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Patient Protection and Affordable Care Act Compliance Letters - The Automated Benefit Services Account Management team has begun distribution of letters which details numerous compliance issues that must be addressed prior to 2014 new plan years.

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New ABS Website Expanded Content and Heightened Functionality Offer Daily Relevance.

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USHL recently introduced its Wellness Resources Center, a convenient one-stop health and wellness information library on the USHL website which visitors can reference for a variety of objectives.

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The Centers for Medicare and Medicaid (CMS) recently issued guidance regarding a Marketplace Special Enrollment Period for COBRA beneficiaries.

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  • First Edition: July 24, 2014

    Today's headlines include more analysis of this week's conflicting appeals courts' decisions regarding a key part of the health law.  

    Kaiser Health News: New Health Law Court Decisions Could Have Limited Political Impact
    Kaiser Health News staff writers Mary Agnes Carey and Julie Rovner report: “Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplace” (Carey and Rovner, 7/24). Read the story.

    Kaiser Health News: Groups Sue Tennessee Over Medicaid Enrollment Delays
    Kaiser Health News staff writer Phil Galewitz reports: “The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor” (Galewitz, 7/23). Read the story

    The New York Times: Court Ruling On Health Care Subsidies Risks Loss Of Coverage
    The conflicting court rulings left much unresolved — both cases will be appealed further, and additional cases challenging the subsidies in federal exchange states are still making their way through trial courts in Indiana and Oklahoma. But the ruling in Halbig v. Burwell, in which a panel of the United States Court of Appeals for the District of Columbia found that subsidies could be awarded only in states that set up their own insurance exchanges, raised the possibility that many of the 4.5 million people who were found eligible for subsidized insurance through the federal exchange would drop their new coverage (Goodnough, 7/23).

    The Wall Street Journal: Key Question On Health-Law Subsidies: Were Plaintiffs Harmed?
    That argument is simmering beneath court battles about the legality of insurance subsidies tied to the Affordable Care Act. Mr. Klemencic is a key plaintiff in a case in which a Washington, D.C., court Tuesday invalidated subsidies for consumers in up to 36 states, the ones relying on a federal insurance exchange. Whether challengers like Mr. Klemencic had legal standing to sue the Obama administration in the first place turns on whether he was harmed by the subsidies. The ruling struck down an Internal Revenue Service rule that said qualifying consumers could receive subsidies whether they bought coverage on a state-run insurance exchange or a federal one. A second court, in Virginia, upheld the legality of the subsidies in another ruling Tuesday (Kendall, 7/23).

    The New York Times: Bolstered By Ruling, Republicans Attack Health Law
    Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved (Pear, 7/23).

    The Associated Press: Study: 10M Have Gained Coverage Through Health Law
    A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama’s law took hold in much of the country. The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points (7/23).

    Politico: New England Journal Of Medicine Report: 10 Million Newly Insured
    The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans — this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage — although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation (Winfield Cunningham, 7/23).

    ProPublica/NPR: Federal Health Exchange Stays Busy After Open Enrollment Ends
    For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using HealthCare.gov by April 19 (Ornstein, 7/23).

    The Associated Press: Medicaid Enrollees Strain Oregon
    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. But 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 (7/23).

    Politico: GAO: Too Early To Draw Obamacare Fraud Conclusions
    It’s too early to draw conclusions about fraud in the Obamacare marketplaces, a congressional investigator said at a hearing focused on a report finding 11 out of 12 fake applicants were able to obtain subsidized health insurance. Republicans jumped on the report as proof that the health care law invites fraud, but the Government Accountability Office official said the sample is too small and investigators “can’t draw any conclusions” until their work is complete. The investigation is ongoing, GAO’s Seto Bagdoyan said, and the “intent of this sample was not to project in any way” based on this initial stage of work, but instead to identify areas of potential focus for future work (Weinger, 7/23).

    USA Today: Health Care Jobs Lift Less-Educated Workers
    The boom in health care jobs is skewed toward positions requiring less education, providing lower-paid workers a potential pathway to better careers, a new Brookings Institution report says. From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46%, vs. 39% growth for all health care jobs, the study says (Davidson, 7/24).

    The Washington Post’s The Fact Checker: Exemptions For Congressional Staff In ‘Obamacare,’ Or Hypocrisy?
    This is a complicated issue which we have explored before, but we will try to keep it simple. The health-care law requires members of Congress and at least some staffers to leave the Federal Employees Health Benefit Program (FEHBP) and join the health-care exchanges (Kessler, 7/23).

    The Washington Post: Paul Ryan To Unveil Anti-Poverty Plan
    The new proposal, called an “Opportunity Grant,” would begin on a pilot basis. It would consolidate a range of safety-net programs — from food stamps to housing vouchers — into a single grant offered to states. State governments, working with local officials and nonprofit and faith groups, would then distribute the money, with strict accountability standards. Medicaid, the health program for the poor, would not be included (Goldfarb, 7/22).

