The unlikely epicenter of Obamacare lies in a solidly Republican working-class town just 10 miles outside the Miami stomping grounds of Jeb Bush and Marco Rubio.
The city of Hialeah — a Cuban-American neighborhood of Spanish speakers that is blanketed with Obamacare advertisements — enrolled more people under the Affordable Care Act than anywhere else in the country.
Monday marked the start of a special session called to pass Florida’s budget. Right on cue, the heavily hospital-connected State Senate is pushing Obamacare’s Medicaid expansion again. With a slightly modified version now rebranded as FHIX 2.0 (or Florida Health Insurance Affordability Exchange Program), the Florida Senate is pushing against a resolute House and a Governor that has all but threatened a veto.
As of the end of the 2015 Affordable Care Act open enrollment period, 11.7 million people had signed up for coverage in a Health Insurance Marketplace (though somewhat fewer likely ended up paying their first month’s premium and getting covered.)
2015 Marketplace signups varied substantially across states when looked at as a share of the “potential market” for the Marketplaces, ranging from a high of 70% in Vermont and 64% in Florida to lows of less than 25% in Iowa, South Dakota, Minnesota, North Dakota, Hawaii, and Alaska.
The Supreme Court is expected to issue a ruling by the end of June in King v. Burwell, a case challenging the legality of health insurance subsidies provided to low- and middle-income people in the 34 states where the federal government is operating the insurance Marketplace under the Affordable Care Act.
With one month until the Supreme Court is expected to rule on King v. Burwell, Pennsylvania submitted a blueprint to the federal government to establish a state healthcare exchange. The plan, submitted on Tuesday, hedges against the possibility that the court could rule healthcare subsidies illegal, a decision that would affect millions of Americans throughout the 34 states that rely on the federal exchange, also known as healthcare.gov.
Officials from states across the nation flew to Chicago in early May for a secret 24-hour meeting to discuss their options if the Supreme Court rules they have to operate their own exchanges in order for residents to get health-insurance subsidies.
A new survey shows that 44% of Covered California policyholders find it difficult paying their monthly premiums for Obamacare coverage.
And a similar percentage of uninsured Californians say the high cost of coverage is the main reason they go without health insurance.
The issue of just how much people can afford will loom large as the state exchange prepares to negotiate with health insurers over next year’s rates.
Many analysts are predicting bigger premium increases for 2016 in California and across the country. Insurers have more details on the medical costs of enrollees, and some federal programs that help protect health plans from unpredictable claims will be winding down.
There have been numerous disasters along the way as the federal government and the states have struggled to implement the Patient Protection and Affordable Care Act (a.k.a. Obamacare), but none come close to Oregon’s sorry effort for the millions of dollars lost, the raw political opportunism, and the melodramatic plot twists. Now from the Insult-to-Injury Department comes word that it all could have been avoided.
Earlier this month, five years after President Barack Obama signed ACA, The Hill published a series of articles about how Obamacare is working around the country. It reported that many of the 13 states that established their own stand-alone health-care marketplace exchanges are looking for ways to mitigate the damage and get something up and running before federal funding dries up.
The Supreme Court is expected to rule soon on the legality of insurance subsidies in 37 states that use the federal HealthCare.gov site. Some states have discussed creating their own exchanges in the wake of the court’s decision, but those may not be fiscally sustainable.
The Los Angeles Times reported last week that Covered California, the Golden State’s exchange, “is preparing to go on a diet,” cutting its budget 15% for the fiscal year beginning July 1 because of lower-than-expected enrollment. Earlier this month, Hawaii’s state exchange prepared plans to shut down this fall amid funding shortfalls. Hawaii’s exchange had technical problems that have impeded signups since its launch, but Covered California has had relatively few computer glitches. During the HealthCare.gov rollout problems in 2013, columnist Paul Krugman held up California as a model of efficiency:
Health care reform has dominated our nation’s political and social conversations for the past six years. After the implementation of ObamaCare, it is clear the law brought radical change and real pain to our nation’s families, economy, and health care system. The promised “affordable health care fix” made things worse.
The pending King v. Burwell case reveals another interesting legal problem with the policy and text of the Affordable Care Act. As written, the federally controlled subsidies and employer mandates are not allowed, unless a state chooses them. Now the Supreme Court debates, behind closed doors, the question of state responsibility and textual intent to determine the direction of health care in America. The resulting Supreme Court opinion could dismantle the structure of ObamaCare and give America a second chance to get health care reform right.
Ironically, the issue of state responsibility could take ObamaCare down and lift individual citizens up.