Archive for the 'Lawsuit' Category

End of Obamacare: What Happens When Trump Repeals the ACA?

The GOP has hated what they’ve coined “Obamacare” from the start. Obamacare, also known as the “Affordable Care Act,” certainly has its kinks. For instance, high deductibles for its Bronze plan users make up about 20 percent of its customers. Nevertheless, the fact of the matter is that it has helped millions of people, most of whom are low-income or working class, who otherwise would not have health insurance. It has done this without raising taxes.

President Trump promised to repeal Obamacare as soon as he was elected. When he finally took office, he again promised to repeal Obamacare. Initially, indications from the GOP were that a repeal would occur within the first 100 days of Trump’s presidency. The repeal seems to have lost its initial steam.Obamacare

Possible Timeline

The Senate and House of Representatives started the repeal process in earnest. In January, both the House and the Senate passed a budget resolution that set the stage for introducing a bill that would strip major provisions from Obamacare.

In order to repeal Obamacare, the next step is for President Trump to the sign the budget resolution bill while simultaneously introducing a bill to replace key provisions of the Affordable Care Act, but the GOP seems to have faltered at this step. What they initially wanted to happen swiftly is now being pushed back to the end of 2017, primarily because the party is still trying to figure out what to replace Obamacare with.

Even when a replacement for Obamacare is presented and signed by President Trump, there will be delays built into the repeal bill in order to ease the transition. No one knows how long the delay will take, but it’s presumed a delay of two to four years is likely. For this reason, major changes are unlikely to affect Affordable Care Act consumers right away.

Why Delay Repeal?

For one, there are many parts of Obamacare that are popular. Under Obamacare, insurance companies cannot deny coverage based on a preexisting condition, and children stay on their parents’ plan until they turn 26. These provisions are popular among the majority of Americans.

Moreover, the Affordable Care Act has insured over 20 million people who otherwise wouldn’t have health insurance. Republicans have been bombarded with constituent concerns about the potential loss of coverage. There are stories of everyday Americans who say they would’ve died had it not been for the Affordable Care Act.

How Will Repealing Obamacare Affect Americans?

Under Obamacare, millions of Americans are insured and can’t be turned away despite pre-existing conditions. Senior citizens pay less for Medicare coverage and for their prescription drugs. Many Americans receive free contraceptives, mammograms, colonoscopies and cholesterol tests, Repealing Obamacare could threaten all these advantages.

For instance, “repairing” Obamacare could mean higher premiums and deductibles for those enrolled on Medicare, most of whom are on fixed incomes. Companies with at least 50 employees may no longer be required to provide affordable insurance to their employees who work more than 30 hours a week. This could affect millions of employees who work at least 30 hours per week but less than 40 hours. In addition, companies will no longer have to keep children on their parents’ health insurance plans until they turn 26.

Finally and perhaps most devastating, a repeal on Obamacare would no longer require nearly all Americans to obtain insurance or pay a penalty. Millions of Americans covered by the Affordable Care Act may be dropped by their insurance carrier with no way of obtaining alternative insurance.

Aetna Health Insurance Lied About the ACA and Triggers Anti-Trust Claim

The Affordable Care Act (ACA), also known as Obamacare, has been an extremely contentious bit of legislation.  The future of the act is currently extremely uncertain, President Trump signed an executive order his first day in office which–while vague enough to be nearly symbolic in nature–still serve to limit the law to some extent.  However, the law has also been at the heart of a recent court decision which put a stop to a $37B dollar merger between two health insurance behemoths.

Aetna ACA

The decision comes as part of the ongoing anti-trust case over the merger between Aetna and Humana–two of the five biggest health insurance companies in the nation.  The announcement of the merger agreement of these two companies in 2015 led to an immediate investigation, and ultimately led to the Department of Justice, eight different states, and the District of Columbia all filing lawsuits saying the merger was anti-competitive.

Aetna obviously disagreed and between the government and them they managed to produce millions of pages of arguments and evidence for each side as to the exact economic impact of the merger.  Aetna’s dedication to the issue is no surprise, beyond the desire to see the merger go through they had some serious skin in the game–a $1B dollar fee to be paid to Humana if the merger fell through.

