Posts tagged: U.S. Supreme Court
Here’s a link to my full story at spokesman.com on the impact in Idaho of this morning’s landmark U.S. Supreme Court decisions on same-sex marriage; Idaho’s sweeping ban on same-sex marriage and civil unions won’t change. However, same-sex couples living in Idaho who were married in other states may qualify for some recognition in federal programs or benefits, depending on how the Obama Administration and Congress react to the rulings.
Meanwhile, supporters of this morning’s rulings have scheduled a rally on the state Capitol steps at 4:30.
Here’s the latest from the ACLU on how this morning’s U.S. Supreme Court rulings could affect same-sex couples living in Idaho who were legally married in other states: It depends. For some federal programs, the ACLU, which brought the case that resulted in the federal Defense of Marriage Act being overturned, says the Obama Administration could decide through regulation to extend recognition. For others, including Social Security benefits, any changes would require an act of Congress.
“Under current law, the federal government typically defers to the states in designating whether a couple’s marriage is valid,” said Monica Hopkins, Idaho ACLU director. “There’s no one rule across all federal programs, as to whether the validity of a marriage is determined by where a couple is living, which is the place of domicile, or where the couple got married, which is the place of celebration. So that’s the question there. … . So right now, I would say same-sex couples that reside in Idaho that were legally married in one of the 13 states or D.C. are in a sort of limbo, while they wait for the administration to implement this decision, hopefully swiftly and smoothly, and apply all relevant statutes.” Said Hopkins, “Much of the uncertainty can be completely corrected by saying it’s the place of celebration.”
She added, “We concur with the Attorney General – this doesn’t change anything about Idaho’s marriage laws. However, DOMA is a different question. … Now the question is up to the Obama Administration.” President Obama issued a statement today saying he’s directed top officials to review all the relevant statutes and implement the decision “swiftly and smoothly.”
Kim Beswick, a high-tech worker from Boise who has two young children with her same-sex partner and has lived in the state for two decades, welcomed the rulings. “Idaho unfortunately isn’t leading the way on this issue,” she said. “We have the constitutional amendment in place that absolutely forbids not only marriage but any of the individual rights of marriage. … I think these rulings show that’s certainly going to be at some point on the wrong side of history.” But she said the DOMA ruling could affect her family on everything from end-of-life decisions to federal taxes. “That has a big impact on us in a pretty far-reaching way.”
Idaho ACLU Executive Director Monica Hopkins says the U.S. Supreme Court’s decision today on the federal Defense of Marriage Act, or DOMA, leaves open one question that could affect Idaho: What about same-sex couples who legally married in another state, but now reside in Idaho? Would they be eligible for federal benefits like family medical leave and Social Security survivor benefits?
“There are 1,100 places in federal laws and programs where being married makes a difference,” said Hopkins, whose organization brought the DOMA case on behalf of Edie Windsor, an elderly New York resident who was required to pay $363,000 in estate taxes after her same-sex spouse passed away, though the two had been legally married in Canada and the state of New York recognized the Canadian marriage. Windsor wouldn’t have owed any estate tax if she’d been married to a man.
“Now what we have to do is kind of untangle what this DOMA decision means,” Hopkins said, “because it has federal applications, but what does it mean for Idahoans who were legally married in a state that legally recognizes those marriages, but reside in Idaho?” Hopkins said she’ll be participating in a conference call mid-day today with the ACLU’s national attorneys to address that and other questions about the decisions.
David Adler, director of the Andrus Center for Public Policy at Boise State University and a constitutional scholar, said, “I think the opinion is unclear on the issue of whether same-sex couples married in another state who move to Idaho are going to be entitled to some federal benefits. I think there’s room in the opinion to draw the conclusion that they will be entitled to some benefits, including (federal) tax filings, but it’s not immediately clear.”
Adler said, “The reasoning in the opinion employed by Justice Kennedy is going to have national implications for the discussion and debate on gay rights and same-sex marriage as it goes forward in this country.” He added, “While the immediate opinion does uphold the right of states to determine the status of marriage, the reasoning and the language of that opinion will be used to promote same-sex marriage across the country.”
