An ACA Class Action? Here’s what The Legal News Group said…

March 31st, 2014. By AbiK

Recently a reader (thanks Roger!) submitted a question regarding Obamacare and the possibility of a class action lawsuit. We threw the question out to our Legal News Group on LinkedIn (where a number of lawyers and legal industry types hang out) and we’ve shared their answers below…

Roger’s Question: Do you think there is a potential class action resulting from the President’s decision to allow insurance companies to continue to offer health insurance coverage that does not meet the requirements of the Affordable Care Act? Individuals whose plans were cancelled as a result of the ACA can now continue to hold such plans for another two years if their insurance company makes the plan available. However, the plans do not meet the coverage requirements of the ACA. If an individual is treated for some condition that is not covered by their non-ACA-compliant plan but would have been covered by an ACA-compliant plan, the individual should have a cause of action against their insurance company for the out-of-pocket cost for that treatment. What defense does the insurance company have? That the President allowed the non-compliant plan? The President has no authority to do so. While the cost borne by one individual under a non-compliant plan might not justify a lawsuit against the insurance company, many individuals will have the same loss. Does that not suggest a class action?

Stephen: That’s interesting. However, didn’t the Dept. of Health and Human Services actually write the regulations that determined what is and what is not a compliant plan? And since that Dept. is under the Executive Branch and the President is the Chief Executive, can in not be argued reasonably that he does in fact have the authority to decide when to implement the regulations?

Gordon: Although I like parts of the ACA, there is an internal contraction of social production of medical care and the private reaping of profits. It would have made more sense to extend medicare to all ages. There (Medicare) is a social production of medical care and any profit is returned to the public. This has been the basis of the universal health care systems in other industrialized nations. Whether there is a class action suit potential is actually an indication of the internal contradiction.

Helen: Yea, possibly for political reasons. Why would anyone sue for that? What to say that the non-compliant insurance has an unfair advantage possibly but wouldn’t that claim bolster the intent of the reform rather than hurt?

Kristin: If you’re on a non-compliant plan, could you switch out to a compliant plan with more coverage? I thought the main idea behind two-year extension was to avoid a time crunch leaving people uninsured, not to perpetuate non-compliant plans (Helen, I think this is reform intent, right?). Stephen, I agree with the idea that the President can implement the regs when he wants. Gordon, I’ve seen the US healthcare system used as an example of what not to do more than once (pre-ACA). Private healthcare seems so entrenched, do you think an alternate approach would succeed?

Kari: I agree with Gordon T. Davis, my ten cents worth: There should have been the single payer/Medicare option, as initially submitted. Simply there is no reason to kill the healthcare industry “cash cow” without a good fight (Obamacare has been repealed some 50 times, maybe only Congress work creating activity) i.e. patients are not going to travel to China for low cost treatment like many jobs have gone. Just an observation this year, I visited at my doctor in the same office, no changes from previous visits, hospitals are still where they always have been, no challenges even if there was a preexisting condition, just pay the bill …. Obamacare has not killed my healthcare rather it has provided peace in mind without concern do I have it or not. Rush Limbaugh promised to move out of country, if Obamacare will come a law ….. darn still here, can not trust on anything what he says.

Helen: It was the original intent. The problem was the latent news release that the grandfather clause had been tampered with during the passage of the legislation in Congress (note that the clause intended to allow folks to keep their preexisting plan, plans that preexisted prior to the Reform with only minor adjustments, if necessary). That delay or revelation later than sooner, plus the feet dragging to implement the Act together produced the mess. In the aftermath, it turns out most people who learned their current plan (prior to Reform) would be non-compliant were switched automatically by their insurance companies to plans that are compliant albeit possibly more expensive (but better coverage). The delays as implemented by Executive decision isn’t anything new and people have to realize that in any major reform reminiscent of others like Social Security and Medicare, the road of implementation was bumpy! It is true now that few would want those programs to vanish, let alone changed!

Kari: Expect changes/improvements Ref.: Why Employers Will Stop Offering Health Insurance

Got an opinion? Let us know what you think. Comment below, or comment on the original thread for this question at our Legal News Group on LinkedIn.

Tags: ACA, ACA Class Action, Affordable Care Act, LinkedIn, Obamacare Class Action Lawsuit, The Legal News Group

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