    The Wall Street Journal: Paul Ryan To Propose Sweeping Consolidation In Antipoverty Pitch
    A signature part of Mr. Ryan's past budget plans has been deep reductions in spending on Medicaid, the hybrid state and federal health care program for the poor. Mr. Ryan, in his op-ed, didn't say whether Medicaid spending would be effected by his Opportunity Grant plan (Paletta, 7/23).

    The New York Times: Gilead Reports Strong Sales of Sovaldi, Putting It On Pace to Become A Blockbuster 
    Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, a huge figure that puts it on track to become one of the world’s best-selling medicines but could intensify concerns about society’s ability to pay for it. The sales, announced on Wednesday by Gilead Sciences, were an increase from the $2.3 billion in the first three months of the year, the first full quarter of sales since the drug’s approval in December (Pollack, 7/23).

    The Wall Street Journal: Hepatitis C Pill Rockets Gilead Into Big Leagues
    For decades, a liver disease that would slowly kill the infected person didn't even have a name, let alone an effective medicine. Now, a new pill promising to cure most cases of the disease, eventually called hepatitis C, is believed to be the biggest new drug launch ever, catapulting maker Gilead Sciences Inc. 13% into the ranks of the top-selling pharmaceutical companies (Rockoff, 7/23).

    Politico: Robert McDonald Could Soon Be Confirmed To VA
    The Senate is expected to vote on the White House’s nominee to lead the embattled Department of Veterans Affairs before senators leave for a five-week August recess, Sen. Bernie Sanders (I-Vt.) said on Wednesday (French, 7/23).

    Politico: CDC Lab Head Quits After Anthrax Scare
    The head of a laboratory at the Centers for Disease Control and Prevention in the spotlight after dozens of employees were potentially exposed to live anthrax bacteria has resigned. Michael Farrell resigned on Tuesday, CDC spokesman Tom Skinner said. Farrell had led the Bioterror Rapid Response and Advanced Technology laboratory on the agency’s Atlanta campus since 2009 (Norman, 7/23).

    The Wall Street Journal: Invoking Anti-Fraud Law, Louisiana Doctor Gets Rich
    Over two decades, the 65-year-old internist has filed 12 lawsuits accusing health-care companies of defrauding taxpayer-funded programs such as Medicare. Five of his suits have together led the government to recover hundreds of millions of dollars. Those successful suits have also enriched Dr. LaCorte, who has received a $38 million cut under a federal law that encourages fraud reporting. Much was from a $250 million U.S. settlement with Merck & Co. in 2008 over allegations it overcharged Medicaid for Pepcid, a heartburn drug. He used part of his portion to buy a boat he named Pepsid (Loftus, 7/23).

    The Washington Post: Virginia Psychiatric-Bed Registry Does Not Work As Intended, Lawmakers Told
    A four-month-old psychiatric-bed registry that is supposed to provide up-to-the-minute information for Virginians who need emergency mental health treatment is being updated as seldom as once a day, state officials told a panel of lawmakers this week (Shin, 7/22).

    The Associated Press: Healthy Virginians Aim Of State Panel
    First lady Dorothy McAuliffe is joining a panel of public health experts intent on promoting policies to ensure a healthier Virginia. The Virginia Department of Health is convening the meeting Wednesday at the University of Virginia in Charlottesville. Called the “Excellence in State Public Health Law Conference,” the meeting is intended to assess policy proposals for improving the health of all Virginians (7/23).

    NPR: States Help New Mothers Get Birth Control Through Medicaid
    Here's the catch: Her Medicaid plan won't pay for contraception if she tries to get it while she's still at the hospital. New York has just joined five other states in making it easier for our fictional mom to have access to the kind of family planning options she was seeking without worrying about the price tag. At first glance this is a technical issue about Medicaid reimbursements. But it is also about postpartum contraception and which women have access to it (Farrington, 7/23). 

    Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

  • New Health Law Court Decisions Could Have Limited Political Impact

    Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections.

    The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplaces.

    Political candidates as well as voters will have to wait until the outcome of appeals of the cases to know their impact. But that didn’t stop some politicians from trying to immediately exploit the issue, among them House Speaker John Boehner. He said Tuesday the ruling by the Court of Appeals for the District of Columbia that the health law prohibits subsidies in federally run exchanges is “further proof that President Obama’s health care law is completely unworkable. It cannot be fixed.”

    While individual candidates may try to capitalize on the decisions, political analysts see difficulties for both parties.

    It may be too late for the threat of millions of Americans losing health law subsidies to be a major issue in the fall elections, said Jim Manley, of Quinn Gillespie Public Affairs and a Democratic strategist.

    “I’m not convinced it’s going have much impact either way. Republicans are entering dangerous ground again where they’re going to be in a position to be taking away people’s health care. But a final court decision won’t occur for a while,” Manley said. He thinks the focus of the elections will be on jobs and the economy, rather than the health law.

    John Feehery, also of Quinn Gillespie and a Republican strategist, agreed. He said the Republican base “is already mobilized. Some of them hate Obamacare and some of them hate Obama.” But it’s easier for Republicans “just to run against Obama” rather than the health law.