Here’s what Idaho Attorney General Lawrence Wasden had to say this morning on the U.S. Supreme Court decisions on same-sex marriage: “There really isn’t a direct impact on Idaho law. It’s still in effect. … so there really isn’t a lot of change there.”
He noted that his office is still analyzing the decisions. “We’re trying to react to what we’ve been able to review and read very rapidly,” Wasden said. But overall, he said, “My job is to defend the Constitution and the statutes of the state, and those haven’t changed.”
I am still awaiting word from the experts, but it appears that today’s landmark U.S. Supreme Court decisions on same-sex marriage won’t change anything in Idaho. That’s because the decisions defer to states to regulate marriage, even while striking down the federal Defense of Marriage Act, or DOMA. The result is that couples legally married in the 12 states where same-sex marriage is permitted are eligible for federal benefits; a second decision declined to take up an appeal of a California appellate court ruling over that state’s Proposition 8. But Idaho has a sweeping constitutional provision banning not only same-sex marriage, but also civil unions.
In 2006, Idaho voters approved HJR 2, an amendment to the state Constitution, with 63.35 percent of voters in favor and 36.65 percent against. The ballot measure asked, “Shall Article III, of the Constitution of the State of Idaho be amended by the addition of a new Section 28, to provide that a marriage between a man and a woman is the only domestic legal union that shall be valid or recognized in this state?” Once it passed, this section was added to Idaho’s Constitution:
“Section 28. Marriage. A marriage between a man and a woman is the only domestic legal union that shall be valid or recognized in this state.”
The official statement of effect of adoption of the ballot measure said this: “If adopted, the proposed amendment would add language to the Constitution of the State of Idaho to provide that a marriage is only between a man and a woman. The language prohibits recognition by the state of Idaho and its political subdivisions of civil unions, domestic partnerships, or any other relationship that attempts to approximate marriage. The language further prohibits the state and its political subdivisions from granting any or all of the legal benefits of marriage to civil unions, domestic partnerships, or any other relationship that attempts to approximate marriage.”
Gov. Butch Otter's health insurance exchange working group meets today from 10 a.m. to 3 p.m. in the Capitol Auditorium; Idaho Public Television will video-stream the meeting live here. The agenda includes speakers, via teleconference, from the Cato Institute and ALEC, along with health law consultant Jack Rovner; you can see the full agenda here. A second working group, looking into a potential Medicaid expansion, is scheduled to meet again in mid-September; both groups will present recommendations to Otter in the fall as to how to proceed under the national health care reform law.
After hours of presentations, including extensive information about federal requirements and about what other states are doing, the governor's Health Insurance Exchange Working Group has wrapped up its first meeting and set another for late August, likely the 29th or 30th. “We really want to move forward with this committee and get those recommendations to the governor as soon as we can,” said working group Chairman Bill Deal, director of the Idaho Department of Insurance.
Among the key points covered today: If Idaho were to do nothing or fail to meet the federal government's mid-November deadline to decide what it'll do on a health insurance exchange, it'll get a federally run exchange. One mid-way step, if the state isn't in a position to meet the deadline, is to propose a partnership in which the feds would facilitate the exchange, but the state would take on certain duties, possibly as a transition toward a fully state-run exchange in a future year.
“I hope this meeting today was of benefit to you to get started with this,” Deal told the working group. The group is dividing up a list of 14 questions to research in the weeks before its next meeting. Said Deal, “We're going to move as fast as we can.”
There's a capacity crowd of more than 60 in the audience this morning as the governor's Health Insurance Exchange Working Group gathers for its first meeting. “Our challenge is to find some solutions,” state Insurance Director Bill Deal told the audience, adding, “We also extend a welcome to all of you who have chosen to join us this morning. We've got a good crowd, and that is good.”
The agenda for today's meeting, which runs from 10 a.m. to 3 p.m. in the west conference room of the J.R. Williams Building across from the state Capitol, includes overviews of the Supreme Court's health care decision; the Idaho insurance market; insurance and market reforms in the health care act; legal requirements, deadlines and options for a health insurance exchange; and discussion of next steps for the panel. “Today I think our goal of this working group is to establish the foundation for future meetings,” Deal said. The 13-member panel includes lawmakers, representatives of Idaho's major insurers, lobbyists, a business owner, a physician and an insurance agent.
