Category Archives: Insurance

Arguments provide few clues about how Supreme Court will rule on Obamacare subsidies

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U.S. Supreme CourtBy Julie Rovner
KHN

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.

To read the full transcript go here

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. Continue reading

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Behind Supreme Court’s Obamacare case, a secretive society’s hidden hand

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by Nina Martin ProPublica

The Supreme Court has no shortage of potentially precedent-shattering cases on its docket this term. But the one the justices are hearing tomorrow, King v. Burwell, could be the most consequential.

King focuses on the issue of whether low-income people who get insurance under the Affordable Care Act’s federal exchanges are entitled to tax subsidies. Much has been said (and written) about what could happen if the justices rule “no”: Millions of people in as many as 37 states could lose their health coverage. The political earthquake could be cataclysmic.

Yet, few reports have highlighted the role of the Federalist Society, the conservative law group whose ideas are at the intellectual heart of the King v. Burwell challenge. That’s not surprising, given that the group’s members have played a mostly behind-the-scenes part in King 2014 and in many of the most significant conservative legal victories of the last 30 years.

In a new book, “Ideas with Consequences: The Federalist Society and the Conservative Counterrevolution,” Pomona College political scientist Amanda Hollis-Brusky channels her inner investigative journalist to trace the group’s influence on the courts, and especially, the Supreme Court. Continue reading

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What’s at stake as health law lands at Supreme Court again

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By Sarah Varney
KHN

BURNSVILLE, N. C.— It’s been a bitterly cold winter in the Blue Ridge Mountains for Julia Raye and her 13-year-old son, Charles. But despite the punishing weather, 2015 has been looking good: Raye is finally able to afford insulin and the other medications she needs to keep her diabetes under control.

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Julia Raye of Burnsville, N.C. is paying $30 a month for insurance under Obamacare. (Photo credit: PBS Newshour)

She’s a self-employed auditor who relies on a $400 per month government subsidy to afford the private health plan she bought on healthcare.gov, the online federal marketplace for health insurance.

Before the Affordable Care Act made tax credits available to low- and moderate-income workers, Raye was uninsured. Back then, just one of her diabetes medications cost her $320.

“During that time, I had no insurance, and I really wasn’t taking my medicine. There were times when my sugars and things would get up to 600,” Raye said. “I remember getting to a point where the ambulance had to go take me in because I was pretty much in a diabetic shock.”

On Wednesday, the U.S. Supreme Court will hear oral arguments in a case that could cripple the Affordable Care Act and imperil financial assistance to 8.2 million health insurance shoppers like Raye in the states that rely on the federal health insurance exchange.

Since January 2014, Raye has had steady insurance, paying just $30 a month, while her son was covered by Medicaid, the public insurance program for low-income people. Treating her diabetes has improved her vision and the numbness in her feet, and, at age 48, she has gotten a long overdue mammogram.

Raye says she is watching the latest legal challenge to the Affordable Care Act with growing anxiety. If the court wipes out her subsidy, Raye says she wouldn’t be able to pay for treatment. Her diabetes would again worsen, she would be unable to work and she and her son would face financial ruin, she says.

Continue reading

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Sign-up season is over, but the list of special enrollment events is expanding

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CalendarBy Michelle Andrews
KHN

When the annual sign-up period for individual Obamacare coverage ended earlier this month, it meant that in general, people are locked into their plans for the year.

There are exceptions, however, for those who experience life changes such as marriage, the birth of a child or the loss of their job-based coverage.

The list of situations that trigger a special, 60-day enrollment period will get longer in April, when a new rule issued by the Department of Health and Human Services takes effect.

The rule’s additional circumstances include:

  • Losing a dependent or dependent status because of divorce, legal separation or death. This provision would enable someone who no longer needs family coverage, for example, to switch to single coverage. Although not required until 2017, exchanges are encouraged to offer this as soon as possible.
  • An increase in an individual’s income to the federal poverty level in states that haven’t expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level ($16,243 in 2015).At that income level, the person could qualify for premium tax credits that are available for those with incomes between 100 and 400 percent of the poverty level to make marketplace coverage more affordable.Last year, such individuals could also qualify for a special enrollment period, “but we read this as a bit broader,” says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. Last year, “you had to have applied for Medicaid to qualify.” Now, that’s not necessary.
  • If a court order requires someone to provide health insurance, the coverage must be available the first day the court order takes effect.“It’s extremely important for ensuring the coverage of children,” says Dania Palanker, senior counsel at the National Women’s Law Center.
  • People who are currently enrolled in non-calendar year plans will qualify for a special enrollment period when that coverage ends, even if they could renew them.

