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Monthly Archives: June 2014

Hobby Lobby Decision May Not Be The Last Word On Birth Control Coverage

The Supreme Court’s decision Monday saying that “closely held corporations” do not have to abide by the contraceptive coverage mandate in the Affordable Care Act may not give those firms the ability to stop providing that coverage after all.

Religious freedom supporters hold a rally in Chicago to celebrate the Supreme Court’s decision in the Hobby Lobby contraception coverage requirement case (Photo by Scott Olson/Getty Images).

More than half the states have “contraceptive equity” laws on the books that require most employers whose health insurance covers prescription drugs to also cover FDA-approved contraceptives as part of that package. Unlike the ACA, those laws do not require that coverage to be available without deductibles or co-pays.

The court’s decision Monday does not directly affect those state laws, several analysts say.

The Religious Freedom Restoration Act, which the court used to say the closely held companies don’t have to abide by the federal mandate, “doesn’t supersede state law,” said Marcia Greenberger, co-president of the National Women’s Law Center.  “They stand as independent protections.”

Many of those state laws have religious exceptions similar to the one the Obama administration has granted to nonprofit religious hospitals and universities, but only two, Arizona and Illinois, extend those exceptions more broadly. Two other states, Arkansas and North Carolina, do not require coverage of emergency contraception, which is among the products that were at issue in the Supreme Court case.  

Firms like Hobby Lobby, the nationwide arts-and-crafts chain that was the lead plaintiff in Monday’s case, aren’t subject to state insurance laws, because they self-insure their workers and don’t buy state-regulated insurance. Their plans are subject only to federal regulation.

Burwell v. Hobby Lobby Stores

  • Supreme Court Limits Contraceptive Mandate For Certain Employers
  • What The Hobby Lobby Decision Means For Employers
  • FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate
  • Court Suggests Narrow Application Of Birth Control Case, But Others See Broader Impact
  • Hobby Lobby Decision May Not Be The Last Word On Birth Control Coverage

But they are still likely subject to a ruling issued by the Equal Employment Opportunity Commission in the year 2000 that employers that fail to cover contraception as part of their health insurance benefit package are discriminating against women in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.

So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.

Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.

Meanwhile, others have suggested that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.

“There will be no shortage of exciting moments in the coming months,” said Amiri.

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Court Suggests Narrow Application Of Birth Control Case, But Others See Broader Impact

The Supreme Court’s decision on contraceptives and employer health plans could affect companies and workers far beyond Hobby Lobby and the other plaintiffs.

But nobody seems to know how far.

The ruling applies to “closely held for-profit corporations,” a small subset of employers, Justice Samuel A. Alito Jr. wrote for the majority. But in a dissenting opinion, Justice Ruth Bader Ginsburg suggests the impact will be far broader.

“Although the court attempts to cabin its language to closely held corporations, its logic extends to corporations of any size, public or private,” she said.

“Closely held” commonly refers to a company owned by a few insider shareholders, rather than publicly traded giants such as IBM or Bank of America.

(Photo by Mark Wilson/Getty Images)

But government statisticians don’t keep track of companies that way.

“I’ve never seen data on how many closely held businesses there are out there,” says Paul Fronstin, a senior researcher with the Employee Benefit Research Institute.

Nor is it clear that the court’s idea of closely held is the same as other definitions. For tax purposes, the IRS says a company is closely held when five or fewer shareholders control at least half the stock — as long as it’s not a law firm, architectural shop or other professional practice.

But the court, which makes no reference to the IRS regulation, seems to understand closely held another way.

The decision applies to “corporations like Conestoga, Hobby Lobby and Mardel,” the companies involved in the case, Alito wrote.

What do those companies have in common? They are “closely held corporations, each owned and controlled by members of a single family,” he said.

The case hinged on whether regulation of corporations can impinge on the religious convictions of their owners. For retailer Hobby Lobby and the other plaintiffs, Alito argued, the company and the owners are virtually the same.

Burwell v. Hobby Lobby Stores

  • Supreme Court Limits Contraceptive Mandate For Certain Employers
  • What The Hobby Lobby Decision Means For Employers
  • FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate
  • Court Suggests Narrow Application Of Birth Control Case, But Others See Broader Impact

At Conestoga, a maker of cabinet components, the Hahn family exercises “sole ownership of the closely held business they control its board of directors and hold all of its voting shares,” he wrote. “One of the Hahn sons serves as the president and CEO. The Hahns believe that they are required to run their business ‘in accordance with their religious beliefs and moral principles.’”

Such one-family companies are a narrow slice of the IRS’ definition of closely held. At many companies the tax agency considers closely held, not all shareholders are related.

