Starting March 27, legally married same-sex couples will be able to take unpaid time off to care for a spouse or sick family members even if they live in a state that doesn’t recognize their marriage.

The final rule issued by the Department of Labor revises the definition of “spouse” in the Family and Medical Leave Act to recognize legally married same-sex couples regardless of where they live. Prior to that, only couples that lived in a state that recognized same-sex marriage could take advantage of the act’s benefits.

Currently, 37 states plus the District of Columbia permit same-sex marriages.

“We’re really excited about it,” says Robin Maril, senior legislative counsel at the Human Rights Campaign, a lesbian, gay, bisexual and transgender advocacy group, of the final rule. The old interpretation “wasn’t fair for employees. It meant they had different federal benefits based on their zip code.”

The new rule was prompted by President Barack Obama’s instructions to federal agencies to review federal statutes following the 2013 Supreme Court decision in United States v. Windsor. That decision struck down part of the Defense of Marriage Act that said that a marriage must be between a man and a woman.

The Family and Medical Leave Act entitles workers to take up to 12 weeks of unpaid leave annually to care for a spouse or family member for medical or family reasons without losing their jobs. It applies to private sector companies with 50 or more workers and public sector agencies and schools of any size.

In addition to legally married same- and opposite-sex couples, the final rule’s revised definition of spouse applies to common law marriages and those that took place outside the United States if they would have met legal standards in  could have been entered into in at least one state.

“There are many good corporate policies, but companies look to the FMLA” as the mandated standards, says Maril.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The percentage of Latinos and African Americans who signed up for subsidized health coverage through California’s insurance exchange increased modestly during the second annual open enrollment period, officials announced Thursday.

About 37 percent of subsidized enrollees are Latino, up from 31 percent during the first enrollment period ending in March 2014, according to data released by Covered California. About 4 percent are African American, up from 3 percent last year. The numbers, released by Covered California during its monthly board meeting, include only those enrollees eligible for subsidies who responded to questions about their race or ethnicity.

Covered California faced criticism last year for failing to sign up enough Latinos, particularly those who spoke primarily Spanish. The insurance exchange launched a dedicated, bilingual campaign – both in the media and on-the-ground to educate and enroll more Latino consumers.

Covered California Executive Director Peter Lee said the increases in both Latino and African American enrollment show the targeted efforts were successful.

“This is a reflection of not just the advertising and marketing … but very good outreach in communities throughout the state,” Lee said.

Advocates praised the exchange for the more diverse population of enrollees. The percentages enrolled roughly match the proportion believed to be eligible for subsidized coverage in the population at large.

“It’s good that Covered California has reached further into Latino communities, but there’s more to do,” Anthony Wright, executive director of the nonprofit Health Access California, said in a statement.

Wright and others said the next challenge is ensuring that Californians don’t drop coverage when they experience life changes, such as moving or switching jobs.

The exchange also saw a jump in the percentage of younger enrollees. About 34 percent of new enrollees are between 18 and 34, compared to 29 percent of enrollees last year.

Younger enrollees are critical to balancing out the older, sicker population that signed up for coverage right away.

Open enrollment ran from November until Feb. 22 for most people. Those who did not know about the tax penalty for not having insurance can sign up until the end of April.

Altogether, more than 495,000 people signed up for private health coverage in the second open enrollment, including about 88 percent who were eligible for federal subsidies. An additional 779,000 people signed up for Medi-Cal, the program for poor and disabled Californians.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Public opinion polling agency Gallup reported that 80% of Americans rate the honesty and ethics of nurses as high or very high. It’s not the first time the poll found such high appreciation for nurses either; we’ve mentioned it before. In fact, “Americans have been asked to rate the honesty and ethics of various professions annually Continue Reading

MARY AGNES CAREY:  Welcome to Health on the Hill, I’m Mary Agnes Carey. The lawyers have spoken and the Supreme Court’s deliberations on the latest challenge to the health law will begin. In question are the law’s tax credits that help residents of nearly three dozen states afford health care insurance. The challengers say that the law clearly states that those premium subsidies be available only to exchanges established by a state and not in states that have deferred to the federally run marketplace. The law’s proponents say Congress intended everyone, no matter where they live, be eligible for the subsidies. Julie Rovner, a senior correspondent for Kaiser Health News, attended oral arguments at the Supreme Court and is here to give us the latest. Julie, welcome back.

JULIE ROVNER:  Nice to be here.

MARY AGNES CAREY:  You know this court and you know this case. What did you hear today that surprised you?

