidate for another supervisor's seat is president of the Arizona Restaurant Association.

Carr-Jordan is getting support from the county's public-health director, Dr. Robert England.

"It's just common sense. You don't want to facilitate something that's going to make kids' hands filthy dirty right before they handle food," he said. "But we also don't want to do anything that discourages physical activity. For some, this is the best playground equipment available."

England said he hasn't read the proposed health-code changes but would support "reasonable" play-equipment-cleanliness requirements.

The mother's outrage started about a year ago when she took her then-3-year-old son to a Tempe McDonald's. He asked to go on the slide and Carr-Jordan followed him.

"Inside I saw filth and grime coupled with clumps of dirt, matted hair and rotting food ... the entire structure was riddled with swear words and gang signs," she said.

She pulled her children out of the area and notified the manager.

The next day she returned, alone, and said the play area was still dirty.

Over the next month, Carr-Jordan complained several times and photographed the conditions.

"I was so appalled that I spent my own money and hired a lab to run tests," she said.

According to the test report by Legend Technical Services Inc., her samples contained "opportunistic human pathogens" that can cause disease and are found in fecal material, mucus, matted hair and food.

"I was shocked by the results," Carr-Jordan said.

Since then she has traveled across the country testing samples of playground filth and seeking law changes that would mandate cleanliness.

"In every state, in every city, the results indicate the presence of potentially dangerous, opportunistic pathogens, including those that can cause meningitis; sepsis; hair, scalp and skin infections; abscesses ... and more. Some of the strains we found are multiple-drug resistant," she said.

There are no state or federal regulations governing playground cleanliness nor are they regulated in most of the counties and cities she visited in 15 states, Carr-Jordan said. One county in Texas may regulate them, she said, "but to the best of my knowledge, that's the only one."

Today she is meeting with officials in Illinois about what she hopes will become the first state law granting health officials jurisdiction over restaurant play areas.

Bruce Bartholomew, Brock's chief of staff, said the supervisor contacted Carr-Jordan after seeing news reports of her crusade and discovering she is one of his constituents.

"She impressed him with the importance of the issue," he said.

The Maricopa County Board of Health will discuss the proposed health-code changes April 23, Bartholomew said. At that time, board members can authorize the Environmental Services Department to proceed with stakeholder meetings and public participation.

"We hope to have that process completed in time to bring a final ordinance back to the Board of Health at their July 23 meeting," he said.

If the health group recommends approval, the proposal could go to the Board of Supervisors by the end of August. However, delays or lack of a quorum could extend the process for months as the Board of Health meets only four times a year.

During that time, candidate Steve Chucri will be campaigning for a seat on the Maricopa County Board of Supervisors. Chucri, longtime president and chief executive of the Arizona Restaurant Association, is seeking the District 2 post that will be vacated by Don Stapley, who recently announced he is running for Congress. Campaign-finance records show Chucri raised more than $63,000 in January, and many of his contributors were restaurant owners and suppliers.

Chucri said he has received a copy of the proposed restaurant play-area regulations and will discuss them with association members at the next meeting. The group has not yet taken a position on them, he said.

Sherry Gillespie, government-relations manager for the restaurant association, said the organization would prefer advisory, not mandatory, cleaning standards for play areas.

"Our restaurants do everything in their power to make sure these locations are clean," she said.

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