Even Walmart, the retailing giant with publicly traded stock, seems to fit the IRS definition of closely held. A few Walton family members own more than half the shares. 

And closely held companies without public shares can also “be very big entities,” such as Mars Inc., the family owned candy maker with 70,000 employees, said Marcia D. Greenberger, co-president of the National Women’s Law Center. “So there’s a question about how broad the reach of the Hobby Lobby decision is.”

That will ultimately depend on how many employers decline to offer contraception based on the ruling and whether courts allow it.

“We’ll have to see how broadly other corporations try to jump on the bandwagon to say, ‘Me too; we don’t want to provide this either,’” said Greenberger. “It opens the door for many, many lawyers to be providing all kinds of advice.”

KHN Senior Correspondent Julie Rovner contributed. 

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FAQ: High Court's Hobby Lobby Ruling Cuts Into Contraceptive Mandate

In a 5-4 decision Monday, the Supreme Court allowed a key exemption to the health law’s contraception coverage requirements when it ruled that closely held, for-profit businesses could assert a religious objection to the Obama administration’s regulations. Here are some frequently asked questions and answers about the case.

Q: What did the court’s ruling do?

A: The court’s majority said that the companies that filed suit — Hobby Lobby Stores, a nationwide chain of 500 arts-and-crafts stores, and Conestoga Wood Specialties, a custom cabinet manufacturer — did not have to offer women employees all Food and Drug Administration-approved contraceptives as part of a package of preventive services that must be covered without copays or deductibles under the law. The companies had argued that several types of contraceptives violate their owners’ religious beliefs. The ruling also covers a Hobby Lobby subsidiary, the Mardel Christian book stores. 

Q: What does the health law say about contraception coverage?

A: As part of the law’s coverage of preventive health services, health insurance plans are required to cover all FDA-approved contraception methods  for women without any cost-sharing, such as deductibles or co-payments.  Those methods include birth control pills, intrauterine devices and sterilization procedures.  Employers with 50 or more workers who offer coverage that doesn’t meet that standard would face fines of $100 a day per worker.  These large employers that do not offer any coverage face a fine of $2,000 for most employees. The contraceptive guidelines apply to women only.

Writing for the majority, Justice Samuel Alito stated that Hobby Lobby would have faced fines of $475 million per year and Conestoga $33 million for excluding some forms of birth control from their health plans.  If the employers had decided to drop coverage altogether, Hobby Lobby would have paid roughly $26 million in penalties and Conestoga $1.8 million, far less than the fine for not covering all FDA-approved methods of birth control.

The Department of Health and Human Services set the contraception requirement based on an Institute of Medicine study that recommended prescription contraception and services, including all FDA-approved methods of contraception, be included as preventive services for women. Most health plans had to cover contraceptive services for plan years beginning on or after Aug. 1, 2012, according to HHS.  Grandfathered plans that had not changed significantly after the health law passed do not have to offer preventive health care – including contraception – without cost-sharing.

Q: Why did these companies bring suit?

A: Hobby Lobby and Conestoga are family owned, and they said that the health law’s contraception requirement violated their religious views.  While both employers’ health plans cover some forms of birth control, the employers object to emergency contraceptives such as Plan B and Ella that can prevent a pregnancy if taken within a short window after unprotected sex. The owners contend that these contraceptive methods prevent a fertilized egg from implanting in the woman’s uterus and therefore are a type of abortion. Hobby Lobby’s owners also object to two types of intrauterine devices, or IUDs, for the same reason.

The companies argued that they should be exempted from the contraceptive requirement because the 1993 Religious Freedom Restoration Act (RFRA) says that the government may not pose a “substantial burden” on the free exercise of religion unless that burden is the narrowest possible way to further a compelling government interest.  The federal government and advocates for the health law’s contraception requirements argued that only individuals – not corporations – can exercise religious rights.

Q. Does everyone agree that the contraceptives that Hobby Lobby and Conestaga object cause abortions?

No. U.S. Solicitor General Donald Verilli said during the oral arguments in the case on behalf of the Obama administration, “Federal law and State law – which do preclude funding for abortions – don’t consider these particular forms of contraception to be abortion.”

Burwell v. Hobby Lobby Stores

  • Supreme Court Limits Contraceptive Mandate For Certain Employers
  • What The Hobby Lobby Decision Means For Employers
  • FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate

The brief filed by 10 medical groups led by the American College of Obstetricians and Gynecologists noted: “there is a scientific distinction between a contraceptive and an abortifacient and the scientific record demonstrates that none of the FDA-approved contraceptives covered by the Mandate are abortifacients.”

That’s because the standard medical definition of the start of pregnancy is when a fertilized egg implants in a woman’s uterus, not when sperm and egg first unite.

