Question set two and three

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EMPLOYMENT LAW FOR HUMAN RESOURCE PRACTICE CHAPTER 12 BENEFITS 

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Commentary

The ACA Individual Mandate

As Walsh discusses, the Patient Protection and Affordable Care Act (ACA) required that individuals sign up for health insurance, a mandate that was enforced by way of a tax penalty. In 2012 the Supreme Court upheld that aspect of the ACA based on Congress’ power to tax. But as part of an effort to undermine the ACA, Congress has since eliminated that tax penalty, thereby effectively repealing the individual mandate:

“Under the tax reform legislation, effective January 1, 2019, the tax is repealed by reducing the individual responsibility payment to zero for individuals who do not purchase health insurance that qualifies as minimum essential coverage. At this point, it is unclear what effect this might have on other aspects of the ACA, but it’s important for employers to understand that there is NO CHANGE to the employer mandate. That provision is completely unaffected by the tax legislation and the repeal of the individual mandate.” (Emphasis in original.) (Webb-Ayer, 2018)Please respond to each question set in the order in which it appears below, inserting the number of the question set as a heading or in the first line of the response to that set.

In light of the course reading in chapter 12:

QUESTION SET TWO

Totale has also made a pitch to administer Repacordy’s employee health care plan, offering these cost saving ideas:

  • Repacordy should genetically test all applicants for their potential to develop expensive disorders so that Repacordy could avoid hiring those applicants in the first place.
  • Repacordy should genetically test all current employees for their likelihood to develop expensive disorders so that the employee health care premium contributions could be adjusted, i.e., expensive employees could be charged their “fair share” of health insurance costs.

In light of the Lesson 5 and Lesson 10 course reading,

1. State whether Total’s ideas raise any legal issues. If so, identify, describe and analyze each issue.
2. Identify and describe the applicable laws and how they impact each issue.

QUESTION SET THREE

Jake has two children with cystic fibrosis, each of whom has undergone a series of expensive medical procedures and requires medication on a continuing basis. When Jake submitted a request for approval for an experimental surgical treatment (with supporting medical documentation), the Repacordy plan administrator, well aware that the plan had already spent a lot of money on Jake’s kids, immediately sent the request back to Jake with one word, “Denied,” written across the first page.

A few days later, Repacordy told Jake that he was being permanently laid off because the company had decided to downsize his department. Jake was provided with no documentation related to his lay off and was escorted out of the plant the same afternoon.For the last 2 months, Jake has been looking for comparable work, so far unsuccessfully. Although he received a check for his accrued vacation pay, he’s received nothing else related to his Repacordy benefits or lay off. Today he found out that the company replaced him almost immediately and has since hired two additional employees for his department.  All three new hires are single males with no dependents.

  • In light of the course reading:
  1. Does this fact pattern raise any legal issues? If so, identify and describe each of them.
  2. Identify and describe the applicable laws and how they impact each of the issues.
  3. If you believe that Jake could bring a lawsuit based on this fact pattern, identify each claim and the law upon which it could be based, identify the elements of the claim, and explain to what extent he could establish each element.
  4. If you believe that Jake could not bring a lawsuit at this time, explain your analysis in detail.
  5. If additional information would be helpful to your analysis, explain how and why it would impact your analysis.
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