Legal Challenges to the ACA: Risks for Health Insurers – A 2016 Update
Enrollment in health insurance under the Affordable Care Act (ACA) is proceeding more smoothly. In the recent 6-3 King v. Burwell decision, the U.S. Supreme Court excludes premium tax credit subsidies for millions of enrollees in ACA marketplaces run by the federal government.
Several legal challenges to the ACA are still expected by health insurers in 2016. Among these are the uncertain retention of ACA subsidies, the increased regulation of exchange plan network insurers, the enrollment of new uninsured patients to private plans offered by exchanges, and the new Republican Congress’ possible elimination of the ACA.
Other issues in need of clarifications include the 2016 benefit and payment final rules for qualified health plans, solitary dental plans, and exchanges; contract charges for Medicare Advantage and Prescription Drug Plans; the effects of increasing drug costs and employer mandate on employer coverage and businesses; the effects on risk adjustment programs and private Medigap policies.
In a two-hour LIVE Webcast, a panel of thought leaders and practitioners assembled by The Knowledge Group will discuss the latest Legal Challenges to the ACA and the Risks for Health Insurers in 2016. The panel of speakers will suggest possible strategies to minimize the risks health insurers may encounter as legal changes come about.
Key issues include that will be covered in this course are:
- Affordable Care Act (ACA)
- Impact of King v. Burwell Court Decision
- Health Insurance Law Primary
- Other Legal Challenges to ACA Subsidies
- Elimination of Premium Tax Credit Subsidies
- Exchange Plan Networks
- Employer-Based vs. Exchange-Based Coverage
- Potential Actions of Republican Congress & Their Consequences
- Final Rules in Qualified Health Plans, Dental Plans, and Exchanges
- Medicare Advantage and Prescription
- Employer's Directive in Employee's Coverage
- Risks Adjustment Programs
- Compliance Issues and Litigation Risks
- Best Practices in Mitigating Risk
Brunswick Group LLP
- How the ACA Impacts ERISA Plans (employer sponsored coverage) and Exchange Plans (ACA compliant individual coverage). Insurers need to comply with both federal and state regulations. This is a general background section.
- Preparation for and evaluation of insurer risks in a highly regulated and highly politicized environment.
- Exchange Plans (Qualified Health Plans) direction and economics for 2016
- 2016 enrollment, changes and trends
- 2016 premiums, changes and trends
- Changes in risk corridors and related programs, potential insurer impact
- Significant changes in regulatory requirements, in particular network scope and non-discrimination
- Interesting stories about how insurers deal with the serious economic and political risks presented by the serious economic challenges insurers face in offering individual policies on the exchanges. As I understand this, the problem is that insurers are losing a lot of money on these exchange act plans because sick folks enroll, but health folk do not enroll, they pay the ACA penalties (which are cheaper than insurance premiums). This poses economic and political risk.
- Employer Sponsored Coverage, ERISA plans
- Significant 2016 regulatory changes
- Cost impact of employer mandate, implications for benefit design
- Strategies to deal with rising costs, consumer driven healthcare
- Unique risks employers face concerning both ACA compliance and political concerns. Employer cooperation and clout?
- Future trends, 2016 and 2017
- Legislative changes, political drivers?
- Exit of the Kentucky Health Benefit Exchange
- Demise of Co-op plans?
Who Should Attend:
- Health Care Insurance Companies
- Health Care Law Attorneys
- Healthcare Consultants
- Healthcare Service Professionals
- Medical Directors
- Medical Providers
- Employment Law Attorneys
- Other Related/Interested Professionals and Organizations
Elizabeth Mann is a partner in Mayer Brown’s Los Angeles office. She concentrates her practice on health care regulatory and litigation matters and co-leads the firm’ significant Health Care practice.
Elizabeth's health care litigation experience is quite varied. She was lead counsel for American Specialty Health in a nationwide antitrust litigation concerning Medicare Advantage benefits. She defended Amgen, Inc. in a nationwide antitrust matter involving the marketing and sale of anticancer therapies. Elizabeth has handled a number of qui tam actions involving claims under federal and multiple state laws. In addition, Elizabeth acts as outside General Counsel to a health care organization that insures, delivers and administers clinical care in 48 states.
Elizabeth is very active in the Los Angeles legal community. She is the Chair Emeritus of the Litigation Section of the Los Angeles County Bar Association. Elizabeth has twice been named by the Daily Journal as one of the top 100 women litigators in California. Elizabeth is also a member of the Board of Directors of LA's Promise, a non-profit organization that partners with Los Angeles Unified School District to manage two inner city high schools. In addition, Elizabeth is a member of the Board of Directors of the Constitutional Rights Foundation.
Elizabeth Mann is a partner in Mayer Brown’s Los Angeles office. She concentrates her practice on health care regulatory and …
David Seldin is a Partner in Brunswick’s Washington, DC office, and co-lead of the firm’s healthcare practice. He advises companies across the health sector on critical communications and public affairs challenges around mergers & acquisitions; regulatory and litigation matters; crisis and issues management; thought leadership; and core reputation management. Clients include leading companies in the biopharmaceutical, health insurance, medical devices, health IT, and pharmacy distribution industries, as well as biotech startups, and not-for-profit research institutions. He has also advised clients outside of healthcare on critical issues, including helping to lead Brunswick’s support for BP during the Gulf of Mexico crisis.
Prior to joining Brunswick he led corporate communications at Blue Shield of California. He served as a press aide on President Bill Clinton’s White House staff, Communications Director for U.S. Senator Ron Wyden, senior strategist on successful statewide campaigns in Michigan and Maryland, and as head of communications and marketing for a prominent national advocacy organization. He is a graduate of Colgate University, and studied in the Graduate Writing Program at The Johns Hopkins University.
David Seldin is a Partner in Brunswick’s Washington, DC office, and co-lead of the firm’s healthcare practice. He advises companies …
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About Mayer Brown
Mayer Brown is a leading global law firm advising clients across the Americas, Asia and Europe. The firm is known for its client-focused approach to providing creative solutions to complex problems on behalf of businesses, governments and individuals worldwide. Mayer Brown serves many of the world’s largest companies, including a significant proportion of the Fortune 100, FTSE 100, DAX and Hang Seng Index companies and more than half of the world’s largest banks. The firm provides legal services in areas such as banking and finance; corporate and securities; litigation and dispute resolution; antitrust and competition; US Supreme Court and appellate matters; employment and benefits; environmental; financial services regulatory & enforcement; government and global trade; intellectual property; real estate; tax; restructuring, bankruptcy and insolvency; and wealth management.
About Brunswick Group LLP
Brunswick is an advisory firm specializing in critical issues and corporate relations: a global partnership with 23 offices in 14 countries. Founded in 1987, Brunswick has grown organically, operating as a single profit center – allowing us to respond seamlessly to our clients’ needs, wherever they are in the world.