But while blocking implantation of a fertilized egg does not fit the medical definition of pregnancy, it does qualify as ending a life for many religious people.

Q: Are there any religious exceptions from the health law’s contraception mandate?

A: Churches and other houses of worship are exempt from the requirement to provide contraceptive services at no cost to employees. However, religious-affiliated institutions, such as universities and hospitals, would have to provide coverage for all FDA-approved contraceptive methods. Those organizations objecting to such coverage can turn to a third party, such as an insurer, to cover the cost of contraception, under a plan outlined by the Obama administration last year. 

Some of these religious organizations, including some Catholic and other Christian groups, have also brought suits  against the government mandate. Those are still being adjudicated in lower courts.

Q: How does this federal case relate to state laws governing contraception coverage?

A: More than half the states have their own laws mandating contraception coverage and most of them have some sort of exemption for religious employers. One key difference between the federal law and state laws is that under the federal health law, employers offering non-grandfathered health coverage must provide contraceptives without cost-sharing to women employees.

Q: What does the ruling mean for employers? 

A: Some analysts who agreed with the Obama administration think the ruling means  that employers could use religious objections to opt out of other areas of health care coverage. For example, earlier this month  Barry Lynn, executive director of Americans United for Separation of Church and State, told KHN that in health care alone, “Scientology-believing employers could insist upon non-coverage of its nemesis, psychiatry. And Jehovah’s Witnesses’ corporations could demand exclusion of surgical coverage, under the theory that so many of such procedures require the use of whole blood products, forbidden by their faith.”

But Justice Alito’s decision went to lengths to limit the scope of the decision. “This decision concerns only the contraceptive mandate and should not be understood to hold that all insurance-coverage mandates, e.g. for vaccinations or blood transfusions, must necessarily fall if they conflict with an employer’s religious beliefs.”

KHN senior correspondent Julie Rovner contributed to this report.

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What The Hobby Lobby Decision Means For Employers

KHN’s Mary Agnes Carey and legal analyst Stuart Taylor discuss Monday’s ruling on the health law’s contraception mandate, examining what the decision could mean for future challenges to the law.

>>Click here to listen to audio of the conversation

MARY AGNES CAREY: Welcome. I’m Mary Agnes Carey. 

By a vote of 5 to 4, the Supreme Court has ruled that family-owned, closely held corporations do not have to comply with the health law’s contraception coverage requirements if they violate the owner’s religious views. Legal analyst Stuart Taylor Jr. joins us now to discuss the decision. Thanks for being with us.

STUART TAYLOR: Nice to be with you.

MARY AGNES CAREY: Why did the court rule this way?

STUART TAYLOR: Well, the court held that under an act of Congress passed in 1993, the Religious Freedom Restoration Act, the right is conferred on all religious groups, including, the court said in this case for the first time, for-profit corporations as well as churches and, say, nonprofit religious groups — they all get broad protection of their religious freedoms. And in a very detailed analysis of the various steps you go through under this law, first, can you invoke protection at all if you’re a for-profit corporation. The court said yes. Then, does it substantially burden your religious exercise. The court said yes, because these companies have objections to providing contraception coverage, and then they go on and say is this the government’s least restrictive means they could use to serve the need of the women who want the contraceptives, in this case. And the court said no; they have other ways they could to it. The government could pay for it or they could use an accommodation they are already using for nonprofit religious employers.

MARY AGNES CAREY: These companies, Hobby Lobby, which is a very well-known craft store, and Conestoga Wood Specialties, which is a cabinet maker, what were their arguments against the contraception mandate?

STUART TAYLOR: Unlike the Catholic groups that are also challenging the mandate, these groups have a religious objection only to what they call abortifacients—the morning after pill, certain kinds of IUDs that they think operate to induce abortion.

Now, it doesn’t induce abortion as the government describes abortifacient, but it does in the beliefs of these companies. And the government says they are entitled to their beliefs. So [companies] say: For us to help someone get that kind of contraception, violates our religious beliefs. We cannot do it without violating our religious beliefs. The government is trying to force us to do it against our religious beliefs, and that puts us in a terrible position, because the fines are enormous for not complying with this provision of the Affordable Care Act.

Anti-abortion advocates cheer in front of the Supreme Court after the decision in Burwell v. Hobby Lobby Stores (Photo by Chip Somodevilla/Getty Images).

For Hobby Lobby, which is a pretty [good-sized] company, it would be fines of $1.3 million a day, or $475 million a year, if it refuses to provide all federally approved contraceptive coverage, including these so-called abortifacients, and they say that’s an intolerable burden: We shouldn’t be put to that choice and the Religious Freedom Restoration Act exempts us from that choice.

MARY AGNES CAREY: What does this ruling mean for female employees of Hobby Lobby and similar companies that have objections to some forms of contraception coverage?

