Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Tuesday, March 05, 2024

Christian Employers Protected from Requirement to Provide Insurance for Gender Transition Procedures

 In Christian Employers Alliance v. U.S. EEOC, (D ND, March 4, 2024), a North Dakota federal district court enjoined the Department of Health and Human Services from enforcing the Affordable Care Act, and the EEOC from enforcing Title  to require the Christian Employers Alliance or its present or future members to provide their employees insurance coverage for gender transition procedures. The court said in part:

... [I]f CEA had to comply with these mandates, its members would have to violate their sincerely held religious beliefs which is an impermissible exercise under the First Amendment and RFRA. ...

While protecting the right of transgender patients to access crucial healthcare and protecting workers from sex discrimination is certainly a compelling interest, the Defendants here have done nothing more than identify a broadly formulated interest in an attempt to justify the general applicability of the government mandates....  Even if the Court were to accept the Defendants’ purpose for the mandates as a compelling interest, the Defendants failed to provide any evidence showing this policy was the only feasible means to achieve its compelling interest....

Just The News reports on the decision.

Friday, April 21, 2023

Suit Challenges Tennessee's Ban On Gender Transition Treatment For Minors

Suit was filed yesterday in a Tennessee federal district court challenging Tennessee's recently enacted law banning medical or surgical treatment of gender dysphoria in minors. The complaint (full text) in L.W. v. Skrmetti, (MD TN, filed 4/20/2023), alleges that the ban violates plaintiffs' Equal Protection rights and their rights to parental autonomy, as well as violating provisions of the Affordable Care Act. ACLU issued a press release announcing the filing of the lawsuit.

Tuesday, January 31, 2023

HHS Proposes Repeal of Exemption from Contraceptive Mandate for Entities with Nonreligious Moral Objections

 Yesterday, the Department of Health and Human Services along with several other federal agencies filed a 147-page release (full text) proposing rule changes to the Trump Administration's exemptive rules under the Affordable Care Act for employers and universities with objections to furnishing employees and students coverage for contraceptive services. The proposed rule changes would eliminate the current exemption for employers and schools that have moral, as opposed to religious objections. The new rules would retain the exemption for employers and universities with religious objections.  However, under new arrangements, their employees and students could, in addition to existing options, obtain contraceptive services through an individual contraceptive arrangement with another provider, and without any involvement on the part of the employer or university with religious objections. The Center for Medicare and Medicaid Services issued a press release explaining the proposed rules, and CNN reports on the proposals.

Wednesday, January 11, 2023

Catholic Hospital's Denial of Gender Dysphoria Procedure Is Illegal Sex Discrimination

In Hammons v. University of Maryland Medical System Corp., (D MD, Jan. 6, 2023), a Maryland federal district court held that a hospital's refusal to allow plaintiff to have a hysterectomy performed at the hospital to treat gender dysphoria was sex discrimination in violation of the Affordable Care Act's discrimination ban. The hospital was originally a Catholic hospital, and when the University of Maryland System acquired it, the purchase agreement required it to continue to abide by the Ethical and Religious Directives for Catholic Health Services promulgated by the United States Conference of Catholic Bishops. In finding discrimination, the court said in part:

It may be true that St. Joseph prohibits medical personnel from performing hysterectomies on all individuals, regardless of sex, who do not have a medical need for that surgery—i.e., individuals who seek a hysterectomy solely for the purpose of elective sterilization. However, Mr. Hammons did have a medical need for his requested hysterectomy; he was not seeking a hysterectomy for the purpose of elective sterilization.

The court also concluded that since defendant is a wholly owned subsidiary of a state actor, a RFRA defense is not available to it. It added that even if defendant is considered a private actor, a RFRA defense is not available because RFRA only applies to burdens on free exercise imposed by the government. Daily Citizen reports on the decision.

