iLoveBenefits: Industry News Blog

Recent articles on health care mergers and acquisitions

18 Recent Hospital Mergers and Acquisitions
Becker’s Hospital Review, March 4, 2013

Expert: Hospitals’ ‘Humongous Monopoly’ Drives Prices High
Kaiser Health News Blog, March 4, 2013

High court ruling opens hospital mergers to more scrutiny
American Medical News, March 4, 2013

Health Care: Supreme Court Decision – in case you missed it!

In case you missed the Supreme Court’s ruling on the Affordable Care Act – perhaps you were asleep under a rock . . .

This process demonstrates why we are the greatest nation on earth. The process works, the Supreme Court fulfilled its role, as established under Marbury v. Madison in 1803. While some are bound to disagree and the unintended consequences of the decision will not be known for some time (almost all decisions have unintended consequences) the process works and civility reins.

The U.S. Supreme Court issued its decision on the Patient Protection and Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius. The main findings were:

(1) The Anti-Injunction Act does not bar a challenge to the ACA’s individual mandate, which requires individuals to maintain health coverage for themselves and their dependents or pay a penalty on federal tax returns;

(2) The individual mandate is constitutional as a valid exercise of Congress’s taxing power, but not Congress’s powers under the Commerce Clause; and

(3) ACA’s Medicaid expansion is constitutional, although HHS cannot withhold a state’s existing Medicaid funding for failure to comply.

Since the Court upheld all provisions of the law, all requirements affecting employer-sponsored plans, including (but not limited to) the following, survive:

  • Dependent child coverage to age 26
  • Prohibition on annual and lifetime dollar limits on essential health benefits
  • Coverage of recommended preventive services without cost-sharing
  • Prohibition on preexisting condition exclusions
  • Internal claims and appeals and external review rules
  • Summary of benefits and coverage
  • $2500 limit on health FSA salary reduction elections
  • Prohibition on health accounts reimbursing costs of over-the-counter medicines without prescriptions
  • Employer “free rider” assessment
  • Form W-2 reporting of costs of health coverage
  • Payment for routine care costs for clinical trials
  • “Cadillac” tax on high-cost health plans
  • Exchanges and associated premium tax credit and cost-sharing reductions
  • Medicare reforms, including prescription drug discounts, filling in of the  “doughnut” hole, accountable care organizations, transparency and public reporting provisions, fraud/abuse provisions, and payment reforms
  • Expansion of Medicaid eligibility to individuals under age 65 with incomes up to 133% of the federal poverty level

The text of the decision can be found here:

Post Supreme Court – we need to work hard to deliver a better health care system for everyone

Remember, health care is everyone’s destiny.


This from the Consumer Purchaser Disclosure project:


June 28, 2012

What a historic day!  Below is the CPDP statement in response to today’s Supreme Court ruling on the ACA.  For a copy of the ruling, click here.

Now that  the Supreme Court has rendered its decision regarding the constitutionality of the Patient Protection and Affordable Care Act (ACA), it is time to focus on how best to implement the law to achieve its critical goals of expanded measurement, public reporting, payment reform, and delivery system innovation. Working together we can improve the way care is delivered so that patients get the care they need when they need it and in the most efficient ways possible. We have been encouraged by the early progress by Medicare to begin testing such innovations as the Patient-Centered Medical Homes and Accountable Care Organizations as well as the broader efforts to expand the use of health information technology. We also look forward to continuing our work with States and the Federal government to develop Health Insurance Exchanges that can help to drive improved transparency and value across the system. Consumers and purchasers look forward to working with policymakers from both parties in Washington and in State capitols across the country to make the promise of reform a reality for patients, providers, and purchasers.

The Consumer-Purchaser Disclosure Project is a broad coalition, dedicated to improving the quality and affordability of health care in America for consumers and health care purchasers. The project’s mission is to put the patient in the driver’s seat—to share useful information about provider performance so that patients can make informed choices and the health care system can better reward the best performing providers. The coalition is comprised of consumer organizations, leading national and local employers and labor organizations. For more information contact or visit our website at

A Supreme Court decision for the ages

Supreme Court upholds ACA but makes Medicaid expansion optional for states
The Supreme Court today largely upheld the Affordable Care Act, but it ruled that the government cannot withhold Medicaid funds from states that choose not to comply with provisions for the expansion of Medicaid. The Wall Street Journal (6/28)

Those that know have spoken and now we know too

PPACA is upheld 5-4


Really complicated logic. There will be lots of commentary in the coming hours, days, weeks, months and years. Stay tuned.