STUART TAYLOR Jr.: In this case, it’s not going to have much effect. In fact, the majority opinion says the effect of this on the women employed by Hobby Lobby and other companies involved in these cases would be precisely zero. And the reason is that the court says if the administration extends the same so-called accommodation to these religious employers who are for-profit companies then it’s already extended to nonprofit Catholic hospitals, nonprofit religious schools, nonprofit religious colleges, and nonprofits – if it extends the same so-called “accommodation” to these for-profit companies, that it has already created for the nonprofit companies, then the women will get the coverage anyway through the same insurance companies that cover everything else.

MARY AGNES CAREY: So these accommodations, the justices suggested, for example, number one, the government can pay for it. Or, they could put into play some accommodations that are already there for religiously affiliated employers, which is having the insurers cover it.

STUART TAYLOR Jr.: Yes, and that’s a tricky little thing that would apply in this case and not many others. And what makes it work is that the cost of providing the contraceptive coverage is really about zero, whether it’s the employers paying for it or whether it’s the insurance company that’s paying for it because they save money on the other end, because they don’t have the child birth expenses, which are larger than contraceptive coverage. So nobody’s really paying out much money. It’s a matter of who’s got the symbolic function of providing the coverage.

This accommodation that’s already been given to nonprofit employers basically says: OK, all you have to do is certify that you have a religious objection to providing this coverage and then the government will require that your insurance company provide the coverage at no cost to you. And that’s what’s being done already in some cases — and what the court now says they can do in the cases of company, for-profit companies like Hobby Lobby. 

MARY AGNES CAREY:  There are many other non-profit employers like Catholic hospitals that have said even these accommodations, these other arrangements, are going to violate their religious beliefs. So what does this mean for them?  

STUART TAYLOR:  That’s right, and the reason they say it violates their religious beliefs is that they are required, at least by the regulation to certify to the insurance companies that they have this religious objection, then that triggers the insurance companies obligation to provide it. So these companies are saying, yeah, but if we have to certify and then it gets provided that means we are doing what we object to doing, which is providing a link in the chain of causation that leads to women using contraceptives. 

Burwell v. Hobby Lobby Stores

  • Supreme Court Limits Contraceptive Mandate For Certain Employers
  • What The Hobby Lobby Decision Means For Employers

So it’s a little peculiar because the court has said that Hobby Lobby and its co-plaintiffs who do not object to the certification can be covered by this, but at least technically the possibility remains that the court would eventually decide that you cannot require, say, Catholic organizations that object to providing the coverage to object to certifying that they won’t provide the coverage to do so.

MARY AGNES CAREY:  Does this ruling mean that privately held for for-profit corporations can ignore other requirements of the health law if they find those requirements objectionable on religious grounds?

STUART TAYLOR:  Justice Ginsburg’s long and eloquent dissent implied that, but the majority and more specifically Justice Kennedy who provided a concurring opinion say that no that wouldn’t really do that, it’s not nearly as broad as Justice Ginsburg says it is. The quote is Justice Kennedy says: The Court’s opinion does not have the breadth and sweep ascribed to it by the respectful and powerful dissent of Justice Ginsburg’s. So you have a disagreement between the dissent and at least some of the majority of whether this is going to be a far reaching decision or whether it’s going to be one that covers this case and not too many other cases.

MARY AGNES CAREY:  What did Justice Ginsburg mean in her dissent when she called the ruling a decision of startling breadth?

STUART TAYLOR:  She meant that, she went on to say, that it says: The court holds that commercial enterprises, including corporations, can opt out of any law, except tax laws, they judge incompatible with their sincerely held religious beliefs.

It would be a decision of startling breadth if the court had said that. But as the majority and Justice Kennedy’s concurrence both say: No, no, no, Justice Ginsburg. It isn’t nearly as broad as you’re saying it is.

And, by the way, this kind of dialogue is fairly common when dissenters, in order to emphasize what terrible things could happen as the result of a decision they don’t like, they tend to read it as broadly as possible to make it sound worse, and then the majority tends to say: Oh, no, it’s not that broad. And you never really find out how broad it is until the next case comes along.

MARY AGNES CAREY:  What does today’s decision mean for other litigants who are challenging the contraception mandate because they say it violates their religious freedom?

STUART TAYLOR:  I think most of them are going to win their cases if they can make it clear that their religious objections are sincere. I think most of them can, or they don’t file lawsuits.

It should be clear: A public company, certainly a big public company, would not be able to pull off a sincere religious objection of this kind, because the bigger a company gets, the less likely it is that all of the people who have an ownership or management interest in it are of the same religion and share the same objections. So this is, by its nature, this sort of logic is confined to family-owned companies, or maybe companies owned by a small group of like-minded religious people who say their religion is very important to the way they operate their businesses.

