Tony Pugh, McClatchey News Service
"WASHINGTON -- Contrary rulings Tuesday on a key element of the Affordable Care Act by two separate federal appeals courts raise a variety of questions.
Q: What happened?
A: The U.S. Court of Appeals for the District of Columbia Circuit decided 2-1 that tax subsidies available to help people pay for health coverage through the Affordable Care Act can only be used in the 14 states and in D.C., which run their own insurance exchanges without any help from the federal government. But in a unanimous decision on a similar case a short time later, the 4th U.S. Circuit Court of Appeals in Richmond, Va., ruled just the opposite.
Q: Who’s eligible for the tax subsidies?
A: Individuals and families who earn between 100 percent and 400 percent of the federal poverty level. For those who enrolled this year, it includes individuals earning $11,490 to $45,960, and a family of four earning from $23,550 to $94,200.
Q: Does the D.C.
Kaiser Health News
"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.
Kaiser Health News
"Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans.
Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them.
Guess what? People looked for help on the decision.
During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average.
Sandhya Somashekhar, Washington Post
"A federal appeals court panel in the District struck down a major part of the 2010 health-care law Tuesday, ruling that the tax subsidies that are central to the program may not be provided in at least half of the states.
The ruling, if upheld, could potentially be more damaging to the law than last month’s Supreme Court decision on contraceptives. The three-judge panel of the D.C. Circuit Court of Appeals sided with plaintiffs who argued that the language of the law barred the government from giving subsidies to people in states that chose not to set up their own insurance marketplaces. Twenty-seven states, most with Republican leaders who oppose the law, decided against setting up marketplaces, and another nine states partially opted out.
The government could request an “en banc” hearing, putting the case before the entire appeals court, and the question ultimately may end up at the Supreme Court.
Brett Norman, Politico
"Anger over limited choice of doctors and hospitals in Obamacare plans is prompting some states to require broader networks — and boiling up as yet another election year headache for the health law.
Americans for Prosperity is hitting on these “narrow networks” against Democrats such as Sen. Jeanne Shaheen of New Hampshire, whose GOP opponent Scott Brown has made the health law a centerpiece of his campaign to unseat her. And Republicans have highlighted access challenges as another broken promise from a president who assured Americans they could keep their doctor.
It’s not just a political problem. It’s a policy conundrum. Narrow networks help contain health care costs. If state or federal regulators — or politicians — force insurers to expand the range of providers, premiums could spike. And that could create a whole new wave of political and affordability problems that can shape perceptions of Obamacare."
M.L. Johnson, Associated Press
"MILWAUKEE (AP) -- A federal judge on Monday dismissed a U.S. senator's lawsuit challenging a requirement that congressional members and their staffs to obtain government-subsidized health insurance through small business exchanges, saying the senator had no grounds to sue.
Sen. Ron Johnson, a Wisconsin Republican, filed the lawsuit in January after the Office of Personnel Management decided months earlier that lawmakers and their staffs should continue to receive health care benefits covering about 75 percent of their premium costs after leaving the health insurance program for federal workers.
Johnson said the decision would make him decide which staff members must buy insurance through an exchange, potentially creating conflict in his office. He also said it forced him to participate in a program that he believed was illegal and that it could make voters view him negatively because his staff received health insurance subsidies the general public did not.
Patrick Marshall, Seattle Times
"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."
Nick Budnick, The Oregonian
"Gov. John Kitzhaber has defended his handling of the Cover Oregon debacle by noting that he engaged in "cleaning our own house," including holding three officials "accountable" after the health insurance exchange website did not work.
But newly released records reveal that one of those three, Triz delaRosa of Cover Oregon, didn't go quietly.
After Kitzhaber called for delaRosa, the exchange's chief operating officer, to be fired on March 20, she warned the state she'd sue if she was fired, according to documents obtained under Oregon's public records law. She laid blame for the exchange fiasco on Oregon Health Authority mismanagement, as well as Kitzhaber's staff, for failing to confront problems Cover Oregon reported after taking over the project in May 2013.
As a result, delaRosa received a $67,714.90 settlement and continued drawing a salary through May 16. In return, she agreed to say nothing negative about the state."
Grace-Marie Turner, Galen Institute
"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."
"Margot Sanger-Katz, NY Times
"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:"