    GOP strategist John Murray doubts that Democrats will be able to make much of the subsidy issue in the midterm elections, either. “We are within striking distance of the fall elections. The ability to take things like this and infuse them into the bloodstream of a campaign this late in the game – we’re basically in August – I think is wishful thinking for Democrats,” he said.

    And Tony Carrk, of the liberal Center for American Progress, said it’s better for Democrats not to threaten Republicans, but to simply point out that the law is working. He said that particularly with the next open enrollment period starting just after the election, Democrats should “take any chance we can get to highlight what the law does, and who it impacts.”

    On the other hand, should courts eventually rule that subsidies are not, in fact, permitted in the three dozen states whose exchanges are being run by the federal government, then all bets would be off, said those on both sides.

    “Conservatives are putting themselves in a corner,” said Carrk. “Right now they’re rooting for the law to fail and for people to pay more for their health care.”

    GOP strategist Feehery agreed that Republicans might not benefit if the lawsuit invalidating subsidies in federal exchange states eventually succeeds. In that case, he said, “Republicans might have to worry about being blamed for taking the subsidy away.”
  • Groups Sue Tennessee Over Medicaid Enrollment Delays

    Three consumer advocacy groups filed a class-action lawsuit Wednesday accusing Tennessee officials of adopting policies that are depriving thousands of people of Medicaid coverage “to score political points.”

    The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor. 

    Tennessee officials responded to the administration, blaming many of the state's problems on the federal website, healthcare.gov. State officials did not immediately comment on the lawsuit.

    Tennessee is the first state to be sued over Medicaid enrollment problems since passage of the federal health law, said Jane Perkins, legal director of the Washington, D.C.-based National Health Law Program, one of the groups that filed the suit in U.S. District Court in Nashville. The other plaintiffs are the Southern Poverty Law Center in Montgomery, Ala., and the Tennessee Justice Center, based in Nashville.

    The lawsuit alleges that Tennessee makes it harder than any other state to enroll in its Medicaid program, called TennCare. The state has discontinued accepting applications in person at county offices and instead requires use of computer kiosks that connect people to healthcare.gov, making harder to enroll, according to the suit. The plaintiffs said that “thousands” of residents are applying every month and many are facing delays.

    Under federal law, an application for Medicaid benefits must be processed within 45 days. But people in Tennessee are waiting as long as six months, the suit said.

    “Tennessee officials are sacrificing the health of the state’s most vulnerable citizens just to score political points,” said Sam Brooke, an attorney for the Southern Poverty Law Center.

    Tennessee is one of 24 states that did not expand its Medicaid program under the Affordable Care Act, turning down full federal funding that lasts through 2016 when states have to begin paying for up to 10 percent of costs.  The health law also required all states to streamline their Medicaid application process and gave states money to do that.

    Tennessee Medicaid officials have downplayed the problem, saying that only a “small number” of people have had difficulty enrolling and blaming those problems on the federal online marketplace.

    The federal marketplace was initially supposed to be a one-stop shopping place to apply for either Medicaid or subsidized individual health insurance, but there have been technical issues connecting applicants to that site with some state Medicaid programs.

    The lawsuit wants the court to order Tennessee to give people decisions on their applications within 45 days, or grant them a hearing with state officials if that does not occur.

    The plaintiffs in the case include April Reynolds, a mother of three, who applied for coverage in February but still has not been enrolled. In March, she had to be hospitalized with a blood pressure problem and now owes more than $20,000 for her care and was told by doctors that she needs to receive monthly checkups.

    Reynolds has seen a doctor only once since March because she’s afraid to go into even deeper debt.

    "It is time for the state to take responsibility," her husband, Ricky, said in a conference call with reporters. "We can't afford to pay for the doctor."

    The lawsuit also describes how the family of a baby identified only as “S.P.” incurred more than $17,000 in medical bills after the child was diagnosed with a severe bacterial infection. Despite applying for Medicaid shortly after the baby’s birth in February, the family has struggled to get information about the status of their application. They have yet to receive coverage.

    Plaintiff Melissa Wilson, a caretaker of three young grandchildren, has been stuck without care since February. Williams has kidney failure and is supposed to take 17 medications daily but can afford only three of them.

    Wilson has called TennCare every two weeks since February, only to be told the status of her application is not known. Without coverage she can’t afford even to see her primary care doctor or take the drugs she needs, let alone see specialists. "What they are doing to me is wrong," she said of the state.

  • King County's Wellness Plan Beats the Odds

    SEATTLE – When King County, Washington, launched its employee wellness program seven years ago, its motive was clear. “We were being eaten alive by runaway medical costs,” says the county’s top executive Dow Constantine. 

    By all accounts, the previous administration was desperate to bring down double-digit health care cost growth that threatened to destroy the entire budget. 

    That partially explains why King County, which spends nearly $200 million per year to insure 14,000 workers and their families, who mostly live and work here in the county seat, was willing to risk millions more on a wellness program that would prove to break the traditional mold.

