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Barack Obama

New Year Brings New Challenges for Obamacare



(AP) This could be the year that things finally turn around for President Barack Obama's health care law. Yet it could start with another round of glitches that vex consumers and leave Republicans crowing, "We told you so."

The law's major benefits take effect with the new year, along with an unpopular insurance mandate and the risk of more nerve-racking coverage disruptions.

 

The Supreme Court has thrown a hitch into President Barack Obama's new health care law by blocking a requirement that some religion-affiliated organizations provide health insurance that includes birth control.

Justice Sonia Sotomayor late Tuesday night decided to block implementation of the contraceptive coverage requirement, only hours before portions of the law would have gone into effect on New Year's Day.

Her decision, which came after federal court filings by Catholic-affiliated groups from around the nation in hopes of delaying the requirements, throws a part of the president's signature law into temporary disarray. At least one federal appeals court agreed with Sotomayor, issuing its own stay against part of the Affordable Care Act, also known as Obamacare.

Sotomayor acted on a request from an organization of Catholic nuns in Denver, the Little Sisters of the Poor Home for the Aged. Its request for an emergency stay had been denied earlier in the day by a federal appeals court.

The government is "temporarily enjoined from enforcing against applicants the contraceptive coverage requirements imposed by the Patient Protection and Affordable Care Act," Sotomayor said in the order.

Sotomayor gave government officials until 10 a.m. EST Friday to respond to her order. A decision on whether to make the temporary injunction permanent or dissolve it likely won't be made before then.

"The government has lots of ways to deliver contraceptives to people," lawyer Mark Rienzi said. "It doesn't need to force nuns to participate."

Under the health care law, most health insurance plans have to cover all FDA-approved contraceptives as preventive care for women. That means the coverage is provided free of charge.

Churches and other houses of worship are exempt from the birth control requirement, but affiliated institutions that serve the general public are not.

The requirement prompted an outcry from religious groups, which led the administration to try to craft a compromise. Under that compromise, insurers or health plan administrators must provide the birth control coverage, and not the religious institutions.

But the administration's compromise did not satisfy some critics, who called it a fig leaf.

The nuns would have to sign a form authorizing their insurance company to provide contraceptive coverage, which would still violate their beliefs, Rienzi said.

"Without an emergency injunction, Mother Provincial Loraine Marie Maguire has to decide between two courses of action: (a) sign and submit a self-certification form, thereby violating her religious beliefs; or (b) refuse to sign the form and pay ruinous fines," Rienzi said.

The White House did not comment on the order Tuesday night.

The Little Sisters operate homes for the elderly poor in the United States and around the world. They were joined in their lawsuit by religious health benefit providers, Christian Brothers Services and Christian Brothers Employee Benefits Trust.

Sotomayor's decision to delay the contraceptive portion of the law was joined by the U.S. Court of Appeals for the District of Columbia Circuit, which also issued an emergency stay for Catholic-affiliated groups challenging the contraceptive provision, including the Archdiocese of Washington, D.C., and Catholic University.

The archdiocese praised the appeals court's action in a statement.

"This action by the U.S. Court of Appeals for the D.C. Circuit is in line with the rulings of courts all across the country which have held that the HHS mandate imposes a substantial and impermissible burden on the free exercise of religion," the archdiocese said. "These decisions also vindicate the pledge of the U.S. Catholic bishops to stand united in resolute defense of the first and most sacred freedom - religious liberty."

The Supreme Court already has decided to rule on whether businesses may use religious objections to escape a requirement to cover birth control for employees. That case, which involves Hobby Lobby Inc., an Oklahoma City-based arts and crafts chain with 13,000 full-time employees, is expected to be argued in March and decided by summer.

Big improvements are in store for some, including Howard Kraft of Lincolnton, N.C. A painful spinal problem left him unable to work as a hotel bellman. But he's got coverage because federal law now forbids insurers from turning away people with health problems.

"I am not one of these people getting a policy because I'm being made to," Kraft said. "I need one to stay alive."

But the biggest health care headlines early this year could come from continued uncertainty over the insurance program's messy rollout.

The consumer-facing side of the HealthCare.gov website appears to be largely fixed - with 2.1 million enrolled through federal and state websites. But on the back end, insurers say they are still receiving thousands of erroneous sign-ups from the government.

That means early in the year insured patients could go for a medication refill - or turn up in the emergency room - only to be told there is no record of their coverage.

One of the main worries is over certain error-tainted enrollment records that insurers call "orphans" and "ghosts."

"Orphans" are sign-ups that the government has a record of, but they do not appear in insurer systems. Insurers say those customers never left the government's "orphanage" to "go and live" with the carrier they selected.

"Ghosts" are new customers that the insurer does have a record of, but whose information mysteriously does not appear in the government's computers.

The Obama administration says the rate of such errors has been reduced dramatically, and insurers agree. The catch is that the volume of sign-ups has surged in the meantime, which means even with a lower error rate the number of problem cases keeps growing. And there is no automated way to clear up mistakes quickly.

"There are going to be problems for any number of people who thought they had signed up, and it won't work right off the bat," said Mark McClellan, who oversaw the rollout of Medicare's prescription drug benefit - a program that also had its share of issues. "It would be particularly disruptive for people in the midst of treatment."

Anticipating disruptions, major drug store chains like CVS and Walgreens have announced they will help customers who face coverage glitches, even providing temporary supplies of medications without insisting on up-front payment. Many smaller independent pharmacies are also ready to help.

White House health care adviser Phil Schiliro told reporters the administration was working with insurers and health care service providers to minimize disruptions "as we deal with what are always going to be unexpected problems where there is a transition."

Obama had envisioned that the arrival of the Affordable Care Act's major benefits in 2014 would be like a national seminar, showcasing his philosophy that government can and should smooth the rough edges off an unforgiving economy for struggling working people.

The goal was that in a midterm election year, Democrats would be able to point to millions of newly insured Americans, thanks to subsidized private plans and an expanded version of Medicaid. Media reports would feature compelling cases of people handed a lifeline.

That's indeed happening, but it seems to be only part of the story. The Republican portrayal of "Obamacare" as government inept and out of control appears to be unfolding right alongside.

Legal challenges still lie ahead for the health care law. Supreme Court Justice Sonia Sotomayor, acting Tuesday night on a request from an order of Catholic nuns in Colorado, blocked implementation of portions of the law that would have forced some religion-affiliated organizations to provide health insurance for employees that includes birth control. Several other Catholic groups won similar stays in the lower courts.

Although the stated goal of the law was to cover the uninsured, at least 4.7 million insured people had individual policies canceled because they didn't measure up to new requirements. That forced an apology from the president, who had famously promised that if you like your health plan, you can keep it. The administration says it believes most of those people have secured new coverage.

Americans with job-based health plans are also worried. A recent Associated Press-GfK poll found that most people who've seen their employers scale back coverage blame that on Obama's law, even though businesses were shifting health costs to workers before the law passed.

The nation's divisive debate over health care could go on for years. Having failed to repeal the entire law, Republicans may start targeting pieces of it, such as a Medicare cost control board, or various taxes.

For now, administration officials say they are just focused on getting through the March 31 end of open enrollment. People who enroll by that date will not face the law's tax penalty for remaining uninsured.

The administration and its supporters are also planning a big push to get younger, healthy uninsured people to sign up, key to the law's long-term success.


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