JULIE ROVNER: Well, actually, one of the first things that happened was Justice [Ruth Bader] Ginsburg asked about standing, and we weren’t sure whether this was going to happen. Of course, you can’t have a court case unless the people who are suing have something at stake. And there are four plaintiffs in this case – they are all from Virginia – and they all charge that because the Internal Revenue Service is allowing tax credits in the states where the federal government is running the exchange that they are now subject to the individual mandate penalty. Well, it turns out that three, and perhaps all four of them – there’s some question about that – so they went back and forth a little about standing, but the government said they weren’t going to challenge it. They’re going to presume at least one person actually would be injured and therefore has the right to bring this case. So there was discussion that we weren’t sure it was going to happen.

MARY AGNES CAREY:  And that was right at the top.

JULIE ROVNER: Absolutely. The lawyer didn’t get six words out of his mouth before he got interrupted. [Ginsburg] said: “Back up. I want to talk about standing.” So people weren’t sure this was going to happen, because this came out fairly recently – that there was some question about whether these four plaintiffs actually would be hurt if the law continues as is.

MARY AGNES CAREY:  And Justice [Anthony] Kennedy, I believe, raised this concern about coercion, and the subsidies and constitutionality. Can you take us through that?

JULIE ROVNER: In some ways, this really was part two of the case that they heard in 2012, even though that really was a constitutional case and this really isn’t. In that case, they ruled that the part of the law that required states to expand their Medicaid programs couldn’t continue because it was coercive to the state. So what Justice Kennedy was saying today was that if they read this sentence in the law the way the challengers are saying, that basically states would be given a choice between either setting up their own exchange or having their health insurance market be seriously, badly affected. Because of course, all the other requirements would happen, but there wouldn’t be any tax credits. And he said that could be coercive and that could give them a constitutional problem if they read it the challengers’ way.

MARY AGNES CAREY:  Now the arguments seem to break down along partisan lines with the exception of Justice Kennedy, and we didn’t hear much from Chief Justice [John] Roberts. Do you take away any hints on how the court might actually rule on this?

JULIE ROVNER: You know, sometimes you can watch oral arguments and you get a pretty good idea of where they’re going. Last year when the court in the Hobby Lobby decision about contraception — pretty much what went on with oral arguments was what followed in the decision. That’s not usually the case and I think it really wasn’t the case today. Clearly the liberals were behind the government and the way the law is being implemented and the real conservatives were with the challengers. But the swing votes here are going to be — everybody assumes and they’ve assumed from the beginning —  to be Justice Roberts and Justice Kennedy. And as you mentioned Justice Roberts was uncharacteristically quiet and Justice Kennedy had really tough questions for both sides. He questioned whether it was allowable to give the Internal Revenue Service  so much power to basically be able to say: “Yes, we think that these tax credits should be available in the federal exchange.” So he could go either way, at least judging from what he said. You do really never know.

MARY AGNES CAREY:  Do you think Justice Roberts was intentionally quiet, because there has been so many stories with headlines like ‘Justice Roberts In The Hot Seat’? That everybody is looking at him; how is he going to rule? Do you think he intentionally just decided today to not ask too many questions?

JULIE ROVNER: I have no idea what Justice Roberts was thinking, but that’s what everybody wants to know. Which way is he going to go in this case? Although if Justice Kennedy goes with the liberals then they wouldn’t need Justice Roberts. Nobody is quite sure how it’s going to come out and won’t know until June when we see it.

MARY AGNES CAREY:  There’s a lot of concern among advocates for the law if the court decided to say people in federally run exchanges can’t get these subsidies, you’re going to have chaos in the insurance markets, it’s all or nothing. But, Judge [Samuel] Alito suggested an alternative today. What was that?

JULIE ROVNER: He did. He actually suggested that perhaps the Court could rule for the challengers but stay its ruling through the rest of the tax year, which would be another six months. That would give states, he said,  and Justice Scalia said this too, states could still go ahead and create exchanges. But the Solicitor General Donald Verrilli who argued the case for the government said that it would take a lot more than six months for states to set up exchanges and it would, there are all kinds of obstacles. Not the least of which that there’s no longer federal funding for states to set up their own exchanges.  And the states that did set up their own exchanges it took them, in most cases, at least a couple of years to do that. So, six months probably wouldn’t be sufficient whether the court would even do that.

MARY AGNES CAREY:  Right. And there are some state legislatures that, I think you’ve written this in one of your pieces, that have said we prohibit an exchange, period. So they would have to change their own laws on that.

