Seton Hall Law’s John Jacobi Testifies Before the New Jersey Legislature on the Obama Fix

Filed in Health Reform by on December 13, 2013 0 Comments

Last week, John V. Jacobi, the Dorothea Dix Professor of Health Law & Policy at Seton Hall University School of Law—and a contributor to this blog—testified before the New Jersey legislature at a hearing on the New Jersey insurance commissioner’s decision to allow insurers to renew recently-cancelled plans for an additional year.

Professor Jacobi responded to a number of issues, including whether New Jersey, rather than simply permitting insurers to renew policies out of compliance with the Affordable Care Act (as President Obama requested) could instead mandate such renewals.  Jacobi explained that such a mandate would violate specific terms of the ACA, and therefore be unlawful.  The permissive renewals, in contrast, can be seen simply as an exercise of administrative discretion by both federal and New Jersey officials.

Jacobi also, however, suggested that insurers might not be fully protected were they to renew these technically noncompliant policies.  While administrative officials have agreed not to enforce the law, people covered by the insurance have entered into no such agreement.  They could, then, if the renewed policy failed to cover services mandated by the ACA, insist on the coverage as a matter of federal statutory law.

In an article at NJ Spotlight, Andrew Kitchenman writes the following:

Seton Hall University health law professor John V. Jacobi raised a separate point – the possibility of legal challenges over coverage being denied in plans that are extended but don’t comply with the ACA.

Jacobi put forward the hypothetical example of a child of a worker at a small business that offers an insurance plan that is extended but would otherwise have been cancelled because it didn’t comply with the ACA. Jacobi said that if that child were to become sick and be denied coverage that would be mandated by the ACA, the child’s family would be in a strong position to challenge that denial.

For example, pediatric dental care and treatment for some mental illnesses aren’t covered by current health plans, but must be covered under ACA-compliant plans.

“While the employer and maybe even the employee may have agreed to this lesser coverage, the statute still requires that those services be covered,” Jacobi said.

Read Kitchenman’s entire article, Insurers Face Tough Decisions on Whether to Extend Health Plans, here.

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