At some point between now and the end of June, the Supreme Court will decide King v. Burwell and, in the process, determine whether the phrase “established by the State” actually means “established by the State.” This phrase, which appears twice in the Patient Protection and Affordable Care Act (PPACA) provisions authorizing tax credits for the purchase of health insurance in exchanges, has bedeviled defenders of the IRS rule purporting to authorize credits in federally established exchanges. Some claim this phrase is “convenient shorthand” for “exchange” (even though it’s neither more convenient nor shorter), while others argue the phrase is effectively meaningless, or actually means something else (such as established in the State). The plaintiffs, on the other hand, maintain that the language means precisely what it says.
Five years after the passage of ObamaCare, there is one expense that’s still causing sticker shock across the healthcare industry: overhead costs.
The administrative costs for healthcare plans are expected to explode by more than a quarter of a trillion dollars over the next decade, according to a new study published by the Health Affairs blog.
The $270 billion in new costs, for both private insurance companies and government programs, will be “over and above what would have been expected had the law not been enacted,” one of the authors, David Himmelstein, wrote Wednesday.
Those costs will be particularly high this year, when overhead is expected to make up 45 percent of all federal spending related to the Affordable Care Act. By 2022, that ratio will decrease to about 20 percent of federal spending related to the law.
So the proposed 2016 Obamacare rates have been filed in many states, and in many states, the numbers are eye-popping. Market leaders are requesting double-digit increases in a lot of places. Some of the biggest are really double-digit: 51 percent in New Mexico, 36 percent in Tennessee, 30 percent in Maryland, 25 percent in Oregon. The reason? They say that with a full year of claims data under their belt for the first time since Obamacare went into effect, they’re finding the insurance pool was considerably older and sicker than expected.
Don’t panic, says Kevin Drum. This is just the opening bid in a regulatory dance that will end up somewhere very different: “A few months from now, the real rate increases — the ones approved by state and federal authorities — will begin to trickle out. They’ll mostly be in single digits, with a few in the low teens. The average for the entire country will end up being something like 4-8 percent.”
After the Affordable Care Act kicked in, Michael Kole’s monthly health-insurance premium to cover himself and his family grew to $848 from $513. Like others, he wasn’t happy about it. “It’s taking a lot out of pocket,” he said.
The 52-year-old sales and marketing entrepreneur is one of millions of Americans who earn too much to qualify for government subsidies on policies purchased through the federal insurance exchange. To save…
The Supreme Court is expected to rule soon on the legality of insurance subsidies in 37 states that use the federal HealthCare.gov site. Some states have discussed creating their own exchanges in the wake of the court’s decision, but those may not be fiscally sustainable.
The Los Angeles Times reported last week that Covered California, the Golden State’s exchange, “is preparing to go on a diet,” cutting its budget 15% for the fiscal year beginning July 1 because of lower-than-expected enrollment. Earlier this month, Hawaii’s state exchange prepared plans to shut down this fall amid funding shortfalls. Hawaii’s exchange had technical problems that have impeded signups since its launch, but Covered California has had relatively few computer glitches. During the HealthCare.gov rollout problems in 2013, columnist Paul Krugman held up California as a model of efficiency:
WASHINGTON — They are only four words in a 900-page law: “established by the state.”
But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court.
How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwell claim, to make the tax subsidies in the law available only in states that established their own health insurance marketplaces, and not in the three dozen states with federal exchanges?
Health care reform has dominated our nation’s political and social conversations for the past six years. After the implementation of ObamaCare, it is clear the law brought radical change and real pain to our nation’s families, economy, and health care system. The promised “affordable health care fix” made things worse.
The pending King v. Burwell case reveals another interesting legal problem with the policy and text of the Affordable Care Act. As written, the federally controlled subsidies and employer mandates are not allowed, unless a state chooses them. Now the Supreme Court debates, behind closed doors, the question of state responsibility and textual intent to determine the direction of health care in America. The resulting Supreme Court opinion could dismantle the structure of ObamaCare and give America a second chance to get health care reform right.
Ironically, the issue of state responsibility could take ObamaCare down and lift individual citizens up.
Health insurers on many state exchanges are requesting the right to increase premiums by upwards of 50%
President Obama’s signature legislative achievement–the healthcare law popularly known as Obamacare–is facing a potentially existential fight in the Supreme Court in 2015.
But it’s not just the courts that supporters of the program need to worry about. According to a report published Friday in the The Wall Street Journal, health insurers are requesting the right in many states to increase premiums by upwards of 50%. Health Care Service Corp.–the leading health insurer in New Mexico, has asked state regulators to allow it to increase its premiums on average by 51.6%, for instance. Customers of CareFirst BlueCross BlueShield in Maryland may face an average premium increase of 30.4%.
Health Reform: So much for the “affordable” part of the Affordable Care Act. Looks like ObamaCare premiums will rocket next year while sky-high deductibles make it too costly for many to see the doctor.
Last Monday, IBD’s Jed Graham broke the news that big insurers in six states “are seeking to raise rates an average 18.6% next year.”
BlueCross BlueShield of Tennessee — which currently accounts for 70% of the ObamaCare enrollees in that state — is looking to increase premiums a whopping 36.3%.
CareFirst — which has 80% of the ObamaCare enrollees in Maryland — is pushing for a 30% increase.
Oregon’s Moda Health wants a 25.6% increase, on average, for the roughly half of ObamaCare enrollees it covers in the state.
The Wall Street Journal followed up on Graham’s reporting later in the week, noting that New Mexico’s market leader, Health Care Service, wants an average 51.6% boost in premiums.
“A different health care issue has emerged for Democrats, in sync with the party’s pitch to … middle-class voters … high out-of-pocket costs for people already covered. Democrats call it ‘underinsurance.’ After paying premiums, many low- and middle-income patients still face high costs when trying to use their coverage. … [T]he value of a health insurance card is being eaten away by rising deductibles … Several liberal-leaning organizations have recently focused on the issue.”