JULIE ROVNER: Well, mostly what they said is we prohibit the governor from doing it without us. But most of those state legislatures won’t be in session, so they’d have to come into session.  You would need both the legislature and the governor to go along with it. They would need to spend their own money because there are no federal funds for it. It would be a big deal.  And while there are some states that might do it, there’s already some states leaning towards doing it, there would certainly be, you know, many, many other states that would not do it.

MARY AGNES CAREY:  How concerned is the court about Congress and/or the Obama administration stepping in to remedy a situation if the subsidies in the federal exchanges were struck down?

JULIE ROVNER: You know, in a case like this where they’re trying to interpret what Congress meant when it wrote this particular sentence, the court theoretically shouldn’t be looking at the possible outcome, but they all did.  Both the liberals and conservative talked about the possibility of real problems in the state insurance markets if the federal exchange is not allowed to offer tax credits.  And this is why I think the Republicans in Congress have wanted to reassure the court that something could be fixed. So as I mentioned Justice Alito said the states could create exchanges. Justice Scalia said, “Well, Congress can come in and fix this.” And the Solicitor General said, “This Congress, Your Honor?”  And everybody laughed. This Congress is not really, A. inclined to fix it and B. able to get a whole lot done right now.

MARY AGNES CAREY:  Thanks for the update, Julie Rovner with Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

For the second time in three years, the federal Affordable Care Act went before the Supreme Court Wednesday. And before a packed courtroom, a divided group of justices mostly picked up right where they left off the last time.

Once again, commentators and experts were left to wonder where Chief Justice John Roberts and Justice Anthony Kennedy, considered swing votes in the case, stand. A decision is expected by the end of June.

Unlike in 2012, the current case, King v. Burwell, doesn’t challenge the constitutionality of the law’s centerpiece that requires most Americans to have health insurance or pay a penalty. In a 5-4 ruling, the court that year decided the law could continue, albeit with a twist: states could elect not to expand Medicaid. But the latest case does challenge another piece that’s pivotal to making the law work: Whether tax credits to help moderate-income Americans afford coverage can be provided in the three dozen states where the marketplace is being run by the federal government.

The court’s most conservative justices seemed to side with the challengers, who say that a sentence in the law stipulating that tax credits are available only on health insurance exchanges “established by the state” means just that. In other words, credits would not be available in the three dozen states that are using healthcare.gov, the federal exchange.

“If Congress did not mean ‘established by the state’ to mean what it normally means, why did they use that language?” asked Justice Samuel Alito.

Liberal justices, however, seemed much more comfortable with the Obama administration’s argument that the phrase encompasses both federal and state-run exchanges — and that reading the text to allow tax help only on state exchanges runs counter to the rest of the law.

If they were to read the law the way the challengers argue, said Justice Elena Kagan, “there will be no customers and no products” on the federal exchange, because no one would be eligible. “When you’re interpreting a statute generally, you try to make it make sense as a whole,” she said.

But almost nothing could be gleaned from the questioning and comments of Roberts and Kennedy.

Kennedy had hard questions for both sides. He suggested at one point that withholding tax credits from states that failed to set up their own insurance exchanges could pose “a serious constitutional problem,” because it could disrupt insurance markets in states that do not set up their own exchanges. Giving states such an unpalatable choice would be unfair coercion by the federal government, Kennedy said.

But Kennedy also questioned whether, in the absence of more specific language, Congress intended to let the Internal Revenue Service decide how to distribute billions of federal tax dollars. “That’s a lot of responsibility,” he said. The question specifically before the court is whether the IRS overstepped its authority in interpreting the law to allow tax credits in both state-run and the federal exchange.

Roberts, meanwhile, was uncharacteristically quiet during the nearly hour and a half argument. In 2012, it was the chief justice who surprised many observers by joining the liberals to find the law constitutional because Congress was using its taxing power.

Outside the court, standing in a light rain, those on both sides predicted victory.

“It looks good for the plaintiffs,” said Michael Cannon of the libertarian Cato Institute. Cannon, who helped push the court case – and travelled the country working to persuade states not to set up their own exchanges – said he was pleased by questions about the IRS’ interpretation. “It’s absurd to give the IRS that kind of authority,” he said.

But Elizabeth Wydra of the Constitutional Accountability Center, which supported the administration’s position, said she thought the arguments leaned her side’s way. “If the court follows the plain text of the law and prior precedents, then it’s clear tax credits are available to all Americans no matter what entity runs the exchange,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.