What Did Aetna Claim about the Affordable Care Act (a.k.a. Obamacare)?

One of the most contentious arguments revolved around the ACA itself.  The Affordable Care Act created a public forum through which the public could purchase insurance plans, although it did allow insurance companies to offer alternative plans outside of this public market.  It also requires insurers interested in providing plans through this market to comply with certain obligations.  Just before the lawsuit began, Aetna withdrew from all but four of the states it offered insurance policies through the ACA.

Aetna said that they withdrew because the plans they offered under the ACA were not making them money.  The government argued that they did it as part of strong arm tactic.  They said that Aetna, knowing the impact it would on public perception of the ACA, threatened to leave the program if the merger wasn’t approved

There was a fair bit of evidence that many of the ACA programs were, in fact, making Aetna quite a bit of money.  However, the government struggled to produce evidence showing Aetna’s actual motivations in leaving the ACA programs.  That is, they were having trouble, until they produced an email from Aetna’s Chief Executive to the Department of Justice itself specifically stating that their participation in the ACA hinged on them being allowed to merge with Humana.  From there, they went on to produce conversations with Aetna officers where they heavily suggested, and one time outright stated, that if they weren’t happy with the merger results the government wouldn’t be happy with their involvement in the ACA.  They even found emails where, after a series of emails explaining that the withdrawal was to strengthen their position in their upcoming anti-trust lawsuit, Aetna executives actively mentioned they were trying to avoid leaving a paper trail indicating the reason they withdrew from the ACA and making efforts to shield any such evidence from being produced in a lawsuit.

A few weeks ago, in a 156 page monster of a ruling, the court finally agreed with the government and part of that ruling was based on the fact that Aetna had misled the public–and attempted to mislead the court–as to the motivations behind leaving the ACA program.  So in order to understand how, let’s first discuss exactly how anti-trust law works before looking at how Aetna’s deception as to the ACA effected their case.

How Do Anti-Trust Lawsuits Work?

Anti-trust law is basically the government trying to keep companies from becoming such an enormous market presence that they prevent other businesses from competing with them.  If you’ve ever played Monopoly you get the idea.

The government pays particular attention to health insurance companies in anti-trust cases because of how Medicare operates and specifically how the government pays insurance companies to provide insurance supplements to cover gaps for seniors on Medicare.  Where health insurance companies have huge enough market presence, it leaves seniors paying fees that make these gap-filler plans inaccessible.

In order to establish that a merger would violate anti-trust law, the government has to show that such a merger would “substantially lessen competition, or tend to create a monopoly.”  They don’t need to show that it will absolutely happen, but just that there is a probability that a merger would be anti-competitive.  Establishing this, as you could probably tell from the millions of pages of evidence and a 156-page ruling, is generally an incredibly complicated and in-depth process.  Where the government can show such a probability, there is a presumption that a merger is illegal.  However, a defendant in an anti-trust case, such as Aetna, can produce evidence to rebut such a presumption.

There was obviously an enormous amount of evidence here as to the economic impact of the merger, evidence supporting both sides.  However, the question ultimately came down to how much of the market Aetna would end up controlling–and that’s where their game-playing around their motivations behind leaving the ACA came into play.

The Repercussions of Aetna’s Lie

Aetna’s whoppers about the ACA weren’t the only or the deciding factor in the court’s ruling.  However, they were influential enough to one of the few elements they specifically mentioned in the summary of their ruling out of the over a hundred pages of evidence that ruling discusses.

So what did Aetna’s dishonesty actually mean for their case?  The government argued that because Aetna misled the public, the court had to ignore the fact that Aetna had in fact left the markets for those states and only consider Aetna’s market presence as it was before they withdrew.  The court didn’t buy this, however they still took Aetna’s deception into account.  They looked to the future to consider whether Aetna may expand into those markets in the future.  Given that Aetna was making money in those and only withdrew as part of a strong arm tactic, they felt it very likely they’d return to the markets they left after the merger completed.  They felt this true in Florida, where the ACA markets were actually found to be the only profitable part of Aetna’s business–a situation which led to confused emails from Aetna officials out of Florida–these emails received a hasty response to only discuss the matter over the phone.