Hobby Lobby is quite a big company, for example, but still we’re not talking about General Motors or Ford or McDonald’s or any companies like that.

MARY AGNES CAREY:  That you so much legal analyst Stuart Taylor.

STUART TAYLOR:  Thank you.

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Supreme Court Limits Contraceptive Mandate For Certain Employers

A sharply divided Supreme Court ruled Monday that at least some for-profit corporations may not be required to provide contraceptives if doing so violates the owners’ religious beliefs.

But the five-justice majority writing in Burwell v Hobby Lobby, et al., took pains to try to limit their ruling only to the contraceptive mandate in the health law and only to “closely held” corporations like the family-owned businesses represented by the plaintiffs in the case.

A Hobby Lobby store in Antioch, California. (Photo by Justin Sullivan/Getty Images)

“As applied to closely held corporations, the (Department of Health and Human Services) regulations imposing the contraceptive mandate violate” the Religious Freedom Restoration Act, wrote Justice Samuel Alito for the conservative majority. “HHS has not shown that it lacks other means of achieving its desired goal without imposing a substantial burden on the exercise of religion.”

The decision stressed that the majority did not intend to open the door to allowing employers with religious views to deny other forms of employee benefits, including other health benefits. “Other coverage requirements, such as immunizations, may be supported by different interests (for example, the need to combat the spread of infectious diseases) and may involve different arguments about the least restrictive means of providing them,” Alito wrote.

The court’s four liberal justices strongly dissented. “How does the Court divine which religious beliefs are worthy of accommodation and which are not?” asked the opinion written by Justice Ruth Bader Ginsburg. “The Court, I fear, has ventured into a minefield.”

Indeed, the justices do not even agree on the universe of companies covered by ruling. The majority opinion refers repeatedly to “closely held corporations,” which the IRS defines as those that are more than 50 percent owned by five or fewer individuals. But in the dissent, Ginsburg argued that under the decision “corporations, along with partnerships and sole proprietorships, can opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs.”

The justices all but invited the Obama administration to extend to closely held firms the same accommodation it is already providing to religious nonprofits like hospitals and universities: having insurance companies or third-party administrators directly provide contraceptive coverage. But that is itself controversial and the subject of several dozen lawsuits now proceeding towards the high court.

Without deciding those cases in advance, however, Alito said in his majority opinion, “HHS itself has demonstrated that it has at its disposal an approach that is less restrictive than requiring employers to fund contraceptive methods that violate their religious beliefs.”

The administration, however, suggested that fixing the hole in the Affordable Care Act created by the decision ought to be something done by Congress.

“Congress needs to take action to solve this problem that’s been created, and we stand ready to work with them,” said White House Press Secretary Josh Earnest.

Groups on both sides of the case were quick to declare victory – and to warn of the potential problems resulting from defeat.

Mark Rienzi, senior counsel for the Becket Fund for Religious Liberty, which represented the conservative Christian owners of Hobby Lobby, said the decision  “confirmed Americans don’t give up their religious freedom when they open a family business.”

“Allowing bosses this much control over the health-care decisions of their employees is a slippery slope with no end,” said Ilyse Hogue, president of NARAL Pro-Choice America. “Today it’s birth control; tomorrow it could be any personal medical decision, from starting a family to getting life-saving vaccinations or blood transfusions.” 

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In 5-4 Decision, High Court Sides With Hobby Lobby

The Associated Press: Justices: Can’t Make Employers Cover Contraception
The Supreme Court says corporations can hold religious objections that allow them to opt out of the new health law requirement that they cover contraceptives for women. The justices’ 5-4 decision Monday is the first time that the high court has ruled that profit-seeking businesses can hold religious views under federal law (Sherman, 5/30).

Politico: SCOTUS Sides With Hobby Lobby On Contraception Mandate
The Supreme Court ruledŅ-4 in Burwell v. Hobby Lobby that for-profit employers with religious objections can opt out of providing contraception coverage under Obamacare. The decision could open the door to other employers seeking to withhold coverage for other medical procedures at odds with firm religious beliefs (Haberkorn, 6/30).  

KHN will have more coverage throughout the day.

Earlier from KHN: 

— What’s At Stake For Birth Control In Upcoming SCOTUS Decision 
— Justices To Weigh Contraceptive Mandate Against Religious Freedom Claims

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Concerns Rise About Delays In Getting Generic Drugs To Market

PBS NewsHour explores concerns that settlements on patents for drugs sometimes delay the generic version getting to consumers.