    It may also explain why labor unions took the unusual step of joining management in a plan that would ultimately shift more health care costs to workers. 

    But it doesn’t explain why this employee wellness program, which received an innovation award this year from Harvard University, has far surpassed all others in employee participation, health improvement and health care savings. 

    The program’s unusually high financial incentives for participation and an extensive outreach program to promote it are credited in large part for the program’s success.

    In its first five years (2007 to 2011), the county’s “Healthy Incentives” program invested $15 million and saved $46 million in health care spending with sustained participation by more than 90 percent of its employees. Two years ago, $61 million in surplus health care funds were returned to county coffers because cost growth was lower than actuaries had projected. Seattle, the state’s largest city, is the county seat.

    Employee health improved dramatically, raising King County employees’ health status above the national average and keeping it there. Smoking rates dropped from 12 percent of employees to less than 5 percent, and more than 2,000 employees classified as overweight or obese at the start of the program lost at least 5 percent of their weight, more than halving their risk of diabetes. 

    With an average age of 48.5 years and practically no turnover, the county’s worker population is getting healthier even as it’s growing older.  

    Outsized Performance

    These results, documented in a 2012 internal report by former staff economist John Scoggins, are remarkable when compared to the generally lackluster performance of other wellness programs run by large U.S. organizations, including state and local governments. According to a 2013 report from the Rand Corporation, about half of all U.S. large employers offer some type of wellness program and the number is growing. But few end up saving any money and employee participation has been limited. Many fizzle out after a year or two.

    On average, only 47 percent of employees participate nationwide, and only 2 percent of organizations that offer the plans report any reduction in health care costs, according to the study, which was funded by the U.S. Departments of Labor and Health and Human Services. Overall savings from wellness plans offered by the organizations Rand surveyed were too small to be statistically valid.

    Still, evidence shows that workplace health programs have the potential to promote habit-forming healthy behavior, improve employees’ health knowledge and help workers get necessary screenings, immunizations and follow-up care. The Affordable Care Act encourages employers to expand wellness programs by loosening federal regulations that limit the financial rewards employers can offer workers for reaching certain health goals such as quitting tobacco use.

    King County’s intensive education and outreach effort cost the county nearly $7 million in the first two years. Since then, the effort has tapered, but six full-time employees still work to maintain the county’s high participation rate. “We want to make sure that no one is left out because of lack of knowledge,” said Brooke Bascom, who runs the program.

    The biggest draw, Bascom said, has been the financial incentives King County offers its employees for participating.  Other wellness programs offer much less substantial rewards, according to the Rand report.

    Among the 10 percent of employees who don’t participate in Healthy Incentives, most say it’s because they don’t want to share private information about themselves. A small number are given exceptions because of health conditions or family issues that prevent them from participating.

    More Than a Wellness Plan

    Healthy Incentives offers a model that state and local governments should replicate, said Stephen Goldsmith, director of the innovations award program at Harvard’s Kennedy School of Government. Washington state is already emulating parts of King County’s wellness plan and Oregon is trying to start a similar program. 

    Here’s how the financial incentive part of the program works:

    In the past, county employees didn’t pay a share of insurance premiums, but they did pay deductibles, co-insurance and co-pays. Healthy Incentives allowed workers to shave $200 off of their $500 deductible simply by filling out a health assessment form. They could get another $200 knocked off if they completed an “individual action plan,” such as attending six Weight Watchers meetings at work, completing five phone sessions with a tobacco cessation coach or learning how to better manage diabetes. Four years into the program, nonparticipants’ deductibles went up to $800.

    In addition, employees who did not participate in the program had to pay a 10 percent higher co-insurance share of the cost of medical care after their deductibles were exhausted.  When you put those two incentives together, the individual savings could come to more than $1,000 per year.

    The program also encourages the use of less expensive generic drugs by increasing the co-pay for name-brand drugs from $15 to $30, while decreasing the co-pay for generic drugs from $10 to $7. These changes, put in place in 2010, resulted in $2.4 million savings to the county and a $1 million savings to employees by 2011.

    Higher Value Providers

    The wellness program began when former County Executive Ron Sims, credited with the big idea, donated $1.3 million in county dollars to help a fledgling health care organization, the Puget Sound Health Alliance, develop a medical claims database to help identify doctors and hospitals in the county that offered the highest quality services at the lowest prices. He also recruited large local employers including Alaska Airlines, Boeing and Starbucks to contribute money to the effort.

    By analyzing claims data, the group found that one provider organization, Group Health Cooperative, was costing the county an average of $4,000 less per person per year while providing higher quality services than all other providers in the area. Group Health already served 20 percent of the county’s employees through its Seattle-based accountable care organization.

    To encourage more employees to use Group Health, the county eliminated the deductible and added a graduated co-payment of $20 to $50 based on employees’ Healthy Incentives participation levels. Regence BlueShield patients remained subject to existing deductibles of up to $800. As a result, an additional 2,274 employees switched to Group Health, bringing its share of coverage to 30 percent. Between 2010 and 2011, the shift to Group Health reduced county expenditures by $6.5 million and saved employees $2.2 million. 