With all this in mind, the court felt it was likely that Aetna would simply return to the markets it had abandoned post-merger.  As discussed above, likely is all a court needs in an anti-trust case.  Thus, in a very real way, Aetna’s approach to the ACA had a huge hand in killing their chances of a successful merger.

What Does This Mean on a Broader Level?

First and foremost, the most obvious lesson here is that judges don’t particular care for hiding evidence.  So much so that it took what could have been a fairly small issue and turned into an entire section of the court’s ruling.  However, the reality of the situation also impacts some of the arguments surrounding the ACA.

Just weeks ago, Aetna’s withdrawal was used as evidence to support the end of the act.  However, when the reality is a more profitable one than Aetna led the country to believe, it certainly muddies the water on the issue.  We’re almost certainly going to see a lot of changes to the ACA in coming months and years.  However, it’s important that we look at the facts as they are when discussing the issue–and not spin on the topic such as Aetna’s misrepresentations.

Trump Faces a Record Amount of Lawsuits for a President

In a mere two-week period, Trump faces a slew of lawsuits that already amount to 10 times the average of the three presidents who preceded him.  Over 50 lawsuits have been filed and, at the rate he’s going, it doesn’t look like it will slow down any time soon.  Plaintiffs from 17 different states include religious groups, state attorneys general, doctors, professors, students, refugees seeking help, and Iraqis who have worked for the U.S. military.  While most lawsuits are in reference to Trump’s immigration ban arguing civil rights violations, the President is also facing a financial conflict of interest suit and a lawsuit regarding federal funding.

Trump Lawsuits

Travel & Refugee Ban

Civil rights cases starting flying out of the wood works once Trump signed his executive order restricting travel.  The immigration ban not only restricts access into the United States for those from select black-listed countries, but it halts entrance for refugees seeking political asylum.  Although a federal judge has temporarily blocked the executive order from taking effect, Trump has appealed the lawsuit.  Here’s a closer look at what the executive order will do if Trump prevails his appeal:

  • Suspend the entire U.S. refugee admissions system for at least 120 days.
  • Suspend the Syrian refugee program indefinitely.
  • Ban entry from 7 majority-Muslim countries, including Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen for at least 90 days. This includes dual-nationals that hold passports from other countries as well.
  • Prioritize refugee claims on the basis of religion, with a strong implication that non-Muslim religions would get preference.
  • Lower the total number of refugees to be accepted in 2017 from any country.

The lawsuits allege violations of the 1st, 5th and 14th Amendments, citing religious inequality, due process and equal protection violations, denials of asylum, as well as discriminatory visa processing practices.  Here’s a closer look at the expanding list of who’s suing Trump based on this executive order:

  • Washington state has brought suit on a national level and claims the ban violates both the 1st Amendment and the Equal Protection Clause of the Constitution. The state of Minnesota joined in on the lawsuit, as well as 16 other states who have joined as friends of the court to argue against the ban. At least 127 tech companies have also filed briefs with the U.S. Court of Appeals for the Ninth Circuit in opposition to the ban.
  • The ACLU brought multiple lawsuits by different plaintiffs arguing the ban discriminates against Muslims. Among the plaintiffs are two Iranian national University of Massachusetts-Dartmouth associate professors were detained while returning from an engineering conference and an Iraqi soldier (with a valid visa) was detained in New York while trying to join his family.
  • The Council on American Islamic Relations also brought suit alleging the ban discriminates against Muslims and is unconstitutional on 1st Amendment grounds because it disfavors groups based on their religious faith.

Conflicts of Interest

We’ve been hearing about the numerous ways Trump’s business dealings present conflict of interest issues since his election.  The Citizens for Responsibility and Ethics in Washington (CREW) brought a lawsuit against Trump alleging he violated the Emoluments Clause of the Constitution, which basically says those holding office can’t profit from their power in office.