PBS NewsHour: Are Generic Drugs Being Delayed To Market?
Are generic drugs being delayed to market by so-called “pay for delay” deals between drug companies? The deals happen after generic drug companies challenge the patents on brand-name drugs. The settlements include a date that the generic drug can enter the market, and in some cases, a payment from brand company to the generic company (Thompson, 6/28).

Also, some pharmacies are looking at ways to help consumers who have multiple prescriptions.

USA Today: Companies Help Patients Manage Multiple Medications
Customers with multiple prescriptions end up with numerous refill dates, resulting in many trips to drug stores to pick up medications. The remedy is pharmacy synchronization, which allows pharmacists like Irons to adjust refill dates so customers can pick up all their prescriptions on the same day. To adjust refill dates, pharmacists need to partially fill some prescriptions — and that takes cooperation from insurance companies. Republican state Sen. Kevin Mullin proposed legislation last winter that would have required insurance companies to cover partial refills of medications for chronic conditions when pharmacists are synchronizing prescriptions (Remsen, 6/Ǽ).

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Rule Issued For Small Business Health Insurance Tax Credit

The regulation sets eligibility requirements for businesses seeking tax credits to help them buy coverage for their workers. Meanwhile, a Republican House member complains about not getting information about how the Small Business Health Options Program (SHOP) is working.

Modern Healthcare:  IRS Issues Rule On Small-Business Health Insurance Tax Credit
The Internal Revenue Service issued a final rule on tax credits intended to make it more affordable for small businesses to buy health insurance for their employees. The rule establishes eligibility requirements for a tax credit introduced by the Patient Protection and Affordable Care Act. The credit has been available since the 2010 tax year but was implemented through IRS notices rather than formal rulemaking, according to Timothy Jost, a Washington & Lee University School of Law professor.  … Eligible small employers are defined as those with no more than 25 full-time equivalent employees who have average annual wages of no more than $50,800 each. Employers must contribute at least 50% of the premium cost on behalf of each enrolled employee and in return, they can claim a  tax credit of 50% of the premium amount paid (Dickson, 6/27).

The Hill: Lawmaker Presses HHS For Small-Business Health Insurance Data
A top GOP lawmaker pushed the administration Friday to release enrollment data measuring the success of the Small Business Health Options Program (SHOP) under ObamaCare. Rep. Sam Graves (R-Mo.), chairman of the House Small Business Committee, issued a statement expressing frustration that the Department of Health and Human Services has repeatedly failed to provide the requested data. “It’s astonishing how little information has been disclosed about a law in which the taxpayers are investing billions. What is the Administration hiding?” Graves asked (Al-Faruque, 6/27).

Also, The New York Times examines one insurer’s effort to find out more about customers.

The New York Times: When A Health Plan Knows How You Shop
There may be a link between your Internet use and how often you end up in the emergency room. At least that’s one of the curious connections to emerge from a health care analysis project at the insurance division of the University of Pittsburgh Medical Center. … But the insurer recently bolstered its forecasting models with details on members’ household incomes, education levels, marital status, race or ethnicity, number of children at home, number of cars and so on. … With the addition of these household details, the insurer turned up a few unexpected correlations: Mail-order shoppers and Internet users, for example, were likelier than some other members to use more emergency services (Singer, 6/28).

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23andMe Founder Working To Restore Firm's Business, Improve Health Care

The FDA shut down the genetic company’s sales of personalized health reports, but CEO Anne Wojcicki is working to get that part of her business back up and running.

The Wall Street Journal: Anne Wojcicki’s Quest For Better Health Care
Anne Wojcicki, chief executive of 23andMe, is determined to overturn the way traditional health care works in the U.S. It hasn’t been easy. Last year, the Food and Drug Administration shut down sales of her genetics company’s personalized health reports — one of its main sources of revenue. But Ms. Wojcicki (pronounced wo-JIT-ski) isn’t backing down. … Her company is working with the FDA on getting its reports approved for direct delivery to consumers. Before the FDA’s warning letter, 23andMe had 550,000 customers. Now it has 700,000, though growth has slowed (Wolfe, 6/27).

The Washington Post: 23andMe Co-Founder Anne Wojcicki’s Washington Charm Offensive
In early May, Anne Wojcicki flew into Washington accompanied by two other billionaire Silicon Valley wives intent on shaking up the health-care industry. Her genetic profiling start-up, 23andMe, a darling of the tech industry, had recently run into trouble with the Food and Drug Administration. It was a setback for the company, but it had given her an important lesson in the power of government. … It was Wojcicki’s first time at the soiree, a coming out for her on the political scene, and she had a lot to say. The first is that the U.S. health-care system is broken (Cha, 6/27).

