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Drew Altman for Wall Street Journal
Fri, 2014-07-25
"A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. One of the cases, Halbig v. Burwell, also adds uncertainty to the enrollment process set to begin this fall, when millions more people are expecting to get tax credits–and wondering if they may be taken away. Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics. The plaintiffs paint this as a case about statutory language and intent.
Ryan Radia, Competitive Enterprise Institute
Thu, 2014-07-24
"This week, an unprecedented circuit split emerged in Halbig v. Burwell and King v. Burwell over whether health insurance premium assistance is available in states that didn’t set up health insurance exchanges. Many commentators have since claimed that there’s no way Congress intended to deny premium assistance to residents of the 36 so-called “refusenik” states that have not set up their own health insurance exchanges. But in January 2012, Jonathan Gruber—an MIT economics professor whom the The New York Times has called “Mr. Mandate” for his pivotal role in helping the Obama administration and Congress draft the Affordable Care Act—told an audience at Noblis that: What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill.
The Associated Press
Thu, 2014-07-24
"PORTLAND — Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. However, an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid. The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion."
Elise Viebeck, The Hill
Thu, 2014-07-24
"Health and Human Services (HHS) Secretary Sylvia Burwell continued her management shake-up Wednesday by naming a former vice president at Wal-Mart as senior adviser. The move to bring Leslie Dach to HHS reveals Burwell's interest in heading off problems during ObamaCare's second enrollment period, due to start in November. The new HHS secretary also wants to add professionals with significant private sector experience to her inner circle. "Leslie’s experience, which spans the business, government, and civil society sectors, will further enhance our ability to deliver impact for the American people," Burwell said in a statement. "We want to not only retain, but also recruit, talented individuals to our mission of ensuring every American has access to the building blocks of a healthy, productive life." Dach will focus on ObamaCare's second enrollment period as well as projects across the department, according to a press memo."
Robert Pear, NY Times
Thu, 2014-07-24
"WASHINGTON — Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved. “Time and time again,” said Representative Charles Boustany Jr., Republican of Louisiana, “the administration has chosen to ignore the law, and when it does implement the law, it does so incompetently.” Mr. Boustany presided over a hearing of a House Ways and Means subcommittee on Wednesday. An official from the Government Accountability Office, an investigative arm of Congress, testified at the hearing that undercover agents had obtained insurance coverage and subsidies using fake documents and fictitious identities."
Michael Barone
Mon, 2014-07-28
Words mean what they say. That’s the basis for the decision of the U.S. Court of Appeals for the D.C. Circuit in Halbig v. Burwell invalidating the Internal Revenue Service regulation approving subsidies for Obamacare consumers in states with federal health insurance exchanges. The law passed by Congress, Judge Thomas Griffith explained, provided for subsidies in states with state-created exchanges, but not in states with federal exchanges. That’s factually correct, and under the Constitution, the government can’t spend money not authorized by Congress. This has not prevented Democrats from calling the decision “judicial activism,” which makes as much sense as the claims that the Supreme Court decision overturning the Obamacare contraception mandate cuts off all access to contraception. “We reach this conclusion,” wrote Judge Griffith, “with reluctance.” Judge Roger Ferguson, writing for the Fourth Circuit whose King v.
Julie Appleby, Kaiser Health News
Mon, 2014-07-28
"Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. “They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, Calif. In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him. Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces.
Kyle Cheney and Sarah Wheaton, Politico
Mon, 2014-07-28
"States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren’t asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair. The viability of state exchanges became more urgent this week after conflicting court rulings created uncertainty about whether Affordable Care Act subsidies would be available through the federal exchange — or whether the state market would be the only legal route. A POLITICO survey of the 15 state-run exchanges (including Washington, D.C.) found that 11 are thinking about using federal dollars in 2015 — and four of those states have already applied."
The Associated Press
Mon, 2014-07-28
"New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans. The state's health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins. A majority of board members worried that New Mexico wasn't ready to switch to a state-run online system for individuals. Any technical failures could delay enrollment and discourage consumers from trying to obtain health coverage, they said. Continuing with the federal system for another year is the "safest, most risk-free" way of enrolling New Mexicans, New Mexico Health Connections CEO Martin Hickey said."