Sunday, December 11, 2022

8th Circuit Affirms RFRA Rights of Catholic Health Care Organizations to Refuse Gender Transition Services

In Religious Sisters of Mercy v. Becerra, (8th Cir., Dec. 9, 2022), the U.S. 8th Circuit Court of Appeals affirmed a district court decision that enjoined the federal government from requiring various Catholic health care organizations to perform or provide insurance coverage for gender transition procedures. The district court concluded that plaintiffs' rights under the Religious Freedom Restoration Act were violated by the requirements imposed by the government's interpretation of the Affordable Care Act and Title VII.  On appeal, the government raised only jurisdictional challenges-- standing, ripeness and lack of irreparable harm.  The 8th Circuit rejected the government's challenges, except as to standing of one organizational plaintiff.

Tuesday, November 15, 2022

Court Says Title IX and ACA Do Not Bar Transgender Discrimination

In Neese v. Beccera, (ND TX, Nov. 11, 2022), a Texas federal district court granted declaratory relief concluding that neither Title IX nor Section 1557 of the Affordable Care Act that incorporates Title IX's ban on sex discrimination prohibit discrimination on the basis of sexual orientation and gender identity.  At issue is a Notice and Guidance on Gender Affirming Care issued by the Department of Health and Human Services in March 2022 which is challenged by two physicians who make sex-specific medical decisions relevant to gender identity. The court reasoned that the Supreme Court's Bostock decision that interprets Title VII's prohibition of discrimination "because of" sex does not automatically carry over to Title IX that prohibits discrimination "on the basis of" sex. The court began its opinion as follows:

In his Bostock dissent, Justice Alito foresaw how litigants would stretch the majority opinion like an elastic blanket to cover categories, cases, and controversies expressly not decided. Justice Alito warned: "The entire Federal Judiciary will be mired for years in disputes about the reach of the Court's reasoning."...

And here we are....

The court reasoned in part:

Title IX presumes sexual dimorphism in section after section, requiring equal treatment for each "sex."...

Defendants' reinterpretation of Title IX through the Notification imperils the very opportunities for women Title IX was designed to promote and protect -- categorically forcing biological women to compete against biological men.

ADF issued a press release announcing the decision.

Thursday, September 08, 2022

ACA Mandate To Cover PrEP Drugs Violates RFRA

In Braidwood Management Inc. v. Becerra, (ND TX, Sept. 7, 2022), a Texas federal district court held that the ACA mandate for health insurance coverage of PrEP drugs violates the rights under the Religious Freedom Restoration Act of a for-profit corporation whose owner believes that providing such coverage for his employees would make him complicit in their homosexual conduct and sexual activity outside of marriage. The court said in part:

Defendants dispute Hotze’s beliefs. They argue that Hotze’s claim that PrEP drugs facilitate various kinds of behavior is an empirical one that requires factual support.... But Defendants inappropriately contest the correctness of Hotze’s beliefs, when courts may test only the sincerity of those beliefs...

Defendants claim a compelling interest in reducing the spread of HIV, a potentially fatal infectious disease.... 

But Defendants frame the interest too broadly. “RFRA requires the Government to demonstrate that the compelling interest test is satisfied through application of the challenged law ‘to the person’—the particular claimant whose sincere exercise of religion is being substantially burdened.” ...

... Defendants provide no evidence of the scope of religious exemptions, the effect such exemptions would have on the insurance market or PrEP coverage, the prevalence of HIV in those communities, or any other evidence relevant “to the marginal interest” in enforcing the PrEP mandate in these cases...

Even if Defendants had satisfied the compelling-interest prong, they have not shown that the PrEP mandate is the least restrictive means of furthering that interest...

Much of the court's 42-page opinion relates to other issues. Bloomberg reports on the decision. [Thanks to James Phillips for the lead.]

