Source: http://www.annalsofhealthlaw.com/annalsofhealthlaw/vol__24_issue_2?pg=38
Timestamp: 2019-04-23 04:10:30+00:00

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governed by the ACA. Since Essential Health Benefits are a statutory requirement, Part V considers the need for rules of statutory interpretation. These could compensate for a disadvantage of the doctrine of reasonable expectations – the likely absence of specific expectations by the parties. The article concludes that courts, insurers, and policyholders would be well served by adopting a functional combination of both approaches, which might be called reasonable statutory expectations, to carry out the regulatory and financing functions of ACA plans. As noted in Part VI, this is a modest conclusion, given the circumscribed scope of private health plans currently subject to ACA requirements. It adds only slightly more definition to the picture. Nonetheless, such a functional approach to interpreting ACA plans could play a positive role and inform a growing number of health plans.
15. Nat’l Fed’n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566, 2580 (2012) (“The Act aims to increase the number of Americans covered by health insurance and decrease the cost of health care.”); see 26 C.F.R. § 1.5000A-2 (2014) (West, WestlawNext through Apr. 9, 2015; 80 Fed. Reg. 19,036) (explaining minimum essential coverage).
16. See 26 U.S. C. A. § 5000A (West, WestlawNext through P.L. 111-148, 111-152, 111-159, and 111-173); see also 26 C.F.R. § 1.5000A-2 (West, WestlawNext through Apr. 9, 2015; 80 Fed. Reg. 19,036); 26 U.S. C. A. § 36B (West, WestlawNext through P.L. 113-296, excluding P.L. 113-235, 113-287, and 113-291) (discussing premium assistance tax credits). The majority of those who purchased coverage through an exchange are eligible for subsidies currently, since the IRS interpreted §§ 1311 and 1321 of the ACA to permit subsidies to those who purchased through the federal website. See 26 C.F.R. § 1.36B-2 (West, WestlawNext through Apr. 9, 2014; 80 Fed. Reg. 19,036) (detailing a taxpayer’s eligibility for premium assistance).

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