CREW’s lawsuit alleges because of the payments Trump receives from foreign organizations as through his many businesses, he’s profiting from his presidency.  The argument rests on the notion that these profits limit his ability as President to make unbiased decisions for the benefit of the United States over the betterment of himself.  Although, there’s a good argument CREW doesn’t have standing to win their case, it doesn’t negate the legitimate conflicts of interest.

Withholding Federal Funding

Cracking down on sanctuary cities is a campaign threat Trump followed through on.  In addition to his immigration ban, Trump issued an executive order that would cut federal funding from sanctuary cities that refuse to cooperate with federal immigration officials.  San Francisco, a sanctuary city, has taken a stance and brought a lawsuit arguing the order violates the 10th Amendment.  While the federal government can put conditions on the money they give out, the conditions cannot be coercive, which gives San Francisco a strong argument.

What Happens When a President is Sued?

Qualified immunity can be tricky.  On a general level, public officials are protected from lawsuits alleging they violated a plaintiff’s rights.  Exceptions come into play when there’s an allegation that the official violated a clearly established statutory or constitutional right.  If cases were brought against a president for actions not related to their official capacity, the case would most likely be postponed until their term is over.

There are numerous lawsuits pending against Trump that were filed before his inauguration and don’t relate to his presidency.  The fraud lawsuit regarding Trump University was settled, but most of the other cases will resume once Trump’s time in office is over.   All of the cases filed within the past couple of weeks relate to Trump’s actions as President and pose constitutional violations, so they’ll be able to move forward through the judicial process.

Trump’s Immigration Ban: Domestic and International Rights at Threat

Banning a whole class of individuals based on their nationality is not only hateful, but legal professionals around the globe agree Trump’s immigration ban has a number of constitutional and international human rights issues to overcome.  The immigration ban not only restricts access into the United States for those from select black-listed countries, but it temporarily stops entrance for refugees seeking political asylum and permanently stops entrance for Syrian refugees.

Trump Immigration Ban

First Amendment

The Establishment Clause of the 1st Amendment guarantees religious equality and restricts the government from establishing (or supporting) any one particular religion.  While Trump’s team insists the immigration ban is not a blanket ban targeting Muslims, it’s hard to refute that argument based on Trump’s previous campaign statements.

On its face, the text of the order doesn’t exclude Muslims, but the text of the ban does state priority is to be given to refugees of a minority religion.  Since the ban affects 7 Muslim-majority nations, this language strongly indicates a preference for non-Muslim religions.  I can’t stress enough how much this practice would be in direct contradiction to the establishment clause.

Fifth & Fourteenth Amendment

Trump’s executive order singles out individuals based on both their nationality and religion and encourages discriminatory visa processing procedures, all of which raise discrimination issues that violate due process rights.

Due Process rights under the 5th and 14th Amendment require fair treatment, both procedurally and substantively.  Both the way the law pans out and the way the law is written matter.  Not only must the government provide fair and sufficient notice before denying someone their life, liberty, and property, the government cannot enact laws it doesn’t have the authority to enact.  While executive orders have been traditionally accepted, presidents don’t have the authority to enact laws that are discriminatory and contrary to the principles of the Constitution and laws of our nation.

Trump’s blanket ban provides no processes or procedures for denying entrance into the U.S., which left many stranded, including legal visa holders.  There’s a strong argument those travelers were denied their procedural due process rights.  They were given no notice or chance to make alternative travel plans.  Attorneys scrambled to file writs of habeas corpus demanding that, as asylum seekers on U.S. soil, the government was required under the Immigration and Nationality Act to at least grant asylum hearings, something the order didn’t allow for.

U.N. Experts Say Ban Violates International Human Rights Obligations

In the midst of lawsuit upon lawsuit demanding a halt on the immigration ban for constitutional violations, a group of U.N. human rights experts have weighed in and say the United States is now in violation of its international human rights obligations.  Under non-refoulement principles, the U.N. has long held that nations cannot expel or return a refugee to an area where their life or freedom are threatened.

Will the Ban Hold Up in Court?

After multiple lawsuits were filed, judges across the country issued injunctions blocking certain aspects of the executive order.  The state of Washington filed suit on the order as a whole and U.S. District Judge James Robart blocked the order in its entirety.  Although Trump appealed the decision, normal screening procedures commenced and will remain in effect until a decision is handed down.