    “They needed a third party to do the research,” said Mary McWilliams who now runs the Alliance. “The unions would never have trusted the research if it had come from the county or the providers,” she said. The alliance since expanded to include the state of Washington. 

    Now called the Washington Health Alliance, the group plans to determine the highest-value services by physician groups and hospitals within the Regence network. Once those providers are identified, employees will once again be steered in their direction through reduced out-of-pocket expenses. 

    Too Much Rigmarole

    Not everyone loved the program in the beginning. In its first two years, county employees objected to the time spent filling out forms and documenting their action plans. Some lodged formal complaints. Kathy Pompeo was one of them.  

    A supervisor in the Sheriff’s Office, Pompeo runs a 24-hour crew of data-entry workers who have little time to fill out online forms detailing their daily wellness activities. “My staff was very frustrated and very negative,” she said. They were spending more time reporting on their activities than working on their healthy behaviors. They participated, “kicking and screaming.”

    Bascom said the county took complaints to heart and made the process easier.  With such a diverse workforce — from bus drivers, road workers and custodians to law enforcement officers, doctors, attorneys and administrative workers — the county had to make accommodations so that everyone could participate. Bus drivers, for example, didn’t have access to computers, so the county developed a paper process.

    Even the county executive complained that the process was cumbersome.  “You’d get up in the morning and exercise and then have to sit down and log on to a computer. It didn’t make sense,” Constantine said.

    Now employees can text their activity to the program: “I’m walking my dog,” for example. And the county applies points toward their full participation status. 

    Has the county made it too easy to comply? Bascom doesn’t think so.  Research shows that healthy habits can be formed in just four weeks. As for employees gaming the system by not really performing the activities they say they are, Bascom and others said they doubted much, if any, of that was going on.

    “We’re a pretty ethical group,” Pompeo said, and there’s peer pressure to do the right thing. “It’s like having a running buddy or a diet buddy, only lots of them,” she said.

    When Constantine took office in 2009, he was asked whether he wanted to continue the program. His response was immediate. “There was no question about continuing it,” he said.  “Every employee was doing it, so it got internalized…. My question is why this hasn’t been done a thousand times before.”

  • Questions Abound As Courts Split On Legality Of Health Law Subsidies

    Two U.S. courts of appeals reached different decisions regarding the issue of whether the health law's subsidies can be used by consumers shopping for health coverage on the federal exchange, because their states opted against setting up their own online insurance marketplace. This development injects confusion as the Obama administration works toward the next open enrollment season, which is slated for November. Ultimately, the issue could land before the Supreme Court.

    Kaiser Health News: Appeals Courts Split On Legality Of Subsidies For Affordable Care Act
    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 (Rovner, 7/22).

    The New York Times: New Questions On Health Law As Rulings On Subsidies Differ
    Two federal appeals court panels issued conflicting rulings Tuesday on whether the government could subsidize health insurance premiums for millions of Americans, raising yet more questions about the future of the health care law four years after it was signed by President Obama. The contradictory rulings will apparently have no immediate impact on consumers. But they could inject uncertainty, confusion and turmoil into health insurance markets as the administration firms up plans for another open enrollment season starting in November (Pear, 7/22).

    NPR: Obama's Health Care Law Has A Confusing Day In Court
    Another wild legal ride for Obamacare on Tuesday: Two U.S. Court of Appeals panels issued conflicting decisions on an issue with the potential to gut the health care overhaul. The two rulings could lead to another U.S. Supreme Court showdown over the controversial law, all because of what one of the law's opponents initially called "a glitch" (Totenberg, 7/22).

    The Washington Post: Federal Appeals Courts Issue Contradictory Rulings On Health-Law Subsidies
    The conflicting rulings give traction to the most serious current threat to the Affordable Care Act, which has been battered by a series of legal challenges since it was enacted four years ago. The dispute centers on whether the subsidies may be awarded in states that chose not to set up their own insurance marketplaces and instead left the task to the federal government. About 5.4 million people had signed up for coverage on the federal exchange as of this spring, federal figures show. About 87 percent of them received subsidies (Somashekhar and Goldstein, 7/22).

    The Wall Street Journal: Appeals Courts Issue Conflicting Rulings On Health-Law Subsidies
    In a blow to President Barack Obama's signature legislative achievement, a panel of the U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 health law. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state or federally run exchange. Two hours later, a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va., reached the opposite conclusion, unanimously ruling that consumers in states relying on the federal marketplace could receive subsidies. That handed the White House a victory that counteracted the administration's loss in the other case (Kendall and Armour, 7/22).

    Los Angeles Times: Federal Appeals Courts Issue Conflicting Rulings On Obamacare
    The legal battle gives Obamacare’s opponents another shot at trying to kill the law in the high court, a goal they fell one vote short of in 2012. In that case, four justices voted to strike down the entire legislation as unconstitutional. Chief Justice John G. Roberts Jr. joined the four liberal justices to uphold the core of the law. This time, the outcome at the high court would turn on whether at least one of the five conservative justices agreed to uphold Congress’ broad goal of providing all Americans with insurance they can afford (Savage, 7/22).