Sunday, August 28, 2022

5th Circuit Approves Injunction Shielding Religious Organizations From Mandate On Transgender Medical Care

In Franciscan Alliance, Inc. v. Becerra, (5th Cir., Aug. 26, 2022), the U.S. 5th Circuit Court of Appeals, invoking RFRA, upheld a Texas federal district court's issuance of a permanent injunction barring the government from interpreting or enforcing provisions of the Affordable Care Act to require religious organizations, in violation of their religious beliefs, to perform or provide insurance coverage for gender-reassignment surgeries or abortions. At issue is the interpretation of the ACA's ban on discrimination on the basis of sex. The court however held that an alternative claim based on the Administrative Procedure Act was moot. Becket issued a press release announcing the decision.

Tuesday, August 16, 2022

HRSA Wrongly Eliminated Required Insurance Coverage For Natural Family Planning Methods

 In Tice-Harouff v. Johnson, (ED TX, Aug. 12, 2022), a Texas federal district court held that changes in the language of federal regulations specifying the required cost-free contraceptive coverage by qualified health plans eliminated coverage for fertility-awareness based methods. These natural family planning methods are used, among others, by women with religious objections to use of contraceptives. The court held that the Health Resources and Services Administration violated the Notice and Comment requirement of the Administrative Procedure Act in adopting the amendments and that the amendments were arbitrary and capricious. The court rejected the government's claim that the change in language had not eliminated coverage for such methods. ADF issued a press release announcing the decision.

Tuesday, April 12, 2022

New Alabama Ban On Gender Transition Procedures For Minors Is Challenged

Suit was filed last week in an Alabama federal district court challenging SB 184, the Alabama Vulnerable Child Compassion and Protection Act (full text), which prohibits medical procedures or the prescription of drugs for a minor child to alter the child's gender or delay puberty. The law was given final passage by the legislature on April 7 and signed by the governor on the next day. Parents of two transgender teenagers and two physicians filed suit 3 days later. The complaint (full text) in Ladinsky v. Ivey, (ND AL, filed 4/11/2022), contends that the law is pre-empted by a provision in the Affordable Care Act, that the law violates equal protection, parents rights to direct medical care of their children, and is void for vagueness. Courthouse News Service reports on the lawsuit.

Thursday, July 29, 2021

Catholic Hospital's Refusal To Allow Gender Dysphoria Procedure Violates ACA Discrimination Ban

In Hammons v. University of Maryland Medical System Corporation, (D MD, July 28, 2021), a transgender man challenged the refusal by University of Maryland St. Joseph Medical Center to allow his physician to perform a hysterectomy as part of his treatment for gender dysphoria. The hospital, while a subsidiary of the University of Maryland state system, adheres to Catholic religious doctrine. The court dismissed plaintiff's Establishment Clause and Equal Protection Clause claims on 11th Amendment state sovereign immunity grounds. However the court concluded that plaintiff had stated an adequate claim of sex discrimination that is prohibited by §1557 of the Affordable Care Act.

Tuesday, August 18, 2020

Court Enjoins Trump Administration Roll Back of Transgender Protections In Health Care

 In Walker v. Azar, (ED NY, Aug. 17, 2020), a New York federal district court enjoined the Trump Administration's roll back of anti-discrimination rules under the Affordable Care Act and Title IX. The roll back eliminated protections for LGBTQ individuals, and in particular for transgender persons. Citing the Supreme Court's recent Bostock decision, the court stayed the new rules' definition of discrimination on the basis of sex.  The court said:

As a result, the definitions of “on the basis of sex,” “gender identity,” and “sex stereotyping” currently set forth in 45 C.F.R. § 92.4 will remain in effect.

Politico reports on the decision.

Tuesday, July 21, 2020

23 States Sue HHS Over Rollback of Anti-Discrimination Protections In Health Care

Attorneys general representing 22 states and the District of Columbia filed suit yesterday challenging the Trump Administration's recently-adopted rules under the Affordable Care Act and under Title IX which roll back anti-discrimination provisions protecting, among others, transgender individuals and those who have accessed abortion services. The complaint (full text) in State of New York v. U.S. Department of Health and Human Services, (SD NY, filed 7/20/2020), contends that the new rules deny equal protection of the laws and that their adoption was in violation of various provisions of the Administrative Procedure Act. Courthouse News Service reports on the lawsuit. New York's Attorney General issued a press release announcing the filing of the lawsuit.