Deal said the panel won't take any public testimony today, but is offering the public the opportunity to submit questions on cards, which will be answered via email. Audio streaming also is being offered for those who want to listen from afar; there's a link on the Department of Insurance website here.
Deal said thus far, there are 15 states planning for state-run health insurance exchanges; one planning for a partnership exchange; seven that have decided against a state-run exchange; and the rest, including Idaho, still are weighing options.
Here's a link to my full story at spokesman.com on today's discussions in the Legislature's Health Care Task Force, at which state Insurance Director Bill Deal told lawmakers it may already be too late for Idaho to set up a state-run health insurance exchange in time to meet federal deadlines.
Idaho's catastrophic health care fund, which covers care for indigent patients with no other coverage and is run through Idaho's counties, which each pay $11,000 per case before the fund kicks in, is starting to climb in costs again, CAT fund board Chairman Roger Christensen, a Bonneville County commissioner, told lawmakers on the Health Care Task Force this afternoon. Cost controls implemented in recent years dramatically slowed the expected growth, he said, but, “Unless we can come up with some kind of a rabbit out of a hat, we're going to see some of the trends start going back up.”
Rep. John Rusche, D-Lewiston, a retired physician and CAT fund board member, congratulated Christensen and Sen. Dean Cameron, R-Rupert, on the savings found in the program in recent years, as part of an effort Cameron launched. “We've had roughly a 40 percent decrease over what would have been expected in the indigent costs,” Rusche said. “So, Sen. Cameron, when you put that work group together up in the attic of the (Capitol) Annex, I don't think you realized what a good deal you were doing.” He added, “But you're right, the easy wins are done. We can expect to see a 7, 8 percent increase in the total amount of CAT fund expenditures if we don't have some other alternatives.”
The successful cost-cutting moves included a 5 percent discount on provider reimbursements, which will sunset in 2013; stepped-up efforts to identify alternative payers for specific patients; and a new federal reinsurance pool for people with pre-existing conditions who have been denied traditional insurance, which will expire in 2014. But the cost of health care has continued to rise. Last year, the CAT fund, between state appropriations and county spending, spent a little over $60 million and saw 1,292 cases; in the coming year, it expects 1,425 cases at an average per-case costs of $27,742 .
Christensen said Idaho's CAT fund system is “unique,” in how it targets the same population that now is targeted for a state-option Medicaid expansion under the national health care reform law, and how it pays for their care. “It's one of the only, if not the only state, where the eligible population that would be picked up by the Medicaid expansion are (now) picked up by state general fund dollars and by county property tax dollars,” Christensen said. “That's the safety net. And that's the majority of our clientele, are those single individuals without disabilities.”
The proposed Medicaid expansion, which Idaho has not yet decided whether to sign on for, would cover that population with 100 percent federal funds for the first three years, phasing down to 90 percent federal funds by 2021; the state and counties now bear 100 percent of the CAT fund costs.
One question that's come up several times today at the Legislature's Health Care Task Force: Could the governor implement a particular type of health insurance exchange by executive order, without legislative action? When lawmakers posed that question to Deputy Attorney General Brian Kane, he said, “I think the best way to explain it is that both the governor and the Legislature have authority, but they're both subject to checks by the respective other body.” So, he said, if the governor declared by the Nov. 16 deadline that the state would take a particular course, some legislative action likely would be required to implement that, whether it's through funding or authorizing legislation. The Legislature, when it convenes, could endorse a different course. But legislative decisions are subject to the governor's veto, which could leave the state with no officially endorsed direction.
“I believe the default at this point would be a federal exchange,” Kane told the lawmakers. “But that's a lot of contingencies. … Hopefully, there would be some sort of consensus on which direction the state is moving.”
Asked what would happen if the governor and Legislature disagreed on Medicaid expansion, Kane said, “That would be a very legally interesting situation.” It's unclear what the outcome would be, he said. “That's a very involved powers-of-government question, from my perspective.”
