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With Health Care Repeal, Hospitals in Poor Neighborhoods Face Financial Gloom

The New York Times' Abby Goodnough reports that Temple University Hospital in Philadelphia and other hospitals serving poor neighborhoods face a financial crisis if the Affordable Care Act is repealed. President-elect Donald Trump and Republican Congressional leadership have vowed to do exactly that.

The hospital industry predicts that "hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings."

Prior to the Affordable Care Act, the hospitals had to absorb the cost of caring for uninsured patients. Hospitals who serve a large number of poor and uninsured patients also agreed to funding cuts in exchange for getting more patients with Medicaid and other insurance coverage. If Medicaid expansion is rolled back, hospitals like Temple are hoping that supplemental funds to defray the costs of caring for the uninsured will be restored.

Uninsured Rates Dropping in Most States

Arkansas, Kentucky, Oregon, Rhode Island and Washington all have had a 10-percentage-point reduction in their rates of citizens who don't have health insurance, Gallup's Dan Witters reporst. Seven of the 10 states that have had the greatest reductions in uninsured rates have expanded Medicaid and established a "state-based marketplace exchange or state-federal partnership."

Reuters: CEOs Threatening to Pull Obamacare Support Over Challenge to Workplace Wellness Programs

According to a report in Reuters, several leaders of major American corporations are threatening to start siding with the foes of healthcare reform if President Barack Obama's administration does not stop challenging some workplace wellness programs: "The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't." But the Equal Employment Opportunity Commission has filed lawsuits challenging wellness programs at Honeywell and two other companies, Reuters reports. The EEOC argues that the programs require medical testing in violation of the Americans with Disabilities Act.

According to Reuters, big companies could pursue several strategies to challenge Obamacare: support legal challenges to the subsidies given to people with low incomes to buy health insurance on the federal exchange, make executives available to testify at hearings on Obamacare, and radically change employer-sponsored health insurance by giving workers a fixed amount of money to buy coverage on private insurance exchanges.

Costs of Coverage Under Obamacare Increasing

The costs of health-insurance policies bought under the Affordable Care are projected to go up in 2015--even as much as 20 percent, the New York Times reports. The solution? Switching plans: "The new data means that many of the seven million people who have bought insurance through federal and state exchanges will have to change to different health plans if they want to avoid paying more — an inconvenience for consumers just becoming accustomed to their coverage."

Another Obamacare Glitch Allows Employers to Offer 'Substandard' Insurance

There's another glitch in Obamacare, according to a Washington Post report: "A flaw in the federal calculator for certifying that insurance meets the health-care law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits, such as hospitalization coverage, according to brokers and consultants." The calculator is mainly used by self-insured employers and will allow employers to avoid getting fined as much as $3,000 per worker next year.

Transgender Activists Say State Anti-Bias Law Is Working

Submitted by Amaris Elliott-Engel on Tue, 09/09/2014 - 19:58

Here's a piece I wrote for the Connecticut Law Tribune on the state of transgender rights:

Studying landmark cases may be a hallmark of a legal education, but there are times when the lack of case law may be a good thing.

In the three years since Connecticut enacted a law banning discrimination based on gender identity, James J. O'Neill, a spokesman for the Connecticut Commission on Human Rights and Opportunities, reports that the commission has not received a single discrimination complaint based on gender identity or expression.

The dearth of complaints to the state's civil rights regulators does not mean that transgender people and those who identify with or express themselves as members of the opposite sex do not face discrimination, advocates say. But the law is working to protect people in unofficial ways, said Rachel Goldberg, general counsel for the Stamford Urban Redevelopment Commission and a board member of the national Lambda Legal organization, which advocates for the civil rights of lesbians, gay men, bisexuals and transgender people.

As an advocate, Goldberg, who is transgender, testified in favor of the Connecticut law three years ago. As an attorney, she said she was able to prevent an employee from being fired for undertaking the process to change genders by citing the Connecticut's explicit protection for gender identity. She explained that going to court is not always the best option for employees because new employers are reluctant to hire workers who have sued their past bosses.

"Having that law on the books makes [avoiding court] possible," she said.

The statute codified a 2000 ruling from the CHRO that Connecticut's nondiscrimination laws cover sex and gender identity, Goldberg said. The 2011 law puts lawyers representing individuals in gender identity cases in a stronger position, she said. While opposing counsel might have been able to argue in the past that gender-identity protection was the opinion of just one judge and a CHRO ruling is the opinion of just a few regulators, it's much harder for them to dismiss point-blank statutory language.

