Obamacare

Now that the U.S. Supreme Court has upheld the use of tax subsidies for people buying health insurance on the federal exchange in King v. Burwell, business groups are going to press Congress to modify elements of the Affordable Care Act, Hospitals & Health Networks Daily's Marty Stempniak reports: "Trade groups representing employers — such as the National Retail Federation and American Benefits Council — urged Congress to 'seize the opportunity' and address what they say are shortcomings in the law. Those include repealing the employer mandate and Cadillac tax on pricier plans, reforming reporting requirements, and upping the 30-hour work week standard for eligibility to 40 hours."

Healthcare advocates also are going to push for the expansion of Medicaid in the Republican-led states that have refused to allow for it. Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, told Stempniak that federal regulators may allow more flexibility in Medicaid programs, which could entice more states to participate in Medicaid expansion.

The consensus about the latest Supreme Court case involving the Affordable Care Act is that the two key votes are Justice Anthony M. Kennedy and Chief Justice John G. Roberts Jr. The rest of the Supreme Court justices appeared to be split along ideological lines during oral arguments yesterday over whether the statutory language in the health law only allows federal subsidies to consumers who bought their health insurance through a state-run exchange, not the federal exchange.

The Washington Post's Robert Barnes reports that Kennedy said there was a constitutional problem with the interpretation of Obamacare that states had to create their own exchanges or the federal government would "'send your insurance market into a death spiral'" by taking away their subsidies. That is coercive pressure that the federal government is not allowed to apply, Kennedy said. Barnes further reports that "Kennedy brought up the 'standard of constitutional avoidance.' That means that if there are two possible interpretations of a statute, judges should choose the one that is plainly constitutional instead of the one that raises constitutional questions."

Roberts, who was the swing vote in upholding the constitutionality of Obamacare, did not ask any questions that provided insight into his leanings on the case, Barnes reports.

A ruling against the Obama administration would result in 7.5 million Americans losing their subsidies, Barnes also reports.

The updates about the U.S. Supreme Court's arguments today in King v. Burwell are coming fast and furious. The petitioners are seeking to invalidate the insurance subsidies in states with federal exchanges. SCOTUSBlog reports that Justice Anthony Kennedy, often the swing justice on the court,  "expressed deep concern with a system where the statute would potentially destroy the insurance system in states that chose not to establish their own exchanges – likening this to an unconstitutional form of federal coercion. That made him seem skeptical of the petitioners’ reading of the statute, a hopeful point for defenders of the existing subsidies in all states."

Arkansas and Kentucky, followed by Oregon, Washington and West Virginia, had the sharpest reductions in their uninsured rates among adult residents, Gallup reports. Of the 11 states that had the greatest increases in the number of their residents who have health insurance, 10 expanded Medicaid.

Massachusetts has the lowest uninsured rate in the country at 4.6 percent, and Texas has the highest at 24.4 percent.

Next month, the US Supreme Court is going to hear a case over whether the Affordable Care Act authorizes the federal government to give subsidies to people who purchase health-insurance policies through the federally run insurance exchange. The argument against allowing the subsidies is that the law may have been drafted to only authorize subsidies given to people who buy their policies through state-run exchanges. If the justices rule in favor of that argument, Florida could lose $441.9 million in subsidies, Texas $247.5 million, North Carolina in $163.2 million and so on, the Washington Post's Greg Sargent blogs.

Sargent also notes that a number of states have argued that they had no notice that their decision not to set up their own exchanges would imperil the tax subsidies: "Thus, they argue, if the Supreme Court guts subsidies, it would impose a “dramatic” hidden punishment on them and their residents for their decision not to set up an exchange, despite the fact that they had no clear warning of the consequences of that decision. This raises serious Constitutional concerns, and as a result, the states argue, the Supreme Court should opt for the interpretation of the statute that doesn’t raise those concerns — the government’s interpretation that subsidies are universal."

Reuters' Lawrence Hurley reports that the U.S. Supreme Court rejected an appeal brought by the Association of American Physicians and Surgeons and the Alliance for Natural Health USA, challenging "various aspects of the law known as Obamacare including the so-called individual mandate that requires people to obtain health insurance or pay a tax."

Gallup's Jenna Levy reports that "the uninsured rate has dropped 4.2 percentage points since the Affordable Care Act's requirement for Americans to have health insurance went into effect one year ago." Levy also reports that the uninsured rate among "blacks dropped seven points over the past year, while the rate among Americans earning less than $36,000 in annual household income dropped 6.9 points." Overall, Gallup's surveys shows the Affordable Care Act has met one of its goals to increase the number of Americans with health insurance coverage. 

According to a report in Reuters, several leaders of major American corporations are threatening to start siding with the foes of healthcare reform if President Barack Obama's administration does not stop challenging some workplace wellness programs: "The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't." But the Equal Employment Opportunity Commission has filed lawsuits challenging wellness programs at Honeywell and two other companies, Reuters reports. The EEOC argues that the programs require medical testing in violation of the Americans with Disabilities Act.

According to Reuters, big companies could pursue several strategies to challenge Obamacare: support legal challenges to the subsidies given to people with low incomes to buy health insurance on the federal exchange, make executives available to testify at hearings on Obamacare, and radically change employer-sponsored health insurance by giving workers a fixed amount of money to buy coverage on private insurance exchanges.

Courthouse News' Jack Bouboushian reports that the First Circuit ruled that the Affordable Care Act requires the state of Maine to keep providing Medicaid coverage to 19- and 20-year-olds from low-income families: "the federal Department of Health and Human Services would not approve the change, because the Patient Protection and Affordable Care Act requires states accepting federal Medicaid funds to 'freeze' their Medicaid eligibility standards for children until 2019." The First Circuit ruled the requirement "does not step on state sovereignty ... as setting conditions of eligibility for participation in Medicaid is not a core state function, such as, for example, regulating state elections," Bouboushian further reports.

Montana Governor Steve Bullock, a Democrat, has asked legislators once again to expand health coverage for 70,000 low-income Montanans, the Independent Record reports: "Legislative Republicans rejected a Medicaid-expansion proposal in 2013, arguing the state couldn’t afford it and that they didn’t want to implement part of 'Obamacare,' the 2010 federal health-care law. Bullock ... said his new plan is a unique proposal for expanding Medicaid. It would use federal money to contract with a private administrator to process claims and run a network of physicians, hospitals and other providers to serve the newly covered population, he said."