Tuesday, June 23, 2020

Suit Challenges Roll-Back of Health Care Protections For Transgender Individuals

Suit was filed yesterday in the D.C. federal district court challenging the Trump Administration's recent rule change that rolled back health care anti-discrimination protection for transgender individuals. The complaint (full text) in Whitman-Walker Clinic, Inc. v. U.S. Department of Health and Human Services, (D DC, filed 6/22/2020) alleges in part:
[T]he Revised Rule imports broad and sweeping exemptions for discrimination based on personal religious or moral beliefs from the identified statutes in Section 1557 [of the Patient Protection and Affordable Care Act] and other statutes, including the Religious Freedom Restoration Act ... which Section 1557 does not reference. These exemptions invite individual health care providers, health care entities, and insurers across the country to opt out of treating patients, including many transgender patients, if they believe doing so would compromise their faith....
HHS’s attempt to create new religious exemptions in Section 1557 is contrary to law and endangers patients’ health in the name of advancing the religious beliefs of those who are entrusted with caring for them—a result sharply at odds with HHS’s stated mission to “enhance and protect the health and well-being of all Americans” and to “provid[e] for effective health and human services.”
 The Hill reports on the filing of the lawsuit.

Wednesday, May 06, 2020

Supreme Court Will Broadcast Contraceptive Mandate Case Arguments Today In Real Time

Beginning at 10:00 am (EDT) this morning, the U.S. Supreme Court will hear consolidated oral arguments in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania  (SCOTUSblog case page) and Trump v. Pennsylvania (SCOTUSblog case page). In the case, the 3rd Circuit upheld a nationwide preliminary injunction against enforcement of the Trump Administration's final rules expanding exemptions under the Affordable Care Act for employers with religious or moral objections to contraceptive coverage. Little Sisters of the Poor were intervenors in the 3rd Circuit case. (See prior posting.)  Under the Supreme Court's special procedures for arguments during the COVID-19 crisis, arguments will be conducted via teleconference which will be broadcast live by C-Span at this link.

Tuesday, December 24, 2019

New HHS Obamacare Rule Requires Separate Bill For Abortion Services

The Department of Health and Human Services last week issued a group of rules (full text) on oversight of state Obamacare exchanges.  One portion of the new rules changes the billing requirements for health insurance policies that cover abortion services. The Affordable Care Act requires a separate payment by the policyholder for the amount of the premium that covers abortions in order to avoid public funds being used to pay for abortions.  The new rules sharpen that requirement.  As explained in the HHS Fact Sheet on the new rules, health plan issuers will now be required to:
(1) send an entirely separate monthly bill to the policy holder for only the portion of premium attributable to coverage of certain abortion services, and (2) instruct the policy holder to pay the portion of their premium attributable to coverage of certain abortion services in a separate transaction....  QHP issuers sending paper bills will be permitted to send the separate paper bill in the same mailing as the separate bill for the rest of the enrollee’s premium. QHP issuers sending bills electronically will be required to send the separate bill in a separate email or electronic communication.... However, if the policy holder fails to pay the separate bill in a separate transaction as instructed by the issuer, the issuer may not terminate the policy holder’s coverage on this basis, provided the amount due is otherwise paid.

