Sedgwick’s Top 10 List of Healthcare Issues to Watch in 2014

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We are watching decisions and regulatory developments that will impact health insurers and the way they do business.  What are you watching for in 2014?  Issues surrounding the implementation of the Affordable Care Act (ACA) capture our top three spots.  Next, we are following several decisions rendered on four cutting-edge topics.  Our final group is a trio of rapidly emerging healthcare developments.

1.  The first issue we expect to keep us busy in the new year is the question of whether the federal government can offer subsidies for coverage obtained through the federal exchange under the ACA.  We are closely watching Halbig v. Sebelius in the U.S. District Court for the District of Columbia and three other cases that involve challenges to the IRS’ interpretation of the act to permit subsidies for policies purchased on the federal exchange as an attempt to legislate under the guise of interpretation.

2. Also ACA related are the challenges to the contraceptive mandate.  The U.S. Supreme Court will resolve a split in the circuit courts:  Kathleen Sebelius et al. v. Hobby Lobby Stores Inc. et al., USSC docket number 13-354 [10th Circuit], and Conestoga Wood Specialties Corporation, et al.  v. Sebelius et al., USSC docket number 13-356 [3rd Circuit].

3. The third ACA-related issue is probable litigation arising from ACA enrollment and pricing.

4. A decision from FTC trial challenging St. Luke’s Health System's acquisition of Idaho's largest multi-specialty independent practice association.

5. Decision in Aetna’s antitrust lawsuit against Blue Cross Blue Shield Michigan based on the use of “most favored nations” clauses.

6. Decision in Alabama MDL alleging a conspiracy among the Blue Cross and Blue Shield Association and its member plans to divide the U.S. healthcare market into geographical areas that allowed plans to avoid competing with each other.

7. Rollout First Enterprise Risk Report filings (Form M) in 2014.

8. Development of enterprise risk assessment tools in anticipation of the ORSA (Own Risk and Solvency Assessment) rollout in 2015.

9. In the ERISA area, ramifications of the Sixth Circuit Court of Appeal's recent ruling in Rochow v. LINA, which affirmed a $3 million award to the plaintiff and ruled that because the ERISA plan wrongfully denied the plaintiff’s claim for benefits, it not only had to pay the back benefits plus interest, but also had to disgorge any profits it made on investing this money along with the other funds in its general assets.

10. Texas Prompt Pay litigation. 

 

 

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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