A project of the Galen Institute

Issue: "Business Impact"

Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits

Kaiser Health News
Wed, 2014-07-23
"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.

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."

Washington Health Exchange Sounds the Alarm, Questions Deloitte

Patrick Marshall, Seattle Times
Tue, 2014-07-22
"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."

BREAKING: D.C. Appeals Court Overturns Subsidies For Federal Exchange

Sandhya Somashekhar, Washington Post
Tue, 2014-07-22
"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.

Largest US Insurer, United Healthcare Move Signals Industry Shift

Tom Murphy, AP Business Writer
Fri, 2014-07-18
"The nation’s largest health insurer expects to play a much bigger role in the health care overhaul next year, as the federal law shifts from raising giant questions for the sector to offering growth opportunities. UnitedHealth Group said Thursday that it will participate in as many as 24 of the law’s individual health insurance exchanges in 2015, up from only four this year. These state-based exchanges debuted last fall as a way for customers to buy individual health insurance, many with help from income-based tax credits. They played a key role in helping roughly 8 million people gain coverage for 2014. But UnitedHealth and other insurers approached them cautiously, in part because they had little information about the health of the people who would sign up.

What will Obama do on employer mandate?

Elise Viebeck and Benjamin Goad, The Hill
Fri, 2014-07-18
"The White House needs to make a decision soon on whether ObamaCare's controversial employer mandate will take effect in 2015. With the mandate set to take effect in January, businesses are awaiting final word from the administration on whether they will be required to track and report how many of their employees are receiving coverage. Federal officials are late in delivering the final forms and technical guidance necessary for firms to comply, raising suspicions the mandate could once again be delayed. The mandate has been pushed back twice before, the first time in late summer. The delays to the mandate have angered House Republicans, who are now taking President Obama to court for what they say is his refusal to follow the letter of the law."

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