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Viewpoints: Nothing In Health Care Is Free; Obamacare Opponents Lack Facts; 'Nurse Jackie' And The ER

Los Angeles Times: Mandating Preventive Care Without Co-Pays Is Good, But It’s Not ‘Free’
The Department of Health and Human Services released a report Friday declaring that 76 million Americans with private insurance became eligible for more preventive services with no out-of-pocket fees as a result of the 2010 healthcare law, the Patient Protection and Affordable Care Act (a.k.a. Obamacare). Because Democrats are counting on female voters to help them at the polls in November, the report highlighted how women had been helped by that aspect of Obamacare. “Altogether, a total of 48.5 million women are estimated to benefit from free preventive services,” it stated. But as new HHS Secretary Sylvia Burwell surely knows, given her time as deputy director of President Clinton’s Office of Management and Budget, there is no such thing as “free” services, particularly not in the world of healthcare (By Jon Healey, 6/27).

The New York Times: The Eggs And Us
Both Hobby Lobby and the personhood movement mark a turning point in our long, grueling national battle over reproductive rights. Many Americans are repelled by late-term abortion, but they don’t necessarily feel the same emotional affinity for a fertilized egg. The fact that this is actually a debate about theological dogma gets a lot clearer when you’re closer to the start of the gestational saga (Gail Collins, 6/27).

Los Angeles Times: Healthcare Debate Lacks Factual Arguments Against Obamacare
Americans have always been a politically contentious lot. But one topic seems to produce more pure vitriol than any other: the Affordable Care Act. I posted an item on my Times blog, the Economy Hub, citing new statistics indicating that the act has materially reduced the ranks of the uninsured, kept premiums moderate and seemed likely to keep rate increases modest next year. I sought agreement that, given these developments, “Obamacare is working.” I didn’t get it. What I got instead was an unexampled outpouring of angry, vulgar and bitter emails, almost none of them bearing even the slightest attempt to counter my statistics with alternative facts. … What accounts for the pungent rancor? Here’s a rundown (Michael Hiltzik, 6/27).

Los Angeles Times: I Doubted Heritage Could Run A ‘Straight’ News Site. I Was Right.
And this week, [the Heritage Foundation’s news website] the Daily Signal proudly unburdened itself of a major investigation of the Affordable Care Act that proves our point. It’s chock-full of bogus numbers, basic misunderstandings and tendentious verbiage. The piece is headlined “Obamacare Exchanges are ‘Disappointing’ With Fewer than 4 Million Newly Insured. The Government Hoped for 26 Million.” Misleading on both counts (Michael Hiltzik, 6/27).

The Washington Post: Terry McAuliffe, Virginia Democrats Should Learn Lessons From Defeat On Medicaid
Virginia Democrats are right to be furious that Republicans used a sleazy job offer and a parliamentary gimmick to block Gov. Terry McAuliffe’s top goal of expanding medical insurance for the state’s working poor. Rejecting both compassion and common sense, the GOP went to extraordinary lengths to ensure that Virginia would refuse $2 billion a year in federal funding just because the money was tainted by association with dreaded Obamacare. But after the Democrats have finished gnashing their teeth, they should study the lessons from this major defeat and figure out how to win the contest in the end (Robert McCartney, 6/28). 

The Wall Street Journal: On Medicaid Expansion, Red States Will Be Watching Red States
Since the Supreme Court made expanding Medicaid optional for states under the Affordable Care Act, 26 states have expanded Medicaid. Three of the 24 states that have not–Indiana, Utah and Pennsylvania–are considering expanding via federal waivers that they are negotiating with the Obama administration. … If Indiana, Pennsylvania and Utah reach agreement with the administration and move ahead, that would bring to 10 the number of states with Republican governors that have expanded Medicaid. … Republican governors and legislators will be watching the red states that have expanded Medicaid especially closely. They will want to know if those states are benefiting economically from their new federal funding; how the expansion has affected their state budgets; if their hospitals and counties are less stressed with the federal government paying more of their bills for serving the uninsured; and if Republican elected officials have been hurt or helped politically by their decision to expand (Drew Altman, 6/30).

And on other health topics –

USA Today: Can former P&G CEO Clean Up VA? Our View
On Friday, the White House issued a broadly damning report on the VA, all the more remarkable considering that the administration has been in charge of the agency for the past six years. And today, President Obama will nominate a man to clean up the mess. Robert “Bob” McDonald, a West Point graduate and the former chief executive of Procter & Gamble, lacks experience in health care, which surely will slow him down. But his experience running a sprawling, private-sector institution should give him an edge over the succession of military commanders and career bureaucrats who have headed the troubled agency. If confirmed by the Senate, McDonald will need every ounce of his reputed managerial abilities to turn around the VA’s vast national network of 1,700 hospitals, clinics and other facilities (6/29).