    Politico: Wild Day For Obamacare: Appeals Court Rulings Conflict
    For now, no one will have their subsidies cut off while the legal battle continues. The Obama administration said it will appeal the D.C. ruling on Halbig v. Burwell by asking for an en banc review involving the full panel. “We are confident in the legal case that the Department of Justice will be making,” said White House press secretary Josh Earnest. The plaintiffs in the fourth circuit’s King v. Burwell in Virginia haven’t yet said what they’ll do next (Winfield Cunningham, 7/22).

    The Associated Press: Appeals Courts Split on Health Law’s Subsidies
    President Barack Obama's health care law is snarled in another big legal battle, with two federal appeals courts issuing contradictory rulings on a key financing issue within hours of each other Tuesday. But the split rulings don't necessarily mean another trip to the Supreme Court for the Affordable Care Act. And White House spokesman Josh Earnest immediately announced that millions of consumers will keep getting financial aid for their premiums as the administration appeals the one adverse decision (7/23).

    Reuters: Latest Obamacare Legal Knot Won’t Be Easy To Untangle
    U.S. judges have their work cut out for them untangling a legal knot created on Tuesday when two federal appeals courts released conflicting rulings hours apart going to the heart of the role the federal government will play in Obamacare. The latest conservative challenge to President Barack Obama's healthcare overhaul will not necessarily land in the U.S. Supreme Court, although it could end up there as soon as this year if the two lower courts go on disagreeing. At stake is how millions of Americans pay for private health insurance, or if they can afford it at all (Ingram, 7/22).

    Bloomberg: Obamacare On Path Back To Higher Court After Ruling Split
    The U.S. Supreme Court may not be done with Obamacare yet. With appellate courts reaching opposite conclusions on the same day about a crucial financing provision of the 2010 law, a third showdown before the justices is probable. Splits among the federal circuits have preceded previous high court rulings on the Affordable Care Act. In 2012, the law was narrowly upheld when the court ruled Congress has the power to make Americans carry insurance or pay a penalty. Last month, the court said private companies can claim a religious exemption from a requirement that they offer birth-control coverage (Harris and Zajac, 7/23).

    USA Today: Appeals Court Panels Issue Split Decisions On Obamacare
    The federal subsidies offered through the exchanges have reduced monthly insurance premiums by 76% for those who qualify, federal health officials say. The average monthly premium dropped from $346 to $82. In 2016, an estimated 7.3 million people in the 34 states with federal exchanges would receive subsidies totaling $36 billion, according to the Urban Institute. To qualify for subsidies, participants must have incomes below 400% of the federal poverty line, or $95,400 for a family of four (Wolf, 7/22).

    McClatchy: Courts Issue Conflicting Rulings on Health Care Tax Subsidies
    Two appeals courts on Tuesday reached radically different conclusions about whether millions of consumers in 36 states can use tax credits to help buy health coverage on the federal health insurance marketplace. The conflicting rulings, combined with two other pending challenges still awaiting decisions, potentially tee up for the Supreme Court its next landmark health care case and leave one of the Affordable Care Act’s signature provisions in a state of legal limbo (Doyle and Pugh, 7/23).

  • How Will The Latest Health Law Decisions Affect You?

    News outlets offer consumer impact insight over Tuesday's rulings on the health law's subsidies to buy health insurance on the federal and state marketplaces.

    McClatchy: Confused About the Health Care Rulings?
    Contrary rulings Tuesday on a key element of the Affordable Care Act by two separate federal appeals courts raise a variety of questions (Pugh, 7/22).

    Kaiser Health News: Brief Consumer Guide To Health Law Court Decisions
    On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people: the availability of subsidies to help purchase coverage under the health-care law. Kaiser Health News’ Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers (7/22).

  • Dueling Rulings On Health Law Subsidies Leave States In Lurch

    States are pondering their places in the health law's federal- or state-based health insurance exchanges after a pair of contradictory appeals court rulings Tuesday threw up in the air if states that use the federal exchange can offer subsidies to their residents to help afford coverage.

    The Richmond Times-Dispatch: Appeals Courts Issue Contradictory Rulings On Health Care Subsidies
    Two federal appeals courts on Tuesday issued contradictory rulings on whether low- and middle-income people may receive federal subsidies to buy policies in the states that did not set up their own health insurance exchanges. The issue, which could be heading to the U.S. Supreme Court, is crucial in 34 states, including Virginia, which did not set up their own health exchanges. … In Virginia, 82 percent of the 216,356 people who signed up for marketplace plans in the first enrollment period got financial assistance. Those 177,000 people are receiving an annual average of $3,048, according to the state Attorney General’s Office (Cain and Martz, 7/22).