The Associated Press
Mon, 2014-07-28
"The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight healthcare fraud. U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases. "My advice to the medical community is to stay away from gray areas or outright fraud that wastes tax dollars, because we will be watching," Johnson told the Sioux Falls Argus Leader. "The end result in many of these cases will be that the taxpayers get their money back with interest and penalties, and the medical professional loses their license." Johnson's office recently settled an alleged fraud case involving two doctors at Dakotas-based Sanford Health.
Caroline F. Pearson, Avalere Health
Wed, 2014-06-04
"A new analysis from Avalere Health finds that consumers in exchanges receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose."
Caroline F. Pearson, Avalere
Thu, 2014-05-22
"A new analysis from Avalere Health finds that individuals choosing an exchange plan based on premiums are most likely to consider plans from Coventry (acquired by Aetna in 2013), Humana, and WellPoint in regions where they participate."
Matthew Eyles, Avalere
Wed, 2014-05-14
"According to a new Avalere Health analysis, 17 of the 26 states that did not expand Medicaid in the first three months of 2014 still reported growth in Medicaid enrollment, ranging from 0.1 percent in Texas to 10.1 percent in Montana. Since these states had decided not to expand Medicaid eligibility levels under the Affordable Care Act (ACA), these numbers show the impact of the “woodwork effect,” which is when individuals who were previously eligible, but not enrolled in Medicaid, newly sign up as a result of increased outreach and awareness. These enrollees may place a strain on state budgets, since states are required to contribute to the cost of their coverage based on traditional Medicaid matching rates."
Caroline F. Pearson, Avalere
Thu, 2014-05-08
The federal government will bear a disproportionate burden of premium increases in states with high rates of subsidized enrollees. Double digit premium increases are likely in many markets in 2014. Age distribution among enrollees varies by state, which may influence plans’ interest in each market.
Caroline F. Pearson, Avalere
Wed, 2014-05-07
"A new analysis from Avalere Health finds that exchange enrollment meets or exceeds expectations in 22 states (44%), even after accounting for any attrition due to nonpayment of premiums. Assuming 15 percent of enrollees do not take the final enrollment step and pay their premiums, over 6.8 million people who enrolled through April 19 will have coverage effective as of May 1."
Stephen Parente
Morning Consult
Mon, 2014-06-09
"Let’s face it, health reform in 2014 is going to be pretty boring from here on out. Why? It’s an election year. That might seem counterintuitive, since the Affordable Care Act (ACA) demonstrated the haunting dance of partisan politics and policy making at its least consensus building. So why the yawns for 2014? Because the positions of the advocates and detractors of ACA are pretty well set in stone going into the mid-term elections."
Yevgeniy Feyman & Fil Babalievsky
Forbes: The Apothecary
Thu, 2014-05-22
"With 2015 premiums forthcoming, a major question hanging over Obamacare’s exchanges is what effect competition among insurers will have on premiums. Currently, the exchanges tend to be sparsely populated, with only 3.9 insurers competing in each rating area of the federal exchanges, on average. Indeed, whether premium increases moderate will be a major test for the health care law."
Ed Rogers
Washington Post
Wed, 2014-05-21
"The problems with Obamacare have moved off the front page recently, which is exactly what the Democrats have wanted to happen. They want to celebrate the “victory” of Obamacare by championing the alleged 8 million sign-ups, answering few questions and moving on."
Megan McArdle
Bloomberg View
Wed, 2014-05-21
"The most transparent administration in history has decided to discontinue the monthly Affordable Care Act enrollment reports now that open enrollment is closed. And why shouldn’t it? you ask. After all, open enrollment is, well, closed."
Joseph R. Antos, James C. Capretta, Robert Doar & Mark Pauly
The Hill
Tue, 2014-05-20
"Healthcare reform has largely ignored the poor. The healthcare safety net has far too many holes, and the Affordable Care Act builds on a flawed system of health insurance. Lower income families, especially those enrolled in Medicaid, have a difficult time finding doctors who will accept their coverage. Insurance is of little value if doctors will not work with your insurer."

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