USA Today: Return VA To Its Core Mission: Another View
If there’s one thing all Americans can agree on, it’s that we owe our veterans the care they need to treat injuries suffered while serving their county. But Congress and the organized veterans groups have stretched that vital mission into massive bureaucracy that builds and owns hospitals, hires doctors and provides care directly to millions of veterans, regardless of whether their illnesses are service-related. In the wake of the Veterans Affairs scandal, we may be tempted to believe that the system can be fixed by changing leaders or simply spending more money. But spending for the VA health system has risen eight times faster since 썗 than the number of unique patients. And the problems go back decades (Michael Tanner, 6/29).

The New York Times: Anthrax? That’s Not The Real Worry
Officials at the Centers for Disease Control and Prevention recently discovered that at least 75 workers there had been exposed to possible anthrax infection. We should be glad that it was only anthrax. Anthrax is a dangerous but noncontagious bacterium; the risk to the exposed workers is real, but there is no danger of transmission to others. Much more troubling would be an accidental exposure to a dangerous, contagious pathogen. And unfortunately, that’s also quite possible (Marc Lipstitch, 6/29). 

The New York Times: House Hypocrisy On Insider Trading
[A] federal judge in New York has ordered a hearing this week for an explanation from the [House Ways and Means] committee and the staff member suspected of leaking to a lobbyist nonpublic information he heard last year about pending Medicare rate increases. According to the commission, the lobbyist passed this valuable word along to a health care brokerage firm that quickly issued a private alert to clients. A suspicious spike in trading of shares profitable to the clients occurred before the government made its Medicare decision public. This is clearly a case worth pursuing if the law known as the Stock (Stop Trading on Congressional Knowledge) Act is to be a credible tool against corruption on Capitol Hill and in numerous executive agencies also covered (6ቹ).

The New York Times: Pushback On Home Care
The salvos keep coming from opponents of a new federal rule to ensure that home care workers are paid at least the minimum wage and time and a half for overtime. The rule, many years in the making, reverses a misguided policy from 1974 that has long denied home care workers those basic wage protections. … Now comes another challenge: Three groups that represent home care agencies have filed a lawsuit in federal court to stop the new rule on the grounds that the department exceeded its authority and did not follow proper procedures. That’s a stretch (6/29).

The New York Times: What ‘Nurse Jackie’ Gets Right About The E.R.
Despite the fact that Jackie is a seriously flawed human being, the show itself is a standout portrayal of nursing, when TV almost always gets nursing wrong. Nurse Jackie, played by the gifted Edie Falco, has enviable clinical judgment and an unshakable commitment to patients. But, like many addicts, she lies and sometimes steals to maintain her habit. … But I praise the show because its clinical portrayals of nursing are realistic and mostly positive, in contrast to almost every other medical program on television. TV hospitals are almost exclusively staffed by doctors. … In real hospitals, those jobs are almost always done by nurses, and “Nurse Jackie,” true to its name, shows that (Theresa Brown, 6/28).

The New York Times: The Trauma Of Parenthood
This is the ideology of modern parenting, and it can lead to unnecessary feelings of guilt and shame, for it ignores an inconvenient truth: that many women and men experience significant psychological distress in response to becoming a parent and that much of this distress isn’t caused by a hormonal epiphenomenon of the birth process. It is driven instead in large measure by the objectively bleak circumstances new parents often face. That you love your child is not always sufficient to counteract this reality (Finkel, 6/27).

The Wall Street Journal: Life Lessons From Dad: Caring For An Elderly Parent
My father was born and died at home. Nearly 91 years separated those two days, as did a lifetime of significant experiences, including one Great Depression, one World War, one wife, three children, and one year at my house, where he, accompanied by my mother, went through hospice during his struggle with dementia. Our family’s experience was hardly unique. … As our population ages, tens of millions of Americans will be called on to care for stricken parents. Over 15 million nonprofessionals are estimated to provide Alzheimer’s care alone. What can families expect? (Dave Shiflett, 6/27).

The New York Times’ Motherlode blog: The Battle Over Vaccinating Grandparents
Our midwife recommended that because of a resurgence in cases of whooping cough, I get vaccinated during pregnancy. In addition, she suggested I ask family members who were going to be in frequent contact with our baby, including my husband and our parents, to make sure their shots were up-to-date. My request sparked a firestorm in my family. My in-laws and my mother agreed to the vaccine. But my dad? He refused (Kim Conte, 6/29).

The Washington Post: West Africa Can’t Manage The Ebola Outbreak
An alarming report released last week by Doctors Without Borders said that West Africa’s current Ebola outbreak is “out of control.” That should shock the governments of Guinea, Sierra Leone and Liberia into action. It marks a frightening moment for a disease that has been contained numerous times before (6/29).

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