Despite Trump’s offensive tweets that questioned Judge Robart’s opinion, Trump seems to be a minority on this one.  Sixteen other state attorney generals have joined the lawsuit.  Massachusetts, New York, Pennsylvania, California, Connecticut, Delaware, Illinois, Iowa, Maryland, Maine, New Mexico, Oregon, Rhode Island, Vermont, Virginia, and the District of Columbia have filed a brief as “friends of the court” to argue against the ban.  At least 127 tech companies have also filed briefs in opposition to the ban.

Trump cited a need to protect our nation from terrorist threats as the basis for the executive order, but it’s arguable the ban will do nothing to actually prevent future attacks.  Media attention has focused on the fact that none of the most recent attacks in the U.S. have originated from the countries on Trump’s list.  Certainly, national security interests can undoubtedly outweigh constitutional protections, but that should only be on a case-by-case basis and not a blanket ban based on nationality.  While courts traditionally have given the executive branch great leeway when it comes to immigration policy, it’s not likely this particular order will pass constitutional muster.

Why the “Muslim Ban” is Still On Hold

In a presidency already jam-packed with sweeping changes and controversial actions, no move has been so contentious as President Trump’s executive order titled “Protecting the Nation From Foreign Terrorist Entry Into the United States;” better known colloquially as the “Muslim Ban.”  The executive order placed a 90-day bar against immigration from seven Muslim-majority countries, a 120-day bar on all refugees, and a permanent bar against refugees coming out of Syria.  The response to the order has been vocal to say the least.  However, the response has not just been protests and outcry–the order has also faced a number of legal challenges.  Just recently, a Washington court placed an emergency injunction on the “Muslim Ban”–a court order temporarily preventing Trump’s executive order from taking effect.

This isn’t the only, or even the first, court place an injunction on the “Muslim Ban.”  Courts in California, New York, and Massachusetts have all issued orders blocking parts of the ban. However, the Washington ruling was the first to stop the entire order in its tracks.

The Washington ruling was quickly appealed to the 9th Circuit Court of Appeals by the Department of Justice with the goal of overturning the injunction.  However, just yesterday, the 9th Circuit came back with a unanimous decision to keep the stay in place.

The Lead Up to the Ruling

In the oral arguments leading up to the decision, the court seemed split but appeared to lean in favor of upholding the ban.  Two of the judges on the three judge panel ruling on the case targeted the attorney for the Department of Justice (DoJ) with sharp questions about what evidence they had to support the need of the ban in the despite its potential for unconstitutional discrimination.  They also questioned the DoJ’s position that they did not have the power to review Trump’s executive order.  The third judge however, an appointee of former President George W. Bush, targeted the lawyer for Washington with equally sharp questions about whether the ban was discriminatory in the first place.

Muslim Ban TrumpA great deal could be read into these questions, and many felt confident that Washington’s injunction would be upheld 2-1.  However, it’s important to remember that questions can be just that–a judge’s job is to challenge both sides of the argument where they see inconsistencies in a pursuit of the truth.  Ultimately, the judges–appointed by a mix of Republican and Democrat presidents, came out with a unanimous 3-0 ruling against the “Muslim Ban.”

Why Did They Rule Against the Order?

Where a law, or executive order as the case may be, discriminates against a protected class (such as race, national origin, or religion) it is held to the highest levels of scrutiny and must be absolutely necessary to a crucial national concern with no other less harsh alternatives before it can be constitutional and thus valid.  My colleague has previously published an excellent article on the constitutionality–or lack thereof–of a immigration ban targeting Muslim majority countries.  While her article focuses on discrimination based on national origin, a very valid concern when we’re talking about an order which singles out people originating from specified nation for worse treatment, Washington’s injunction instead hinges on the argument that the ban singles out Muslims for discrimination.

However, the 9th Circuit’s decision does not go so far as to say that the “Muslim Ban” is or is not discriminatory.  Frankly, it doesn’t need to go that far in order to determine whether to uphold an injunction.  Instead, they need to make a decision based on whether the injunction itself should stand.  This requires them to find that the federal government has provided evidence which establishes that the country would suffer irreparable harm if the “Muslim Ban” were not immediately reinstated.

