A project of the Galen Institute

Issue: "States"

Varying health premium subsidies worry consumers

Kelli Kennedy, The Associated Press
Sat, 2014-07-26
"MIAMI (AP) -- Linda Close was grateful to learn she qualified for a sizable subsidy to help pay for her health insurance under the new federal law. But in the process of signing up for a plan, Close said her HealthCare.gov account showed several different subsidy amounts, varying as much as $180 per month. Close, a South Florida retail worker in her 60's, said she got different amounts even though the personal information she entered remained the same. The Associated Press has reviewed Close's various subsidy amounts and dates to verify the information, but she asked that her financial information and medical history not be published for privacy reasons. "I am the kind of person the Affordable Care Act was written for: older, with a pre-existing (condition) and my previous plan was being cancelled. I need it and I'm low income," said Close, who has spent more than six months appealing her case. "The government pledged to me that original tax credit amount. It's crazy."

The Stakes Beyond the Halbig Lawsuit

Drew Altman for Wall Street Journal
Fri, 2014-07-25
"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.

Oregon feels the strain after health care overhaul floods the system with Medicaid enrollees

The Associated Press
Thu, 2014-07-24
"PORTLAND — Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. However, an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid. The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion."

Two Americas on Health Care, and Danger of Further Division

Margot Sanger-Katz, NY Times
Thu, 2014-07-24
"For decades, the United States has had a fragmented health policy. States called the shots on major elements of how health care and health insurance were financed and regulated. The result: a hodgepodge of coverage and a wide variance in health. The Affordable Care Act was intended to help standardize important parts of that system, by imposing some common rules across the entire country and by providing federal financing to help residents in all states afford insurance coverage. But a series of court rulings on the law could make the differences among the states bigger than ever. The law was devised to pump federal dollars into poorer states, where lots of residents were uninsured. Many tended to be Republican-leaning. But the court rulings, if upheld, could leave only the richer, Democratic states with the federal dollars and broad insurance coverage.

Here’s What Obamacare’s Authors said They Actually Meant

Emily Badger, Washington Post
Tue, 2014-07-22
"The two contradictory appeals court decisions that cast the future of Obamacare into uncertainty Tuesday morning largely center on a question of intent: When the Affordable Care Act was conceived and drafted, did its creators mean to withhold health care subsidies from people living in states that refused to set up their own exchanges?. This latest legal challenge focuses on four words in the mammoth law authorizing tax credits for individuals who buy insurance through exchanges "established by the States." Thiry-six states declined to set up their own exchanges — far more than the law's backers anticipated — and in those states, consumers have been shopping for health care on exchanges run instead by the federal government. Now the D.C.

Appeals Courts Split On Legality Of Subsidies For Affordable Care Act

Julie Rovner, Kaiser Health News
Tue, 2014-07-22
"Two U.S. Appeals Courts Tuesday reached opposite conclusions about the legality of subsidies in the Affordable Care Act, a key part of the law that brings down the cost of coverage for millions of Americans. In Washington, a three-judge panel at the U.S. Appeals Court for the D.C. Circuit ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states. That 2-1 ruling in Halbig v. Burwell could put at risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are run by the federal government. Judge Thomas Griffith, writing the majority opinion, said they concluded "that the ACA unambiguously restricts" the subsidies to "Exchanges 'established by the state.' " But within hours, a unanimous three-judge panel for the Fourth Circuit in Richmond, Va., ruled exactly the other way in King v.

No, the Halbig case isn't going to destroy Obamacare

Ezra Klein, Vox
Tue, 2014-07-22
"The Halbig case could destroy Obamacare . But it won't. The Supreme Court simply isn't going to rip insurance from tens of millions of people in order to teach Congress a lesson about grammar. As Adrianna McIntyre explains, the Halbig case holds that Obamacare's subsidies are illegal in the 36 states where the federal government runs (or partly runs) the exchange. The plaintiffs rely on an unclearly worded sentence in the law to argue that Congress never intended to provide subsidies in federally-run exchanges and so the subsidies that are currently being provided in those 36 states are illegal and need to stop immediately. The point of Obamacare is to subsidize insurance for those who can't afford it This is plainly ridiculous. The point of Obamacare is to subsidize insurance for those who can't afford it.

After Health Law Rulings, Here Are Possible Next Steps

"Margot Sanger-Katz, NY Times
Tue, 2014-07-22
"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:"

Court Upholds the Rule of Law

Grace-Marie Turner, Galen Institute
Tue, 2014-07-22
"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."

Former top Cover Oregon Official Won $67,000 Settlement after Threatening Lawsuit

Nick Budnick, The Oregonian
Tue, 2014-07-22
"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."

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