    The Oregonian: Dueling Health Care Law Rulings Leave Experts Split On Oregon's Insurance Premium Subsidies
    Conflicting federal appeals court rulings over whether the federal health insurance exchange can issue premium tax credits won't have any effect in Oregon over the short term. The long-term outcome may have to wait for a U.S. Supreme Court ruling, and potentially won't even be settled then. That's because Oregon's plan to use the federal exchange in 2015, while keeping some functions under state control, may fall into a legal gray area, experts said Tuesday. At issue is whether all states, including those using the federal exchange, can issue reduced premiums to people with qualifying incomes under the 2010 Affordable Care Act. About 70,000 Oregonians received the subsidies this year (Budnick, 7/22).

    The Boston Globe: Mass. Unlikely To Be Affected By Health Care Rulings
    Will Tuesday’s conflicting court rulings on federal health insurance subsidies have any bearing in Massachusetts? It appears unlikely, even though the state has left open the possibility of joining the federal healthcare.gov insurance marketplace. If the Massachusetts Health Connector does go that route, it would still be considered a state-based exchange, but one supported by the federal government -- and it’s not clear whether the rulings would apply (Freyer, 7/22).

    The Milwaukee Journal Sentinel: Dueling Court Rulings Leave Obamacare Subsidies Up In Air
    The rulings could affect subsidies for more than 4 million people nationally, including more than 100,000 in Wisconsin, and created immediate confusion among some consumers. Arise Health Plan, which sold individual plans in Milwaukee as well as elsewhere in eastern Wisconsin, said it received phone calls Tuesday from confused customers. An estimated 90 percent of the 130,000 people in Wisconsin who have bought health plans sold on the marketplace set up under the law qualified for subsidies (Boulton and Gumpert, 7/22).

    Des Moines Register: Obamacare Rulings Could Affect 24,000 Iowans
    More than 24,000 Iowans could lose subsidized health insurance if courts ban the government from helping pay for policies purchased on the federal government's online marketplace, Iowa's insurance commissioner said today. ... Iowa is one of [36] states that do not have their own health-insurance marketplaces. Leaders here looked into building one, but decided instead to use the federal version of the system, called healthcare.gov (Leys, 7/22).

    Georgia Health News: Exchange Subsidies Draw Conflicting Court Rulings
    More than 190,000 Georgians are enrolled in the health insurance exchange created by the Affordable Care Act. But if a D.C. federal court ruling announced Tuesday on exchange subsidies is ultimately upheld, that Georgia number could shrink precipitously. The U.S. Court of Appeals for the District of Columbia ruled Tuesday that the language of the ACA allows subsidies, or discounts, only for people who obtain coverage through exchanges run by the states, and not by the federal government. Georgia is among 36 states whose insurance exchanges are federally run (Miller, 7/22).

    Kansas Health Institute News Service: Conflicting Rulings On Obamacare Subsidies Put Consumers In Limbo
    Conflicting federal court rulings are raising questions about whether consumers in Kansas and Missouri will continue to be eligible for subsidies when purchasing private health insurance through the Obamacare marketplace (McLean, 7/22).

    The CT Mirror: Obamacare’s Big Day In Court Means Little For CT
    Two federal courts issued conflicting rulings on the health law known as Obamacare Tuesday, but their decisions aren’t expected to directly affect Connecticut residents. That’s because the cases address whether it’s legal for the federal government to help pay the insurance premiums of people who buy their insurance through federally run marketplaces known as exchanges. Connecticut’s health insurance exchange, Access Health CT, is run by the state, not the federal government. That means the legality of federal subsidies provided to Access Health customers is not in question (Becker, 7/22).

  • CNN Poll: Half Of Americans Say Obamacare Has Helped Their Families Or Others
    A CNN poll finds that more than half the public says the health law helped their families or others, but fewer than one in five say they have personally benefited. Meanwhile, election-year politics in Ohio may lead to the release of 2015 premiums on Oct. 1, and business and consumer groups seek to influence benefits.

    CNN: Is Obamacare Working?
    More than half the public says Obamacare has helped either their families or others across the country, although less than one in five Americans say they have personally benefited from the health care law, according to a new national poll. A CNN/ORC International survey also indicates that a majority of Americans oppose the Affordable Care Act, but that some of that opposition is from people who don't think the measure goes far enough (7/23).

    The Star Tribune: Dayton Wants Health Insurers To Reveal 2015 Rates On Oct. 1
    Election-year politics are shining a spotlight on health insurance rates, with Gov. Mark Dayton now asking the state’s insurance plans to voluntarily agree to release them on Oct. 1. Republicans have pressed for release of the 2015 health insurance rates before the November election, even though there’s no requirement that insurers do so until open enrollment starts on Nov. 15. Minnesota had the lowest insurance rates in the nation in the first year under the federal health law, but some Republicans suspect that rates will go up (Crosby, 7/22).

    Kaiser Health News: Capsules: Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits
    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 (Luthra, 7/23).

  • Undercover Agents Get Health Insurance Subsidies With Fake IDs

    Federal investigators, working undercover for the Government Accountability Office, said they had been able to obtain subsidized health insurance under the health law using fictitious identities and false documents. The administration said it was working on remedying the verification problems.

