If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent.

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President Barack Obama declared Tuesday that his 5-year-old health care law is firmly established as the “reality” of health care in America, even as he awaits a Supreme Court ruling that could undermine it.

“This is now part of the fabric of how we care for one another,” he said.

Obama defended the health care overhaul during an address to the Catholic Health Association Conference in Washington, just days ahead of an anticipated decision by the Supreme Court that could eliminate health care for millions of people.

Obama poked fun at opponents who have issued “unending Chicken Little warnings” about what would happen if the law passed. None of those predictions have come true, Obama argued.

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The aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.

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President Obama reentered the political battle over healthcare Tuesday, delivering an extended defense of the Affordable Care Act as the Supreme Court prepares to issue its ruling on a case that could strip away health insurance from millions of Americans.

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Efforts by insurers to boost premiums are the latest evidence that President Barack Obama’s health care law “just doesn’t work” and must be replaced, the Republican chairman of the House Ways and Means Committee said Wednesday.

Rep. Paul Ryan of Wisconsin launched the GOP’s latest attack against the health care overhaul as Health and Human Services Secretary Sylvia Burwell defended it before his committee. Their conflicting views underscored that Obama’s 5-year-old law remains a partisan flashpoint, likely to reverberate through next year’s presidential and congressional elections.

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Every day there seems to be another article focused on how many individuals might lose their subsidies if the Supreme Court rules in favor of the plaintiffs in the King v. Burwell case.

Yet, an even bigger group of individuals harmed by Obamacare has an equally good claim for relief that hasn’t gotten as much attention—the people who, thanks to Obamacare, must pay more for health insurance but who never got subsidies.

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Even in Kentucky, which championed the 2010 health care law by expanding Medicaid and running its own insurance marketplace, about half of poor people say they have heard little about the Affordable Care Act, according to a Harvard University study published Monday in Health Affairs.

Awareness of Obamacare was even lower in Arkansas and Texas—two states that have not embraced the law as warmly. The study — which surveyed nearly 3,000 low-income residents in the three states last December– found 55 percent of those Texans and 57 percent of those Arkansans had heard little or nothing about the law’s extension of health coverage. Arkansas expanded Medicaid eligibility to cover more people under the law, but the state legislature prohibited spending public money to promote that or the federal subsidies available to help people buy private Obamacare plans.

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Senate Majority Leader Mitch McConnell (R-Ky.) on Monday declined to discuss the details of a Republican backup plan for ObamaCare, saying that the party will be ready if the Supreme Court rules against the healthcare law.

“We’ll have a plan that makes sense for the American people,” the Republican leader said during an interview with The Joe Elliott Show. “If the plaintiff is successful it will require some addressing of the issue, and if that were to happen we’ll be ready to announce our proposal.”

The Supreme Court is expected to announce its decision this month in the King v. Burwell case, which could cancel subsidies for millions of Americans who are enrolled through the federal website HealthCare.gov.

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President Barack Obama had barely finished proposing an idea to deal with a far-reaching Supreme Court decision on Obamacare before Republicans fired back with a categorical response: Not gonna happen.

At the G7 conference in Germany on Monday, the president said if the justices strip subsidies from millions of Americans, “Congress could fix this whole thing with a one-sentence provision” making clear that Healthcare.gov subsidies are available in all 50 states. Republicans quickly fired off a rebuttal.

“Let’s be clear: if the Supreme Court rules against the Administration, Congress will not pass a so called ‘one-sentence’ fake fix,” Wyoming Senator John Barrasso, who is leading Republican efforts to craft a contingency plan, said in a statement.

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President Barack Obama expressed confidence that the Supreme Court would uphold subsidies millions of consumers use to buy health insurance, and at the same time warned of possible dire consequences if that doesn’t happen.

Speaking Monday at a news conference in Germany, at the Group of Seven summit, Mr. Obama said the case, which the Supreme Court is expected to decide near the end of the month “should be an easy case. Frankly, it probably shouldn’t even have been taken up.”

Plaintiffs in the case, King v. Burwell, argue that four words in the health law mean subsidies under the 2010 Affordable Care Act can go only to residents of the dozen states that established their own health-insurance exchanges, rather than the rest of the country, which relies on the federal government HealthCare.gov website

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