Idaho Health & Welfare Director Dick Armstrong said the governor's working group that he chairs, on the issues surrounding whether or not to expand Medicaid under the national health care reform law, will be reviewing extensive data on where those patients are now getting their health care, and who's paying for it; that information is being gathered now. “The decision is going to be complicated,” he said. The law gives states the option of expanding Medicaid to cover low-income uninsured adults; for the first three years, the federal government would pay 100 percent of the cost, and after that, it would phase down to 90 percent by 2021.
Armstrong also told lawmakers this morning that if Idaho doesn't create a state-run insurance exchange, there will be costs to connect to a federal exchange, and the state could apply for a federal grant to cover those costs. “It only seems reasonable that if the federal government is going to make us make system changes, that they pay for it,” he said.
Sen. Dean Cameron, R-Rupert, asked state Insurance Director Bill Deal about the “partnership” option on a health insurance exchange. “I think most Idahoans would prefer that the federal government not be in their insurance buying decisions,” said Cameron. “So as I try to analyze, it seems to me that if the state has an exchange, then the state can keep the federal government out of those decisions. … If the state decides not to do an exchange, then the federal government does their exchange and is in the lives of Idahoans.” He asked, “How does a partnership keep the federal government at bay? … And why is that even a viable consideration? It seems to me that either we jump in with both feet and do our own exchange, or we walk away and say 'we're not going to do anything' and we'll let the federal government do it to us.”
Deal said, “I think most us of having to do with insurance have been aiming toward a state-based and run exchange.” But he said time is running out. Deal said states can change their mind every November as to which route they choose. “So many states are considering this partnership thing as a way to get started, a way to fund an exchange, and then down the road, 2015, 2016, they can put together an exchange, move in a different direction, go with a state-based operation. … That's why I mentioned the partnership, because it is an alternative.” He said that also could include partnering with other states. Deal said going with a federally operated exchange would mean giving up a substantial amount of the state's authority to regulate insurance.
The next deadline for Idaho to apply for a federal grant to fund work on a health insurance exchange falls in mid-August, state Insurance Director Bill Deal told lawmakers this morning, but Idaho still hasn't decided whether it wants a state-run exchange, a federally-run one, or a partnership. Therefore, he said, “We have declined to submit a grant application at this particular time, which again puts us a little bit more behind the time with the funding need, should we make that decision. So the next opportunity for a grant is November. I think whichever way Idaho would move … we're going to need some money from the federal government. So that's our next opportunity, is in November.”
In 2011, Idaho received a $20.4 million federal grant to start work on a state-run health insurance exchange, but the 2012 Legislature declined to accept the money, and now it's gone.
Some provisions of the federal Affordable Care Act already have taken effect in Idaho, state Department of Insurance Director Bill Deal reported to lawmakers on the Health Care Task Force this morning. “Most of them took place in September 2010,” he said, including banning pre-existing condition exclusions for people age 19 and under; removal of lifetime benefit caps; and phaseout of certain limits within policies. The ban on pre-existing condition exclusions will extend to all policies in 2014, he said. Other changes also were made in underwriting, rating and bands. “All of these changes have been implemented. They were implemented by federal law,” Deal said. “And I think that as far as the state is concerned, that Idaho is going to need to take a look and see if those changes in coverages be put into Idaho law.”
Deal noted that federal law gives states authority to regulate insurance. Said Deal, “It is recommended by the Department of Insurance, under Title 41, Idaho Code, that we amend those sections necessary to give the state of Idaho the authority to regulate with these new implemented changes in coverages.”
Deal is chairing the governor's working group on health insurance exchanges; it will hold its first meeting on Aug. 2, he said.
Federal officials are currently anticipating they'll have to run health insurance exchanges for lots of states - “as high as 30,” Joy Wilson of the National Conference of State Legislatures told Idaho lawmakers this morning. “And that means that there won't be much customization. So there'll be a template and this is how they'll do it. So if you have particular issues in your state, whether it's geography or special populations or just something that is unique about your state, the likelihood that that will get addressed is diminished if it's a federally facilitated exchange, because they just can't do customization.”