The update to Connecticut's law comes as federal level is expanding as well. The U.S. Department of Labor recently issued a directive to government contractors clarifying that discrimination based on gender identity and transgender status is sex discrimination. President Barack Obama has issued an executive order prohibiting federal contractors from discrimination on the basis of sexual orientation and gender identity, and the Labor Department's directive is an interim step to implement regulations to provide those protections.

The action by the Labor Department is "huge," said Jennifer Levi, director of the Transgender Rights Project at Boston-based Gay & Lesbian Advocates & Defenders, an advocacy group that has been active in Connecticut. "Gay, lesbian and transgender people continue to face an unbelievable amount of discrimination in the workplace," Levi said. "Having a prohibition against discrimination with entities that contract with the federal government really extends the commitment to nondiscrimination."

Levi also said that Connecticut's anti-discrimination law is "a very strong law. It makes it every clear that a person's gender identity is determined by a person's assertion of what it is."

Levi, who has conducted training sessions throughout Connecticut in tandem with the CHRO on the law, said that many of the state's employers have revised their employee manuals to ban discrimination on the basis of gender identity and sexual orientation.

"Laws provide legal protection but they also send an important message to those who are protected under the laws" as well as to those who have to abide by the law, Levi said.

Connecticut's law is not the only legal development that has advanced transgender rights.

Meghan Freed, of Freed Marcroft in Hartford, whose practice includes LGBT law, notes that the Connecticut Insurance Department issued a directive last December to stop insurers from having a blanket ban on providing health insurance benefits related to a person's gender identity or expression.

"The monetary reality of costs associated with gender transition is a huge deal," Freed said. "It's an affirmative thing."

The department said that an insurer's refusal to pay for medically necessary treatment regarding gender transition would be an unfair insurance trade practice. The department cited the General Assembly's enactment of the law to prohibit discrimination based on gender identity and expression.

The Insurance Department also cited Connecticut's law requiring parity between medical coverage and mental health coverage.

Medical services for gender transition are still classified as a medical disorder called "gender dysphoria," although advocates bridle at the notion that the issue is an illness of sorts, Freed said. Gender dysphoria is a diagnosis listed in the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" and refers to people who strongly identify with and want to be the opposite gender.

Goldberg agreed that the biggest impact of Connecticut's antidiscrimination laws has been in the area of health care. Before the enactment of the state law, almost every health insurance policy contained language that excluded medical coverage for people who are transgender, even if the same procedure would be available to someone who was not transgender, Goldberg said.

While there has been a lot of progress in protecting people from gender-identity discrimination, the protections for transgender youth needs a lot of work, as has been illustrated in the case of Connecticut's "Jane Doe," a transgender teen who the Department of Children and Families at one point placed in an adult prison because of her allegedly unruly personality. Attorney Aaron Romano has called the state's treatment of his client unconstitutional.

Goldberg said there are significant issues about ensuring youth can get into the right shelters, are able to use the right bathrooms, and have protection for their gender identity if they end up in the juvenile justice system, Goldberg said.

Medicare Will Now Cover Sex Change Surgery

President Barack's Obama administration has ended a 33-year ban on Medicare coverage for gender reassignment surgery, The Washington Post reports. The decision will likely put pressure on private insurers to cover medical procedures for transgendered people, The Post also reports.

There are still barriers, however: "Patients covered under Medicare will not be guaranteed coverage for surgeries under Friday’s decision; they will have to justify their need just as they have to for any other medical treatments. The ruling does not apply to Medicaid, the health program administered by states for low-income individuals and families," according to the Post.

Insurers Joining Health Exchanges After Sitting on Sidelines

Several insurers who waited out the first round of health insurance applications through online exchanges are going to be selling policies through the exchanges next year, the New York Times reports. Even if insurers wait a year or two to enter the exchanges, they can still compete for customers because "people buying coverage in the individual market tend to be focused on price and may quickly switch plans if better deals become available," Larry Levitt, a Kaiser Family Foundation health policy expert told the Times.

Lower Insurance Premiums Projected Through Health-Insurance Exchanges

Premiums for health insurance sold on the Obamacare's exchanges are going to be lower than expected, the Congressional Budget Office projects, according to the Wall Street Journal. The federal government is expected to spend $165 billion less than projected on subsidizing health-insurance plans, the WSJ further reports.

Final Rule On Mental Health Parity Hits the Books

NPR's Michelle Andrews did an interview with Jennifer Mathis of Judge David L. Bazelon Center for Mental Health Law on the final rule from the federal government to enforce parity in health insurance coverage between physical health and mental health.

A couple interesting nuggets:

One- Since interim parity regulations came out, only a small percentage of plans have dropped mental health or substance use coverage.

Two- The final rules make clear in a way that the interim rules didn't that "intermediate-level mental health services, including residential treatment and intensive outpatient services," have to be covered in parity.


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