Friday, November 29, 2019

State Insurance Regulators Target Trinity Health-Care Sharing Ministry

NPR reported earlier this week on enforcement actions by insurance regulators in Texas, Colorado, Washington and New Hampshire against Aliera and its affiliate Trinity HealthShare for violating rules relating to health-care sharing ministries. These plans for sharing health care costs of members are significantly cheaper than standard health insurance policies. Most of the Christian affiliated ministries will not cover abortion services, and offer prayer hotlines for members. The October 30 press release from the New Hampshire Insurance Department announcing its enforcement action states in part:
Trinity represents itself as a health care sharing ministry, which would be exempt from state insurance regulation. A legal health care sharing ministry is a nonprofit organization in existence since December 31, 1999, whose members share a common set of ethical or religious beliefs and share medical expenses among members. [Trinity was not formed until 2018 and did not show it is faith based and limited its membership to those with common beliefs.]
The Department’s Consumer Services Division received dozens of complaints and concerns from consumers. Some people believed they were buying health insurance and did not know they had joined a health care sharing ministry. Many people discovered this when their claims were denied because their medical conditions were considered pre-existing under the plan, or were not covered because they were deemed inappropriate for a “Christian lifestyle.” 
[Thanks to Scott Mange for the lead.]

Tuesday, October 08, 2019

Cert. Petition Filed In Contraceptive Mandate Exemption Challenge

The Justice Department yesterday filed a petition for certiorari (full text) in Trump v. Commonwealth of Pennsylvania. In the case, the U.S. 3rd Circuit Court of Appeals affirmed a district court's entry of a nationwide preliminary injunction against enforcement of the Trump Administration's final rules expanding the scope of the exemptions under the Affordable Care Act for employers having religious or moral objections to contraceptive coverage. (See prior posting.) The cert. petition presents the following questions:
1. Whether the agencies had statutory authority under the ACA and the Religious Freedom Restoration Act ..., to expand the conscience exemption to the contraceptive-coverage mandate.
2. Whether the agencies’ decision to forgo notice and opportunity for public comment before issuing the interim final rules rendered the final rules—which were issued after notice and comment—invalid under the Administrative Procedure Act....
3. Whether the court of appeals erred in affirming a nationwide preliminary injunction barring implementation of the final rules.
[Thanks to Tom Rutledge for the lead.]

Thursday, March 21, 2019

ACA Mandate Does Not Violate RFRA

In Cash v. United States, (MD PA, March 20, 2019), a Pennsylvania federal district court rejected an attack on the Affordable Care Act's tax penalties for failing to purchase health insurance. Plaintiff taxpayers had religious objections to purchasing medical insurance and contended that the penalties substantially burdened their religious exercise under RFRA (see prior posting). The court disagreed, saying in part:
The Magistrate Judge ... found that the burden imposed on Plaintiffs was de minimis.... RFRA prohibits substantial burdens on the free exercise of religion absent a compelling governmental interest achieved by the least restrictive means.... Describing the thousands of dollars Plaintiffs have paid in ACA penalties since 2014 as de minimis may not be fair. However, that does not render the penalties substantially burdensome, either. Plaintiffs offer no indication that they are forced to decide between their religious beliefs and a benefit generally available. Moreover, Plaintiffs do not allege or otherwise show that the ACA penalty places a substantial burden on them to modify their religious conduct.... [T]he cost of the penalty would not exceed the cost to obtain the required level of insurance. Plaintiffs do not indicate how this applies substantial pressure to forego their religious beliefs. Staying true to their religion and avoiding health insurance would cost no more, and potentially cost less, than purchasing insurance at the expense of their religious beliefs.

Sunday, February 03, 2019

ACA Shared Responsibility Payment Did Not Violate Taxpayer's Free Exercise Rights

In Cash v. Internal Revenue Service, 2019 U.S. Dist. LEXIS 11603 (MD PA, Jan. 23, 3019), a Pennsylvania federal magistrate judge recommended dismissing a taxpayer's claim that the tax ("shared responsibility payment") imposed by the Affordable Care Act for failing to maintain health insurance violated plaintiff's free exercise rights under the 1st Amendment and RFRA.  Plaintiff Robert Cash alleged that, "[a]lthough not required by [his religious denomination] to forego health insurance, [he] has chosen, as a matter of personal faith, to put his health needs in the hands of his Lord rather than the government's health insurance scheme." The court concluded however that the provision is a neutral law of general applicability. It went on to conclude that Cash failed to allege any facts establishing that the requirement restricted or imposed anything more than a de minimis burden on Cash's religious practice.