1. HEALTH CARE REFORM LEGAL UPDATE – WHERE ARE WE GOING NOW? Vickie J. Williams Associate Professor of Law Gonzaga University School of Law September 15, 2015

2. What is Settled by Courts Constitutionality of the substance of the ACA – Individual mandate (NFIB v. Sebelius) – Employer mandate (Hotze v. Burwell) – Methodology for passage (Sissel v. HHS, Hotze v. Burwell – origination clause challenge). Constitutionality of the IPAB (Coons v. Lew) Unconstitutionality of requirement that states expand their Medicaid programs (NFIB v. Sebelius)

3. What is Settled by the Courts (cont’d) Availability of insurance subsidies on federal exchange (King v. Burwell) Right of for-profit corporations to claim religious exemption from the contraceptive coverage mandate (Hobby Lobby v. Sebelius) Constitutionality of religious exemption to the individual mandate (Cutler v. HHS) Legality of requiring members of Congress and staff to purchase health insurance under the ACA with pre-tax employer contributions from the federal government (Johnson v. OPM – decided on standing grounds)

4. What is Not Settled by Courts Legality of Obama administration’s payment of cost-sharing reduction payments to insurers without an explicit appropriation from Congress (U.S. House of Reps. v. Burwell) – Currently at the D.C. District Court on government’s motion to dismiss for lack of standing. Administration’s delay of effective date of the employer mandate (U.S. House of Reps. v. Burwell; Kawa Orthodontics v. Lew) – Kawa case on petition for cert. at SCOTUS, scheduled for Sept. 28, 2015 conference)

5. What is Not Settled by the Courts Extent and nature of exemptions to contraceptive mandate available: – Legality of Obama administration’s accommodation for religious non-profits objecting to contraceptive mandate (Little Sisters of the Poor v. Burwell and numerous others.) Little Sisters case on cert. to SCOTUS – Ability of secular non-profit organizations to claim exemption from contraceptive mandate (March for Life v. Burwell).