    The New York Times: Investigators Detail Missteps In Verification For Health Care
    Federal investigators working undercover said Tuesday that they had been able to obtain subsidized health insurance under the Affordable Care Act using fictitious identities and false documents. The investigators, from the Government Accountability Office, said their tests indicated the Obama administration was not adequately verifying information submitted by applicants (7/22).

    The Washington Post: Federal Undercover Investigation Signs Up Fake Applicants For ACA Coverage
    The results of the inquiry by the Government Accountability Office are evidence of still-imperfect work by specialists intended to assist new insurance customers as well as government contractors hired to verify that coverage and subsidies are legitimate. The GAO also pointed to flaws that linger in the marketplace’s website, healthcare.gov (Goldstein, 7/22).

    The Wall Street Journal: Fictitious Applicants Able To Get U.S. Health-Insurance Tax Credits
    The investigation will be the focus of a House Ways and Means subcommittee hearing Wednesday on the potential for waste and fraud in the subsidies. Republicans opposed to the health law say the GAO's findings are evidence of the government's inability to verify information, which they say creates the potential for fraud and abuse (Armour, 7/22).

    The Associated Press: Agents Get Subsidized ‘Obamacare’ Using Fake IDs
    Undercover investigators using fake identities were able to secure taxpayer-subsidized health insurance under President Barack Obama's health care law. The weak link in the system seemed to be call centers that handled applications for thousands of consumers unable to get through online (7/23).

    NBC News: GAO Sting Finds It Easy to Fake It, Get Obamacare Premiums
    Eleven out of 12 fake applications for government-subsidized health insurance got through a verification process and the bogus beneficiaries are still covered, the Government Accountability Office said Tuesday. The GAO launched the sting to check to see how well the Obamacare process checks for counterfeit applications. The results were messy, GAO’s Seto Bagdoyan says in testimony prepared for a hearing Wednesday of the House Ways and Means oversight subcommittee (Fox and Seidman, 7/23).

  • Marketplace Confronts Confusion In Face Of Conflicting Rulings

    News outlets report that providers and insurers worry the two appellate court decisions could undermine the stability of the newly expanded health insurance markets. Meanwhile, governors in those states that opted not to set up their own marketplaces may face pressure if consumers who used healthcare.gov to shop for coverage lose their subsidies.  

    The Wall Street Journal: Hospitals, Insurers Say Subsidies Rulings Further Confuse The Issue
    Health-industry officials said Tuesday's dueling court rulings over federal health-law subsidies set the stage for another bout of confusion as consumers return to marketplaces this fall to shop for next year's coverage. "People are going to be coming in with more questions about these court cases," said Jason Stevenson, a spokesman for the Utah Health Policy Project, a nonprofit organization that has navigators that aid residents in enrolling on the federal exchange. "People are already asking about the long-term stability of the ACA" (Wilde Mathews, Weaver and Armour, 7/22).

    Modern Healthcare: Clashing Rulings On Exchange Subsidies Raise Fear of Instability
    Healthcare providers and insurers fear that today's conflicting appellate court rulings on the legality of Obamacare premium subsidies offered through the federal insurance exchange could have a destabilizing effect on the newly expanded insurance market (Robeznieks, 7/22).

    The Wall Street Journal: Some Governors Face Fallout Over Health Law Ruling
    The prospect of millions of people losing federal tax credits they obtained under the health law places some governors and legislators in a tough spot in the run-up to this fall's elections. Some 36 states turned over the task of running the health law's insurance exchanges to the federal government. If courts ultimately back Tuesday's decision by a federal appeals court in Washington, D.C., which held that Americans can obtain tax credits only if their state is operating its own exchange, then officials in these states may come under pressure to find ways to ensure residents keep subsidies (Radnofsky and Peters, 7/22).

    Politico: Democrats Still Haven’t Learned Obamacare Lesson
    The conflicting rulings were another wake-up call for Democrats about the fragility of the health care law -- and a reminder that whenever they think a lawsuit is no threat to the law, it’s probably a threat to the law. It’s all because of what most Democrats insist is a drafting error in the law, but it’s kind of a big one. The federal health insurance marketplace is now serving 36 states that couldn’t or wouldn’t set up their own exchanges (Nather and Haberkorn, 7/22).

    Meanwhile, a look at the courts --

    Politico: How Obama’s Court Strategy May Help Save Obamacare
    Last fall, President Barack Obama and Senate Majority Leader Harry Reid deployed the “nuclear option” to help get three liberal judges onto the D.C. Circuit appeals court. Tuesday’s ruling on Obamacare is a dramatic example of why they forced the issue (Gerstein, 7/22).

    The Associated Press: Judges in Health Care Rulings Vote Party Line
    In rapid succession, six federal judges on two appeals courts weighed in on a key component of President Barack Obama's health care law. Their votes lined up precisely with the party of the president who appointed them. It was the latest illustration that presidents help shape their legacies by stocking the federal bench with judges whose views are more likely to align with their own (7/23).