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

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

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Top five health stories of the week

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Credit: Dan Shirly

Credit: Dan Shirly

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5 things to know about the Supreme Court case challenging the health law

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Credit: Dan Shirly

Credit: Dan Shirly

By Julie Rovner
KHN

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using healthcare.gov, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1: This case does NOT challenge the constitutionality of the health law. Continue reading

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Immigration reforms don’t solve health issues

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BorderwallbrownsvileBy Tim Henderson
Stateline

President Barack Obama’s controversial executive action on immigration has highlighted a thorny health care issue for states: Potentially millions of immigrants could legally stay here and work, but still lack health insurance.

Unauthorized immigrants have limited access to health care coverage, and the president’s action likely will make them ineligible for most Medicaid services and bar them from purchasing insurance on the federal and state exchanges created under the Affordable Care Act (ACA).

Some states have sought to solve the problem for low-income immigrants with separate state-funded insurance programs. Those that have not are wrestling with the consequences of a population that is going without routine care, which can drive up costs when preventable illnesses become serious health emergencies.

Millions of immigrants could legally stay here and work, but still lack health insurance.

Treating kidney disease as an emergency condition, for instance, costs almost five times what it would with routine care denied to unauthorized immigrants, according to a Baylor College of Medicine study published by the Texas Medical Association last year.

Unauthorized immigrants without health insurance present other problems for states. In Maryland, for instance, state attorneys face cases of criminally insane defendants who are no longer deportable but can’t get the follow-up care required for release into the community. Continue reading

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Uninsured Ex-Sheriff Who Fought O-care Struggles To Pay Medical Bills

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Arizona FlagFormer Arizona county sheriff Richard Mack, a fierce opponent of Obamacare and a leader in the “constitutional sheriff” movement, is struggling to pay his medical bills after he and his wife each faced serious illnesses. The former sheriff and his wife do not have health insurance and started a GoFundMe campaign to solicit donations from family and friends to cover the costs of their medical care.

via Uninsured Ex-Sheriff Who Fought O-care Struggles To Pay Medical Bills.

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Study: ObamaCare premiums could triple if court tosses subsidies | TheHill

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GavelThe cost of healthcare premiums could rise as much 779 percent if the Supreme Court erases ObamaCare subsidies in a majority of states this year, according to a new study.

A victory for the plaintiffs in King v. Burwell would erase subsidies in 37 states using HealthCare.gov, causing premiums to spike an average of 255 percent, according to new research by the nonpartisan group Avalere Health.

via Study: ObamaCare premiums could triple if court tosses subsidies | TheHill.

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Fewer Americans Have Problems With Medical Bills | Medpage Today

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Twenty-dollar bill in medicine bottleThe percentage of people under age 65 living in a household reporting problems paying medical bills in the past year decreased from 21.3% (56.5 million) in 2011 to 17.8% (47.7 million) in 2014, according to a CDC report.

via Fewer Americans Have Problems With Medical Bills | Medpage Today.

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The Return of the Death of Obamacare – Opinion in Bloomberg Politics

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U.S. Supreme CourtThe immediate effect of a ruling against the ACA would be to hurl the political system, and no small part of the economy, into chaos. Yet there’s little sign that Washington is preparing for that scenario.

Democrats won’t talk about what they would do because they don’t want the court to believe they could contain the fallout.

Republicans don’t want to talk because they’re loath to admit that, even after voting 67 times to repeal or defund the ACA, they have no plan to help the millions who would be affected. (But they’d sure love the court to kill the law anyway.)

Hospitals and insurers understand that bewailing their financial plight might not help their cause. Instead, they’ve channeled their warnings into amicus briefs.

via The Return of the Death of Obamacare – Bloomberg Politics.

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Veterans propose major changes in VA health care

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veteran-affairs-seal-vaA national veterans task force is advocating radical changes in the medical system for America’s former military personnel, including a choice to receive subsidized private care and conversion of the Veterans Health Administration into a non-profit corporation rather than a government agency.

via Veterans propose major changes in VA health care.

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If you want to know who gets health-care handouts, look in the mirror – Opinion in The Washington Post

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cms-logo-200pxDespite all the mockery that oblivious cries of “Keep your government hands off my Medicare!” generated several years ago, older Americans still don’t seem to understand that Medicare is not only the government’s largest health-care program but also one that involves transferring lots of money away from everyone else and toward them — i.e., a subsidy.

Maybe the confusion stems from the fact that Medicare recipients have paid Medicare taxes. Every time I mention Medicare in a column, I’m inundated with irate e-mails proclaiming that seniors “paid for it fair and square” and are therefore not receiving a handout. These claims overlook the laws of arithmetic.

via If you want to know who gets health-care handouts, look in the mirror – The Washington Post.

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High Rate of Shopping and Switching in Obamacare Plans Is a Good Sign – NYTimes.com

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Shopping CartFor most customers returning to the Obamacare marketplaces this year, it really paid to shop around. New data shows that a large number of them did. That bodes well for those shoppers and the future offerings of the insurance marketplaces.

via High Rate of Shopping and Switching in Obamacare Plans Is a Good Sign – NYTimes.com.

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