“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. But if subsidies for half the states are barred, it represents a potentially crippling blow to the health-care law, which relies on the subsidies to make insurance affordable for millions of low- and middle-income Americans.”
“The Affordable Care Act’s success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach.
Recent surveys show, roughly in line with expectations, that 8 million to 9.5 million fewer adults are uninsured compared with last year before the Affordable Care Act went into effect. Specific data are not yet available for uninsured children who probably got covered as well, and an earlier provision of the health-care law that allowed people to stay on their parents’ insurance up to age 26 is thought to have lowered the number of uninsured young adults by as many as 3 million.
But tens of millions of Americans are not yet covered.
Those who enrolled last year during the first open-enrollment season were more likely to want coverage and were best able to navigate the process to get it. After open enrollment this fall and the one after that, the uninsured will gradually become a smaller and different group. Increasingly, they will be people who have been without insurance for a long time or who have never had it; people who are even less familiar with insurance choices and components such as premiums and deductibles, as well as unfamiliar with the tax credits offered under the ACA. These people are more likely to be men, and minorities, and have limited education or language barriers. Increasingly they will fall into harder-to-reach high-risk groups, such as the homeless, who require very targeted outreach, and Hispanics who fear that seeking coverage could endanger undocumented relatives despite assurances from government that it will not.”
“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. That uncertainty was compounded by a provision in the overhaul that prevents them from rejecting applicants based on health.
Now, some of that uncertainty is starting to dissipate, which gives insurers ‘‘a little more confidence to try to tap into some of the opportunities,’’ said Jennifer Lynch, an analyst who covers the sector for BMO Capital Markets.”
“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.”
“UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year.
“We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals.
The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now.
Even analysts who follow the company closely seemed surprised.
“You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in. What’s giving you the confidence … that it’s going to be stable next year?”
The answer, the bosses said, is that the marketplaces look sustainable, even without some of the reinsurance and risk-spreading backstops put in place for carriers in the first few years. They know the prices now, they said. They know the regulations. They know how consumers are behaving.”
“Medicare spending growth will be slow again in 2014 relative to historical standards, and some of the usual suspects are now crediting the Affordable Care Act — Obamacare — for the good news. For instance, a recent post at Vox suggests that the slowdown in Medicare spending can be attributed, in part, to the ACA’s provision penalizing hospitals for excessive readmissions of previously treated patients.
This is nonsense.
At the time of the ACA’s enactment in March 2010, the Congressional Budget Office estimated that the readmission provision would reduce Medicare spending by $0.3 billion in 2014, and only $7.1 billion over a decade. That’s about one tenth of 1 percent of total Medicare spending over that time period. There has been no information from any source since 2010 suggesting that the savings from the readmission provision has escalated into a major cost-cutting reform. In the context of overall Medicare spending, the readmissions provision is simply inconsequential.
The same can be said for the other supposed “delivery system” reforms driven through Medicare and contained in the ACA, such as Accountable Care Organizations and efforts to promote more “bundled” payments to providers of services. These reforms were all assessed by the CBO at the time of enactment and found to be insignificant items in budgetary terms. Moreover, the early experience with these changes indicates they are unlikely to dramatically alter the way health care is delivered to Medicare patients.”
“The White House has begun its search for the next stewards of HealthCare.gov.
A contract solicitation posted online Wednesday enumerates the qualifications and requirements of the next Obamacare website contractor, charged with keeping the online federal health insurance exchange portal up and running.
The 60-page job posting says the next caretaker of the Obamacare site will need to be able to work “under aggressive time constraints” to work with the Federally Facilitated Marketplace in testing and upgrading a variety of hardware, software, and security features. It also states that the contractor will need to be able to perform tests that can demonstrate that the site can function when a large number of users are online.
Accenture currently holds a one-year contract to run HealthCare.gov, which was awarded after a no-bid process back in January. That came after the White House chose to terminate CGI Federal’s contract following HealthCare.gov’s failed launch in October of last year. The website’s rollout was so plagued with problems that for a time it appeared the technical difficulties could severely undermine the implementation of President Obama’s signature legislative achievement.”
“Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage.
Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don’t understand how health insurance works, that could hurt their ability to use their benefits — or to keep their coverage altogether.
Community organizations are scrambling to keep up with the larger-than-anticipated demand, but they are stretched thin. A federal program to help consumers has also run out of money.
“We are hearing this in probably every state that we work in,” said Christine Barber, a senior policy analyst with Community Catalyst, a Boston-based advocacy organization that works with community groups in more than 40 states. “ ‘Okay, I have my card. What do I do now?’ ””
“WASHINGTON — Efforts by congressional Republicans to rein in what they say are the legislative and political excesses of the Obama administration played out in simultaneous hearings on Wednesday, further highlighting how election-year politics are overtaking business on Capitol Hill.
The first hearing, by the House Committee on Oversight and Government Reform, was quickly adjourned after the administration refused to allow testimony from David Simas, the White House political director, who had been called under a Republican subpoena to answer questions about Democratic campaign activities.
The second, a debate in the House Rules Committee on the merits of a lawsuit that Speaker John A. Boehner plans to file against President Obama, exposed simmering partisan tensions as Democrats used the occasion to ridicule the speaker’s move as a hollow ruse.
“We have seen subpoena after subpoena after subpoena, witch hunt after witch hunt,” Representative Jim McGovern, Democrat of Massachusetts, said. “The American people should sue the House leadership for emotional pain and suffering.””
“The fear was this: The Affordable Care Act would give massive numbers of people new access to health care, creating a surge in demand for medical services and long waits to see the doctor.
But in the seven months since new insurance plans began kicking in, Puget Sound-area, Washington, primary-care providers so far seem to be keeping up with growing numbers of patients. The question now is, can they keep ahead of the demand as the formerly uninsured continue seeking care, and as baby boomers age and a sizable fraction of Washington’s physicians retire.”