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Kaiser Health News
Wed, 2014-07-23
"The essential health benefits (EHBs) countdown is on for 2016. That’s when this provision of the Affordable Care Act, which sets out 10 specific health services that must be covered by plans sold on the exchanges, will likely be reviewed by the Department of Health and Human Services. Business interests and consumer advocates are already making their positions clear – the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers’ coverage. During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums. Current policy requires plans cover emergency services, pre- and post-natal care, hospital and doctors’ services, and prescription drugs, among other things.
Tony Pugh, McClatchey News Service
Wed, 2014-07-23
"WASHINGTON -- Contrary rulings Tuesday on a key element of the Affordable Care Act by two separate federal appeals courts raise a variety of questions. Q: What happened? A: The U.S. Court of Appeals for the District of Columbia Circuit decided 2-1 that tax subsidies available to help people pay for health coverage through the Affordable Care Act can only be used in the 14 states and in D.C., which run their own insurance exchanges without any help from the federal government. But in a unanimous decision on a similar case a short time later, the 4th U.S. Circuit Court of Appeals in Richmond, Va., ruled just the opposite. Q: Who’s eligible for the tax subsidies? A: Individuals and families who earn between 100 percent and 400 percent of the federal poverty level. For those who enrolled this year, it includes individuals earning $11,490 to $45,960, and a family of four earning from $23,550 to $94,200. Q: Does the D.C.
Grace-Marie Turner, Galen Institute
Tue, 2014-07-22
"The U.S. Circuit Court of Appeals has upheld the rule of law in its decision that the health law does not allow tax subsidies to be distributed through the federal government’s health insurance exchange. The Obama administration’s Internal Revenue Service issued regulations in 2012 authorizing the flow of funds after two-thirds of the states opted not to create their own exchanges, thereby defaulting to the federal exchange. In a 2-1 decision, the appeals court ruled that the law plainly states that tax credits to subsidize health insurance are to be available only through an “Exchange established by the State.” Shortly after the DC Circuit decision was announced, the Richmond-based Fourth Circuit Court of Appeals ruled in a separate case that the law’s language does allow the subsidies to be distributed through the federal exchanges. This sets up a very likely Supreme Court challenge."
Nick Budnick, The Oregonian
Tue, 2014-07-22
"Gov. John Kitzhaber has defended his handling of the Cover Oregon debacle by noting that he engaged in "cleaning our own house," including holding three officials "accountable" after the health insurance exchange website did not work. But newly released records reveal that one of those three, Triz delaRosa of Cover Oregon, didn't go quietly. After Kitzhaber called for delaRosa, the exchange's chief operating officer, to be fired on March 20, she warned the state she'd sue if she was fired, according to documents obtained under Oregon's public records law. She laid blame for the exchange fiasco on Oregon Health Authority mismanagement, as well as Kitzhaber's staff, for failing to confront problems Cover Oregon reported after taking over the project in May 2013. As a result, delaRosa received a $67,714.90 settlement and continued drawing a salary through May 16. In return, she agreed to say nothing negative about the state."
Patrick Marshall, Seattle Times
Tue, 2014-07-22
"One message came through loud and clear at today’s meeting of the Washington Health Benefit Exchange’s Operations Committee: It may not be time to panic about the health exchange’s problem-riddled invoicing and payments system, but it is time to sound the alarm and get all hands on deck. “We are really out of rope on this one,” Chief of Staff Pam MacEwan told the committee. “We need this to be fixed a while ago. We don’t have the patience of the public or the carriers on this anymore.” Software problems have prevented payments for up to 6,000 consumer accounts from posting properly and being reported to insurers, resulting in some consumers being told they don’t have coverage. Beth Walter, operations director, noted the exchange had received a commitment from Deloitte, the exchange’s primary contractor, to “engage additional resources on their side.” “What does that mean?” asked a committee member. “More people,” Walter replied."
Timothy Jost, Washington and Lee University
Thu, 2014-07-24
"July 22, 2014 was arguably the most important day in the history of the implementation of the Affordable Care Act since the Supreme Court issued its ruling in the National Federation of Independent Business case in June of 2012. As no doubt most readers of this blog know by now, shortly after 10 a.m. the United States Court of Appeals for the District of Columbia Circuit handed down its decision in Halbig v. Burwell. Two judges ruled over a strong dissent that an Internal Revenue Service rule allowing federally facilitated exchanges to issue premium tax credits to low and moderate income Americans is invalid. Approximately two hours later the Fourth Circuit Court of Appeals in Richmond, Virginia, unanimously upheld the IRS rule in King v. Burwell. Combined, the cases contain five judicial opinions, three in the Halbig case and two in King. Four of the six judges voted to uphold the rule, two to strike it down."
Bob Laszewski, Health Care Policy and Marketplace Review
Thu, 2014-07-24
"Today's 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law. The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do not set up exchanges––at least the 27 states that completely opted out of Obamacare.
Kaiser Health News
Wed, 2014-07-23
"Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans. Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them. Guess what? People looked for help on the decision. During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average.
"Margot Sanger-Katz, NY Times
Tue, 2014-07-22
"We now have two federal appeals courts that have issued conflicting rulings on a major provision of the Affordable Care Act. Those decisions are not the final word on whether residents of some states will be able to continue receiving financial assistance to buy health insurance. Here are some possible next steps:"
Ezra Klein, Vox
Tue, 2014-07-22
"The Halbig case could destroy Obamacare . But it won't. The Supreme Court simply isn't going to rip insurance from tens of millions of people in order to teach Congress a lesson about grammar. As Adrianna McIntyre explains, the Halbig case holds that Obamacare's subsidies are illegal in the 36 states where the federal government runs (or partly runs) the exchange. The plaintiffs rely on an unclearly worded sentence in the law to argue that Congress never intended to provide subsidies in federally-run exchanges and so the subsidies that are currently being provided in those 36 states are illegal and need to stop immediately. The point of Obamacare is to subsidize insurance for those who can't afford it This is plainly ridiculous. The point of Obamacare is to subsidize insurance for those who can't afford it.
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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