“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. The health-care law said that tax credits would be provided only in state-run exchanges, they argue, and it is executive overreach to provide credits in federal exchanges. Proponents of the Affordable Care Act see this as a thinly veiled game of gotcha being played over imperfect legislative language despite clear legislative intent. They believe that providing tax credits in the exchanges was always a central element of the Affordable Care Act’s strategy to expand coverage whether in state or federal exchanges–and that everybody knows it.”
“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:”
“1.) AEI’s Joseph Antos and James Capretta present “A health reform framework: Breaking out of the Medicaid model.” Here’s a peek:
The Congressional Budget Office (CBO) projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance. Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care….
2.) “Some still lack coverage under health law,” notes The Wall Street Journal:
Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don’t have coverage due to problems in enrollment systems. In states including California, Nevada and Massachusetts, which are running their own online insurance exchanges, some consumers picked a private health plan and paid their premiums only to learn recently that they aren’t insured.
3.) “Brace for the next round of Obamacare rate shock,” comments Philip Klein at The Washington Examiner:
As insurance companies begin to propose premiums for 2015, it’s time for Americans to brace themselves for the next round of rate shock in the wake of President Obama’s health care law. There are several ways in which Obamacare drives up the cost of health insurance. The primary way is that it requires insurance plans to offer a certain raft of benefits specified by the government and to cover everybody who applies, regardless of pre-existing conditions. It then limits the amount that insurers can charge older and sicker patients relative to younger and healthier patients, driving the costs up for the latter group.
4.) “Automatic Obamacare enrollment is anti-patient,” according to Diana Furchtgott-Roth:
With a new Avalere study showing that many Obamacare participants will face premium increases in the fall, the administration’s proposed rule that would automatically reenroll Americans in their existing federal health exchange plan is likely to leave many people paying higher premiums than necessary. Plus, Uncle Sam will be unable to verify correct amounts of health insurance premium subsidies. America is not yet ready for auto enrollment in Obamacare.
“Conservative criticism of the Affordable Care Act has created the impression that liberal, “big government” ideas are driving the health-care system. But plenty of ideas that conservatives like are taking hold in health care as well. To wit:
*The number of Medicare beneficiaries in private Medicare Advantage plans reached nearly 16 million this year, a record, and the Congressional Budget Office projects that it will hit 22 million by 2020. This partial privatization of Medicare is happening despite concerns that reductions in payments to private plans (what some call over-payments) would curtail enrollment.
*More than half of people on Medicaid are enrolled in managed-care plans, which are typically run by private insurers that contract with states on a capitated, or risk, basis. More than 30 million low-income Medicaid beneficiaries are in private plans. The number is growing as states move sicker and disabled populations covered by both Medicaid and Medicare to managed care and as many states expand their Medicaid programs under the ACA, putting newly covered beneficiaries into managed care.
About 50 million Americans covered by Medicare and Medicaid at some point in the year are in private insurance arrangements. Now, this is not the block grant of Medicaid or voucherization of Medicare that some conservatives ultimately seek–just as the ACA is not the single-payer system that some liberals want–but it’s a substantial privatization, and one that has occurred largely incrementally and under the radar.”
“One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time.
Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true.
One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse.”
“Alabama, buckle up. You’ll soon learn how much your health insurance premiums will go up for next year. The percentage increase will probably be in the double digits.
But that’s nothing compared to what you’ll face in 2017. In May, I released a comprehensive study showing how the Affordable Care Act — otherwise known as Obamacare — will likely play out. The diagnosis isn’t good.
In two years, the ACA will cause substantial premium increases. This will likely cause Alabamians to leave the insurance market in droves — they won’t be able to afford health insurance, even with federal subsidies. Within a decade, this could swell the ranks of the uninsured by nearly 11 percent.
I reached this conclusion by using a peer-reviewed economic model published in several health journals. It was funded by both private and government sources, including the Department of Health and Human Services.
“ObamaCare hurts businesses. That’s the result of an exhaustive study polling small to medium-sized businesses.
The controversial government health-care reform increases company and employee costs and sometimes stops companies from hiring as well, participants told the International Foundation of Employee Benefit Plans in its new study.
“More than half of single employers believe the Affordable Care Act has had a negative effect on their company,” according to the report.
The survey, which polled some employers and their health-care pros, found that the majority of respondents, 54 percent, thought the effect of the ACA on their firms had been “negative” or “very negative.”
The same respondents also expected that the negative effects from ACA would increase to 66 percent in the near future as the program unfolds.”
“Several indicators suggest that the political waters may be calming for the Affordable Care Act (ACA). This doesn’t guarantee that the law will achieve its goals and be judged a success. It means that the law stands a better chance of being implemented free of constant political turmoil–and will have a better shot at success.
*Public support for the ACA fell after the Web site debacle last fall, but while overall opinion toward the law continues to tilt negative, the falloff in the polls has stopped, according to the June Kaiser Family Foundation Health Tracking poll.
*After the administration rapidly repaired the Web site, the ACA exceeded the widely cited 7 million target for the first open-enrollment season, which had become a political litmus test for the law. And with no similarly big controversy, the ACA has become a far less juicy, and less prominent, media story.
*Some Republicans seem to be shifting their midterm strategy to focus less on the ACA and more on other issues they have with the president and the direction of the country.
*More people say that they are getting their information on the law from personal experience and from the experiences of family and friends, and fewer say that they are getting it from the news media, which they also say focuses mostly on politics and not what the law means for them. Increasingly, public perception of the law is about people’s experiences–whether good or bad–rather than ideology and partisan politics.”
“The Supreme Court’s ruling this week that “closely-held” companies like Hobby Lobby aren’t obligated to comply with the health law’s contraception mandate because it conflicts with their religious beliefs has put a renewed focus on the employer-sponsored healthcare.
Consumers getting their healthcare through their employers is a deeply ingrained practice in the United States (although that trend has been diminishing in recent years), and the court ruling has sparked all kinds of arguments pertaining to that the arrangement. Some have concluded that it will lead workers to seek alternatives outside the workplace, which they can find on the federal health exchanges created under Obamacare.
However, a new poll from Morning Consult found that the public isn’t there yet.
In fact, a strong majority of workers are worried that their employers will stop offering health insurance altogether and move them into the Obamacare exchanges. Workers with employer-sponsored health plans largely have a negative view of what such a move would mean for their coverage, and would even consider looking for a new job under that scenario, the poll found.”
“Robert Gibbs’ prediction that Obamacare’s employer mandate would — and perhaps should — be jettisoned shocked Democrats back in April.
By July, the former aide and longtime confidant of President Barack Obama had a lot more company. More and more liberal activists and policy experts who help shape Democratic thinking on health care have concluded that penalizing businesses if they don’t offer health insurance is an unnecessary element of the Affordable Care Act that may do more harm than good. Among them are experts at the Urban Institute and the Commonwealth Fund and prominent academics like legal scholar Tim Jost.
The employer mandate, Jost wrote in a Health Affairs post in June, “cries out for repair.” Repealing it “might not be such a bad idea,” if it’s replaced with something better for workers and busi