It does not amount to the least bit of hyperbole to suggest that a great many pieces of legislation that are enacted into law might conveniently be subtitled: The Attorneys, Accountants, and Lobbyists Relief Act (fill in the year of enactment). The Patient Protection and Affordable Care Act of 2010 (commonly referred to as either the ACA or Obamacare) fits this description perfectly. To cite just one example, in February last year, 20 attorneys general filed a lawsuit claiming that the 2017 Tax Cut law and the Jobs Act’s reduction of the individual responsibility tax penalty to zero, in effect made the ACA’s individual mandate unconstitutional. Proceeding from that line of reasoning, it means that the entire ACA was invalid because of the disappearance of the tax penalty. In December of 2018, a federal court judge in Texas agreed with this argument, entering a judgment that if it is upheld, the entire ACA would become invalidated. What comes as no surprise is that supporters of the Affordable Care Act have mounted their opposition to this ruling. Democratic attorneys general in 17 states have intervened to defend the entirety of the health reform law.

Apart from this specific example, it is worth noting that once it became apparent that Republicans in Congress in 2017 were unable to repeal and replace the ACA, since then the Trump Administration has used its powers to issue several regulations and guiding principles aimed at crippling the law. Opponents have responded by unleashing countersuits to prevent or delay these administrative actions. Thus, it is safe to assume that the future appears to remain quite bright when it comes to the financial health of many law firms and advocacy groups since additional litigation already can be detected hovering on the near horizon.

Administration Initiative To Create Association Health Plans Faces Challenges
One Trump Administration regulatory initiative is aimed at creating Association Health Plans that do not have to comply with either ACA individual or small-group requirements, In June 2018, the Labor Department finalized a rule to expand the ability of employers, including sole proprietors without common law employees, to join together and offer health coverage through Association Health Plans. These short-term limited duration vehicles can be in effect for one year and also be subject to renewal for as many as 36 months while continuing to be exempt from the Affordable Care Act’s consumer protections. Opponents have reacted in New York and other states by bringing a lawsuit to challenge the health plan rule on the basis that it violates the ACA, the Employee Retirement Income Security Act (ERISA) of 1974 that regulates group health plans, and the Administrative Procedures Act. Oral arguments in federal district court for the District of Columbia were scheduled to begin in January 2019.

Transgender Protections And Religious/Moral Objections To Contraception Coverage
Increased attention is being paid by policymakers to the issue of whether the health care needs of transgender individuals are being addressed satisfactorily. One concern is whether current regulations provide adequate protection from discrimination against transgender patients by insurance companies and health care providers. Federal courts have weighed in on this matter in the past and can be expected to continue doing so in the future. Mandated benefits under the ACA sometimes trigger opposition for moral and religious reasons. Contraception coverage offers an example whenever religious groups are compelled to provide this benefit because doing so may conflict with core spiritual beliefs.

Pursuing The Realization Of Health Care Priorities In Congress
Major differences exist between Democrats and Republicans in Congress, and despite that each party enjoys a majority in only one chamber, it still may be possible to achieve bipartisan agreement on certain issues that could be enacted into law. An example is lowering the cost of prescription drugs. President Trump also has signaled his desire to see constructive action taken in that regard. Recent years have involved a series of proposed buy-outs and mergers among drug companies, insurance firms, and health care providers. Through its oversight powers, committees in Congress may be able to work in an effective bipartisan way to determine if such transactions have the potential either to weaken competition or have a negative impact on health care consumers and taxpayers. Fixing a maldistribution of health resources in the form of an insufficient supply of clinicians and health care facilities in rural areas is a chronic problem that also should be of interest to legislators from both political parties.

More Articles from TRENDS December 2018 - January 2019


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Indicates proposed goals by the Secretary of the U.S. Department of Education on how to rethink higher education in general and accreditation in particular. Read More


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A noticeable amount of BS exists in the world including in health care, but a detection instrument is available to root out preposterous claims. Read More



A settlement made it possible to revise therapy guidelines to increase the number of visits with beneficiaries to improve patient care. Read More