“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. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.
“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.””
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. Burwell decision upholding the IRS was announced the same day, wrote that those challenging the government “have the better of the statutory construction arguments.”
One has a certain sympathy with both judges. They’re being asked to overturn a regulation that has paid most of the cost for health insurance for some 4.7 million Americans. But the problem arose not from sloppy legislative draftsmanship.
Under previous court decisions, Congress can’t force state governments to administer federal laws. So congressional Democrats, seeking to muscle states into creating their own health insurance exchanges, chose to provide subsidies only for those states. Those opting for the federal exchange would have to explain to voters why they weren’t getting subsidies.
“The Obama administration signaled Thursday it’s not backing down from the controversial health law employer mandate that has been delayed twice and is the centerpiece of the House’s lawsuit against the president.
The IRS posted drafts of the forms that employers will have to fill out to comply with the Obamacare requirement that employers provide health insurance to workers.
Some business groups said the information was still too tentative and too incomplete to let them prepare for new obligations under the health law. “Our immense frustrations with the IRS continue,” Christine Pollack, vice president of Government Affairs at the Retail Industry Leaders Association, said in a statement.
An administration official said the White House is sticking to the timeline announced earlier this year. Companies with 50 to 99 employees will have another year — until 2016 — to start the coverage. Companies with 100 or more employees do have to comply next year, although they have two years to phase up so that they are covering 95 percent of their workers. Smaller businesses are exempt.”
“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. The rule lets states decide how specifically to interpret those categories.”
“The two contradictory appeals court decisions that cast the future of Obamacare into uncertainty Tuesday morning largely center on a question of intent: When the Affordable Care Act was conceived and drafted, did its creators mean to withhold health care subsidies from people living in states that refused to set up their own exchanges?.
This latest legal challenge focuses on four words in the mammoth law authorizing tax credits for individuals who buy insurance through exchanges “established by the States.” Thiry-six states declined to set up their own exchanges — far more than the law’s backers anticipated — and in those states, consumers have been shopping for health care on exchanges run instead by the federal government. Now the D.C. Circuit Court of Appeals has ruled that these consumers are not eligible for subsidies because, well, they bought their insurance on exchanges not “established by the States.”
This is a tremendously literal interpretation of a small but crucial part of the law, and it’s one that was arguably never intended by its creators. The plaintiffs in these challenges have argued that the ACA always meant to exclude noncooperative states from subsidies as a way of incentivizing those states to create their own exchanges. Supporters of the law — including the Obama Administration — counter that such intent would never have made any sense in the larger context of a law aiming to expand health insurance to as many people as possible.”
“Two U.S. Appeals Courts Tuesday reached opposite conclusions about the legality of subsidies in the Affordable Care Act, a key part of the law that brings down the cost of coverage for millions of Americans.
In Washington, a three-judge panel at the U.S. Appeals Court for the D.C. Circuit ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states.
That 2-1 ruling in Halbig v. Burwell could put at risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are run by the federal government. Judge Thomas Griffith, writing the majority opinion, said they concluded “that the ACA unambiguously restricts” the subsidies to “Exchanges ‘established by the state.’ ”
But within hours, a unanimous three-judge panel for the Fourth Circuit in Richmond, Va., ruled exactly the other way in King v. Burwell – that Congress always intended to allow subsidies to be provided in both state and federally run exchanges.
“It is therefore clear that widely available tax credits are essential to fulfilling the Act’s primary goals and that Congress was aware of their importance when drafting the bill,” said the decision written by Judge Roger Gregory.
The Obama administration said it will appeal the Halbig decision. The Justice Department will ask the entire appeals court panel to review it, and that panel is dominated by judges appointed by Democrats, 7-4.”
“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. The point of the federal exchanges is to make sure the law works even in states that can’t or won’t set up an exchange.
For Congress to write a law that provides for federal exchanges but doesn’t permit money to flow through them would have been like Congress writing a transportation law that builds federal highways but doesn’t allow cars, bikes or buses to travel on them.”
“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:”
“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.”
“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.”