No matter what the Court decides health care delivery in the US is changing

Making healthcare better, cheaper and more coordinated for everyone is an  attainable goal right now, but it won’t stay that way forever, former CMS  Administrator Dr. Donald Berwick told a keynote audience Monday at the annual  meeting of the American Health Lawyers Association.
“It is not possible,  if you know what I know, to say in America we can’t do it. We can do it,”  Berwick said Monday in Chicago. “The issue is political will, managerial  will.”
Read more: Berwick: Court’s reform decision ‘not the whole game’ – Healthcare business news and research | Modern Healthcare ?trk=tynt

Health Reform and the Supreme Court

The Supreme Court heard three days of oral arguments on the challenge by 26 states and several private plaintiffs to the constitutionality of the Affordable Care Act. Specifically, the plaintiffs argued that the ACA’s minimum coverage requirement — sometimes known as the “individual mandate” — was authorized neither by Congress’s Constitutional power to regulate interstate commerce, nor by its power to levy taxes. The state plaintiffs also argued that they were being unconstitutionally coerced to participate in the ACA’s Medicaid expansion. Health Affairs Blog offers posts by several noted legal experts analyzing the arguments.

Day One: Does the Tax Anti-Injunction Act Deprive the Court of jurisdiction to consider a challenge to the minimum coverage requirement until someone is actually penalized for violating the provision?

Day Two: Does the minimum coverage requirement exceed Congress’s Constitutional powers?

Day Three (morning): If the ACA’s minimum coverage requirement or Medicaid expansion is struck down, what other parts of the law, if any, must also be voided?

Day Three (afternoon): Are states unconstitutionally coerced into participating into the ACA’s Medicaid expansion by the prospect of losing all Medicaid funding if they do not participate?

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Economists Address the Supreme Court

This article from Greg Scandlen:


Today’s Myth Buster is brought to you by 215 economists headed by Douglas Holtz-Eakin, former CBO director and currently with the American Action Forum. These economists have filed an amicus brief with the U.S. Supreme Court in connection with its consideration of the Affordable Care Act, known familiarly as ObamaCare.


In the course of writing the brief, these folks bust a number of long-standing liberal myths that are built into any discussion of health care, including the ideas that:

  • Health care is different than other market segments and so is exempt from the rules that apply to other markets.
  • Because health care is so unique, allowing extraordinary federal interference will have no precedent for other markets.
  • There are no non-consumers of health care services, so each and every resident is “active” in the health care market.
  • Failure to be insured means that people impose large costs on the more responsible members of society.

Each of these ideas (myths) is not just refuted but demolished – and long overdue. Let’s take them one at a time.
Read more here


March 21, 2012 | Categories: Health Reform Law,healthcare,Supreme Court | Tags: , , | Comments (0)

What to expect in health care reform this year

The Supreme Court case on the 2010 health care law, the Oct. 1 changes to Medicare payments and the presidential election are three of the expected watershed events this year for health care reform, Sarah Kliff writes. Others are the launch of accountable care organizations, which occurred this week, and the Dec. 31 deadline for states to have made sufficient progress on health insurance exchanges to avoid a federal takeover of the process. The Washington Post/Wonkblog (1/3)

High court finalizes dates of oral arguments on health care law

  • High court finalizes dates of oral arguments on health care law
    The Supreme Court on Monday announced it would hear oral arguments on the Affordable Care Act for five-and-a-half hours spread over three days from March 26 to 28. The court said it will allot one hour of arguments on March 26 to study whether legal challenges on the mandate must wait until the law takes full effect in 2014. A two-hour argument on March 27 is set to discuss the law’s constitutionality, while a 90-minute argument on March 28 will mull whether other parts of the law will survive if the mandate is struck down. Reuters (12/19)
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