However, the federal government barely bothered to try to produce evidence on this issue.  Instead, they stuck with an argument that the courts had no power to review President Trump’s executive order when it was made on the subject of immigration.  While immigration is a subject where the President’s executive orders have the most sway, the idea that an executive order would beat out the Constitution is patently ridiculous and without support.  The 9th Circuit said as much in their opinion, stating “The Government has taken the position that the President’s decisions about immigration policy, particularly when motivated by national security concerns, are unreviewable, even if those actions potentially contravene constitutional rights and protections…There is no precedent to support this claimed unreviewability, which runs contrary to the fundamental structure of our constitutional democracy. Within our system, it is the role of the judiciary to interpret the law, a duty that will sometimes require the ‘[r]esolution of litigation challenging the constitutional authority of one of the three branches.’ We are called upon to perform that duty in this case.”  Basically, they told the government that–while executive orders receive deference when it comes to immigration and national security–to say that they are immune to the highest law of the land in the Constitution is a very silly argument indeed.

Thus, with the DoJ focusing on arguing that the Court didn’t have the power to intervene on an unconstitutional executive order, they didn’t really bother to produce any evidence of the danger of keeping the injunction in place.  They produced no evidence of terrorist attacks from refugees out of the named countries, really no evidence at all of dangers presented by keeping the injunction in place.  Thus, they lost 3-0.

What the Ruling Means

To put it most simple terms, upholding this injunction means that the entirety of President Trump’s executive order will simply not take effect until the case is fully resolved–immigration from the countries listed and refugees from around the world can continue to seek opportunity in the United States of America.  At a more abstract level, a unanimous ruling from three judges with differing political ideologies sends a message to the world about how strongly the United States values the Constitutional rights it guarantees.

The case is not completely finished, it can and almost certainly will be appealed directly to the Supreme Court of the United States.  However, with large chunks of the executive order designed to end 90 and 120 days after the order was signed it seems likely that these elements will run their course before a decision could come out of the Supreme Court on the issue.  This might require the Trump administration to come out with updates to the order if they want these elements in effect–updates which could face their own legal challenges.

What’s more, the Supreme Court currently has only eight sitting members.  With a very close ideological split in the Supreme Court, as well as a low chance of appointing a ninth member in time to address the issue, it is possible that the Supreme Court may simply deadlock on the issue as they have many times over the last year of inaction on the seat.  This would leave the 9th Circuit ruling in full force.

Still to come is the decision on the actual constitutionality of the order.  The 9th Circuit itself was fairly non-committal on the issue, simply stating that both sides had powerful interests in conflict–the government with an interest in national security and the power of executive orders, the public with an interest in free flow of travel, avoiding separation of families, and freedom from discrimination.  However, what they did rule on the issue was that the courts should consider the past statements of President Trump and his advisers as to whether the immigration ban was meant to target Muslims in a discriminatory fashion.  With President Trump and his advisors frequently declaring, both on the campaign trail and once in office, that an immigration ban targeting Muslims and favoring Christians is on their agenda it seems that this would allow in strong evidence that the “Muslim Ban” is in fact discriminatory and unconstitutional.

Trump Continues his Concerning Disdain for the Court System

As you might have noticed from his argument to the court in this case, President Trump has a penchant for a concerning belief that the he is above the Judiciary Branch of the U.S. Government.  Immediately after the ruling he took to Twitter to again publically blast the decision.  He has repeatedly questioned the intelligence and competence of every judge who has stood in his way.  Just this week he has publically called the courts “disgraceful,” said that they have less understanding than “a bad high school student,” and heavily implied political bias in the entire U.S. Judiciary system.  To say this lack of respect and understanding for the third branch ensuring checks and balances within our government is disturbing would be an understatement.  Even Neil Gorusch, Trump’s own nominee for the Supreme Court, has called his attitude “demoralizing” and “disheartening.”  Hopefully, a unanimous bi-partisan decision such as this will help him understand the importance of law.



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