Long-term care leaders watchful after Supreme Court limits the Affordable Care Act contraception rule

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U.S. Supreme Court
U.S. Supreme Court

Two hotly anticipated Supreme Court rulings handed down Monday elicited measured responses from prominent long-term care stakeholders. In one case, Hobby Lobby succeeded in its battle against the Affordable Care Act's rules over contraception coverage. The other decision dealt a blow to home healthcare unions.

In a 5-4 decision, the justices ruled that the government cannot force closely-held companies such as the family-owned Hobby Lobby chain of craft stores to provide the broad insurance coverage for contraceptives called for by the Affordable Care Act. The company's Christian owners objected to the requirement on religious grounds. The ruling could have a bearing on similar cases involving nonprofit, religiously affiliated nursing home companies such as The Little Sisters of the Poor.

However, the Hobby Lobby ruling applies only to “small, privately held, for-profit companies,” noted Cheryl Phillips, M.D., senior vice president for public policy and advocacy at long-term care provider association LeadingAge. Therefore, the decision does not apply to the association's members, she said in an email to McKnight's.

LeadingAge is continuing to monitor developments, Phillips added.

The Center for Medicare Advocacy also is being watchful as to the ruling's broader impact.

“We are concerned that the Hobby Lobby ruling will open the door to companies deleting other employee health coverage — particularly if it is perceived, correctly or not, as violating some religious concerns,” Executive Director Judith Stein told McKnight's.

Also in a 5-4 ruling, the court limited the ability of some public sector unions to collect dues. The case involved home healthcare workers in Illinois, who are considered public sector employees because they receive payment from Medicaid. Under Monday's ruling, nonmember home health workers will no longer have to pay “fair share” fees.

Home health aide Pamela Harris brought the case, arguing against a 1977 Supreme Court decision holding that non-members can be made to pay fees as long as the money doesn't go toward furthering political causes.

Union interests have said that membership will erode drastically if nonmembers get the benefits of collective bargaining without having to pay any share of administrative costs.

The Supreme Court did not overturn the 1977 decision, but carved out an exception for home health workers. This is because they are employed in private homes and are not supervised by other public employees, making them different than most public sector workers, Justice Samuel Alito wrote in the majority opinion.

Nine other states have similar public sector home health worker unions, according to The Associated Press.

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