She added, “It kind of depends on how comfortable you are with HHS having that big a role in your insurance market. I think it really comes down to if you can find solace in that or not.” That drew a murmur from the crowd at the Health Care Task Force meeting, which has now swelled to about 75, and includes many lobbyists and representatives of various parts of the health care industry.
Wilson told the task force, “The (Medicaid) expansion is a tougher issue. Your providers are very concerned about states not doing the expansion because of the uncompensated care. … So there's a lot of concern by different constituencies in your state, and I think each state's going to have to take a really hard look at how the numbers look, and you're going to see a lot of variation in how states respond.”
Among the insights from Joy Wilson of the National Conference of State Legislatures into the health care choices facing states like Idaho: “The Medicaid expansion affects every state differently. … Most states are in the process of running numbers to try to determine what the impact will be of the expansion in their state.” That's key for all states to do, she told the Idaho Legislature's Health Care Task Force this morning.
On health insurance exchanges, there is a Nov. 16 deadline and three choices for states: A state-run exchange, a federally run exchange, or a partnership exchange, in which the federal government and state share duties, with states handling the eligibility, operations and/or the consumer assistance portions of the exchange.
She also noted that by Sept. 30, states must declare what their essential health benefit package is going to be. “The default plan would be the small group plan in your state with the largest enrollment,” Wilson said. “For the most part, state insurance commissioners are making the decisions,” though in some states, legislators are participating. Wilson also noted that deficit reduction actions in Congress could affect funding for aspects of Medicaid. “It is certain that there will be significant reductions in discretionary health programs as part of deficit reduction,” Wilson said.
There's a crowd of about 50 in the audience for today's legislative Health Care Task Force meeting, which runs all day in room EW 42 of the state capitol. There's particularly high interest, as the state ponders its next steps in the wake of the U.S. Supreme Court decision upholding the national health care reform law. “This meeting, just to set everybody's mind at ease, is not intended for us to make a decision certainly at this point in time,” Sen. Dean Cameron, R-Rupert, co-chairman of the task force, said as the meeting opened. “We're gathering information. We're certainly not trying to get out in front of the governor's select committee.” He noted that a number of lawmakers on the task force serve on the governor's two panels exploring issues surrounding a health insurance exchange and possible Medicaid expansion. “We applaud the governor in his efforts to take a thoughtful approach to the decisions that Idaho must make, and look forward to working with them and trying to determine what is the best for Idaho citizens.”
First up for the joint task force today is a report from Joy Wilson of the National Conference of State Legislatures, by phone, offering an analysis of the Supreme Court decision and its implications for states.
Gov. Butch Otter's health insurance exchange working group, chaired by Idaho Insurance Director Bill Deal, has announced it'll hold its first meeting next Thursday, Aug. 2, from 10 a.m. to 3 p.m. in the west conference room of the J.R. Williams Building, 700 W. State St. The meeting is open to the public; you can see the full meeting notice here.
Meanwhile, the Medicaid expansion working group, chaired by Idaho Department of Health and Welfare Director Dick Armstrong, will hold its first meeting Aug. 6, also from 10 a.m. to 3 p.m.; it'll be at the seventh floor conference room of the Pete T. Cenarrusa Building, 450 W. State St.
Otter appointed the two groups to look into both issues and advise him how the state should proceed after the U.S. Supreme Court upheld the national health care reform law. A joint legislative panel, the Health Care Task Force, will discuss some of the same issues during an all-day meeting on Monday, starting at 9 a.m. in room EW 42 of the state capitol; that meeting's agenda includes presentations from both Deal and Armstrong.
Idaho Gov. Butch Otter has named the 26 members of two working groups he's appointing to explore issues surrounding a state health insurance exchange and a possible Medicaid expansion under the national health care reform law; state Health & Welfare Director Dick Armstrong will chair the Medicaid expansion group, which will hold its first meeting Aug. 6; while Idaho Department of Insurance Director Bill Deal will chair the exchange group, which is still working to schedule its first meeting. The groups include people from both the public and private sectors, including several state lawmakers; click below for the full list. Both groups will report back their findings and recommendations to Otter by fall.