Health reform is a term that closely relates to the word litigation. For example, UnitedHealth Group (United), owner of the largest health insurance company in the United States, proposes to acquire Change Healthcare (Change), the leading source of key technologies that United’s health insurance rivals depend on to compete with United. A trial in the U.S. District Court in Washington, DC is underway as of August 1, 2022 to prevent the UnitedHealth Group from doing so. The proposed merger is opposed by the U.S. Department of Justice, along with the states of Minnesota and New York, on the basis that it would harm competition in commercial health insurance markets and also in the market for a vital technology used to process claims and reduce health care costs.
By ensuring accuracy, avoiding overpayments, and reducing administrative waste, Change’s technologies save United’s rivals tens of billions of dollars each year and reduce health care costs. Change also has access to vast amounts of competitively sensitive data about United’s rivals, data that reveal how their plans are designed and how they calculate payments to providers, for example, and holds “unfettered” rights to use much of this information.
Constitutionality Of Affordable Care Act Continues To Foster Litigation
The Patient Protection and Affordable Care Act, more commonly referred to as the Affordable Care Act (ACA), became law in March 2010. Since its inception, many ACA provisions have been controversial. The courts have been called upon several times to resolve disputes by litigants. For example, Section 2713 pertains to health insurance coverage of certain preventive services that have been approved by the U.S. Preventive Services Task Force (PSTF), a congressionally established private body of experts; the Advisory Committee on Immunization Practices (ACIP); and the Health Resources and Services Administration (HRSA). As an illustration, opponents of Section 2713 are against the provision of coverage of contraceptives and preexposure prophylaxis (a medication that prevents HIV) on religious or other grounds.
The case Leal v. Becerra filed in December 2020 in federal district court in Amarillo, TX resulted in the rejection of a claim by plaintiffs that 2713 unconstitutionally delegates to HRSA the power to adopt legal requirements binding on private parties, a power the Constitution vests in Congress. In the ongoing case Kelley v. Becerra, plaintiffs appealed this decision to the Fifth Circuit federal court in Fort Worth, TX in February 2021. They challenge the constitutionality of the ACA’s provisions and mandates issued pursuant to this grant of authority to the PSTF, ACIP, and HRSA. Specifically, they object to paying for health insurance plans that cover contraceptives, preexposure prophylaxis drugs, and other preventive-care services for religious reasons plus related preventive-care coverage that they neither want nor need. Instead, all plaintiffs express a desire to purchase on the open market insurance policies that meet their needs and are free from the requirements of the provisions and their resulting mandates.
Enhanced Nursing Home Five-Star Quality Rating System Launched By CMS
The Centers for Medicare & Medicaid Services on July 27, 2022 launched its enhanced Nursing Home Five-Star Quality Rating System, which integrates data these facilities report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators. The updated Star Ratings increase transparency aimed at improving the quality of nursing homes so residents obtain the reliable, quality care they deserve. CMS research shows that higher nurse turnover is associated with lower quality of care. It is believed that nurses who have worked at a facility longer are more likely to know residents well enough to recognize small health changes and act before they become larger issues. Similarly, administrators with longer tenures help create stable leadership that can lead to more consistent policies and protocols that are tailored to serve residents better. Last January, CMS began posting weekend staffing and turnover rates on Medicare’s Care Compare website. The agency now is incorporating that information into the consumer-friendly Nursing Home Five-Star Quality Rating System. New nurse staffing information includes registered nurses, licensed practical nurses, vocational nurses, and nurse aides who work under the direction of licensed nurse staff and provide much of the day-to-day care for nursing home residents, such as eating, bathing, grooming, and toileting. Ratings are updated quarterly.