The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

“Legal challenges to various aspects of Obamacare (aka the Affordable Care Act) keep traveling on a rollercoaster. Today’s episode of the law’s continuing courtroom soap opera involves a ruling by a federal district court in Oklahoma, which overturned a 2012 IRS rule authorizing premium assistance tax credits in federal exchanges (since rebranded as “federally facilitated marketplaces”). The decision improves the likelihood that the Supreme Court ultimately will consider this issue on appeal; either in the spring of 2015 or during its next 2015-2016 term.
Judge Ronald White ruled in State of Oklahoma v. Burwell that the IRS rule is “arbitrary, capricious, an abuse of discretion not in accordance with law, pursuant to 5 U.S.C. section 706(2)(A), in excess of statutory jurisdiction, authority, or limitations, or short of statutory right, pursuant to 5 U.S.C. section 706(2)(C), or otherwise is an invalid implementation of the ACA, and is hereby vacated.”
In other words, it was not just a “bad idea,” but an illegal one, too.”

“In a legal setback for the Obama administration, a federal judge in Oklahoma ruled Tuesday that people in states that rely on the federal insurance exchange are not eligible for Obamacare premium subsidies to help them pay for coverage.
Judge Ronald White, a George W. Bush appointee, invalidated an Internal Revenue Service rule interpreting the Patient Protection and Affordable Care Act to allow the premium tax credits in states that have not established their own exchange. “The court holds that the IRS Rule is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law,” White wrote.
In his ruling, White rejected the argument that striking down the subsidies would cripple the entire healthcare reform law. “Congress is free to amend the ACA to provide for tax credits in both state and federal exchanges, if that is the legislative will,” he wrote.”

“The second Obamacare enrollment season could go negative — but not because of the health care law’s critics.
Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don’t get covered. It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year.
There are several challenges: The 2015 enrollment period is shorter, the most motivated Americans are probably already enrolled and the law is still politically unpopular. That means that even if HealthCare.gov works well — and it couldn’t be worse than last October’s meltdown — proponents are confronting a tough messaging landscape.”

“Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.
The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.
This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.”

“As we start the final stretch before the midterm elections, many analysts are convinced that Obamacare isn’t the hot political issue it once was. While the flood of negative publicity about the law has subsided of late, a majority of people still oppose it, according to a Real Clear Politics average of polls taken from Sept. 2-15. And I’ve always believed the voters’ negative impressions of the law were “baked” into their assessments of Democratic incumbents.
That’s partly why Democratic Senators such as Kay Hagan of North Carolina, Mark Pryor of Arkansas and Mark Begich of Alaska find themselves barely breaking 40 percent in recent public polls.
But a new study out this week from Bloomberg Government threatens to bring the Affordable Care Act back to center stage — and in a way that will likely hurt the electoral chances of incumbent Democrats, all of whom voted for the law.”

“CMS decided not to include some payments disputed by doctors and teaching hospitals in the Open Payments database published Tuesday (Sept. 30) in order to give physicians and hospitals more time to review the information, but the highly anticipated database includes de-identified data in cases where it was unclear exactly to which physician the payments should have been linked.
The Open Payments site will include 4.4 million payments valued at almost $3.5 billion, according to CMS. Payments from drug and device makers, as well as group purchasing organizations, which were disputed by physicians or hospitals and not corrected before the end of the review and dispute period (Sept. 11) were not included in the most recent batch of Open Payments data because of timing issues, CMS officials said on a call.”

“The federal exchange is set to cut thousands of individuals from its coverage rolls this week because of unresolved inconsistencies related to immigration status, with HHS saying 115,000 will lose coverage as of Tuesday (Sept. 30). Tuesday is also the deadline for about 279,000 households to submit current income information to the exchange or risk seeing changes in their tax credits and cost-sharing subsidies that could result in higher costs for enrollees.
Furthering the saga on coverage data matching issues, the National Immigration Law Center has filed an administrative complaint under the ACA’s anti-discrimination section due to HHS’ failure to communicate with consumers in languages other than English and Spanish. The center also filed a Freedom of Information Act request in order to glean more insight into why that decision was made.”

“New polling data released from Independent Women’s Voice, conducted by Public Opinion Strategies among 1,000 likely voters in 43 congressional swing districts, is the most comprehensive survey yet on the likely electoral impact of the Affordable Care Act in swing states heading into the November elections.
If the elections were held today, the survey shows that Republican congressional candidates have a built-in advantage (42% – 36%) on the ballot test. Most prevalent in districts that lean Republication (43% – 33%), the GOP lead extends into pure toss-up seats (42% – 35%), and nearly disappears in districts that lean Democrat (40% – 39%).
Voters in key congressional districts are clear in their opposition to the Affordable Care Act. Disapproval of the law remains high with majority (54% – 43%) of voters in swing districts disapproving of the federal health care takeover. Strong opposition (45%) outnumbers strong support (25%) by nearly 2 to 1.”

“When it comes to health insurance exchanges, there’s nothing like the first time to grab voters’ attention and enthusiasm.
Morning Consult polling found 47 percent of voters say they are not at all likely to purchase health insurance through an online exchange this year. In the weeks before the start of open enrollment in 2013, that figure was 19 percentage points lower, with only 28 percent saying they were not at all likely to purchase insurance on the exchange. Voters’ stated likelihood of buying insurance decreased across all categories from 2013 to 2014.”

“Gov. Bobby Jindal has been viewed as a health care policy wonk, and he’s tried to build on that image ahead of a likely 2016 presidential campaign, positioning himself as the candidate with substantive ideas.
But his administration’s handling of health care matters at home could undermine his bonafides in the subject area and threaten his efforts to sell himself as a health care expert.”