Obamacare

Just hours after the U.S. Court of Appeals for the D.C. Circuit threw out the federal tax regulation that implements the Obamacare subsidies available to people with annual incomes of up to 400 percent of the federal poverty level, the Fourth Circuit has upheld them, the National Law Journal's Marcia Coyle reports: "In King v. Burwell, the three-judge panel of the U.S. Court of Appeals for the Fourth Circuit rejected arguments that the subsidies—tax credits offsetting the cost of insurance for low- and moderate-income persons—are limited only to insurance purchased through state-created exchanges under the health insurance law."
 

A major blow has been delivered today to Obamacare, Reuters reports: "The U.S. Court of Appeals for the District of Columbia Circuit accepted one of the main legal challenges to the policy by conservatives opposed to an expansion of the federal government" and threw out the federal tax regulation that implements Obamacare subsidies available to people with annual incomes of up to 400 percent of the federal poverty level.

Several insurers who waited out the first round of health insurance applications through online exchanges are going to be selling policies through the exchanges next year, the New York Times reports. Even if insurers wait a year or two to enter the exchanges, they can still compete for customers because "people buying coverage in the individual market tend to be focused on price and may quickly switch plans if better deals become available," Larry Levitt, a Kaiser Family Foundation health policy expert told the Times.

An estimated $474 million in federal appropriations were spent on developing four state-level Obamacare exchanges that are "now in shambles," Politico reports. Massachusetts, Oregon, Nevada and Maryland now either have to move their residents onto the federal exchange or rebuild their systems, Politico further reports: "Nevada, for one, is still trying to figure out its future. Oregon has decided to switch to HealthCare.gov. Maryland wants to fix its own exchange, maybe by incorporating what worked in Connecticut. Massachusetts actually wants to do both — build a portal from scratch while planning a move to the federal exchange as a backup."

The Centers for Medicare and Medicaid Services has clarified that most of the rules of when liens are asserted by the government to recover the money spent on Medicaid health care for long-term care will apply to people who are getting Medicaid under the Affordable Care Act expansion, The Southern reports. States are entitled to asset recovery for all health care benefits, but CMS hopes that states will only impose liens and try to recover from estates for nursing home cases, The Southern also reports.

Separately, NJ.com reports that the "Affordable Care Act encourages states to expand their Medicaid rolls so single people and childless couples can now qualify if poor enough. That means thousands of newcomers to Medicaid may not realize that ultimately they may have to repay the piper."

The FBI is looking into the problems that led Oregon to scrap its problematic health insurance exchange, the Wall Street Journal reports. The exchange was never fully functional, WSJ adds. Oregon is joining the federal exchange instead: "The state will going forward join roughly three dozen other states and use the federal exchange, which itself suffered multiple setbacks in 2013 but has since mostly recovered," WSJ reports.

Many more people are eligible for Medicaid under the Obamacare expansion: adults with incomes under 133 percent of the poverty level. Can the government recover the expenses paid out for these new Medicaid enrollees through liens on their properties and recoveries from their estates?

The Health Affairs blog reports on how the Centers on Medicare and Medicaid Services is advising states on applying liens to consumers who are getting Medicaid under the new expansion. Elderly Americans often get their long-term care paid through Medicaid, but there has been a concern that people "would voluntarily impoverish themselves, transferring assets to their children or to others to make themselves eligible for Medicaid," the blog reports. Medicaid can impose liens on people's houses and other assets to get that long-term care paid back. Now the questions is how the rules about liens should be applied to people who are newly eligible for Medicaid under the Obamacare expansion.

The first upshot, the blog reports, is that liens can't be placed on the property of new Medicaid enrolees. The second upshot is that CMS advises states to try to recover from the estates of new Medicaid receipients who receive long-term care, but not other types of care: "In sum, most of the rules that apply to traditional Medicaid recipients with respect to [long-term care services and supplies] LTSS (except for lien requirements) are likely to apply to [modified-adjusted gross income] MAGI-eligible individuals who receive LTSS.  CMS intends, however, to take steps to avoid applying estate-recovery rules to [modified-adjusted gross income] MAGI-eligible individuals who do not receive LTSS to keep this from becoming a barrier to Medicaid expansion eligibility."

The U.S. Supreme Court appeared split on whether private for-profit companies have to provide insurance coverage for contraceptives to their employees, even if it violates their owners' religious beliefs, the Christian Science Monitor reports. Swing vote Justice Anthony Kennedy "asked skeptical questions of both sides, but one interaction with US Solicitor General Donald Verrilli might signal trouble for the Obama administration’s position. Kennedy asked Mr. Verrilli whether the administration’s position might mean that for-profit corporations could be forced to pay for abortions for their employees regardless of any religious objections of company owners. 'No,' Verrilli said immediately. A federal law prohibits such a government command, he said. 'But your reasoning would permit that,' Kennedy persisted."

Millions of Americans are stuck in a health coverage gap created by the Supreme Court strucking down the Obamacare mandate that states expand Medicaid and the refusal of many states to voluntarily expand their existing Medicaid programs, The Wall Street Journal reported this week. The WSJ reports on one woman who earns $7,000 as a cleaner, which is too little to get help buying coverage on the healthcare insurance exchanges and too much to get coverage in Alabama's Medicaid program.

Twenty-four Republican-led states have declined the expansion, WSJ also reports. That might be changing in some states: "Some GOP-led states are revisiting their decision as complaints pile up over the coverage gap—and its consequences for businesses—in such states as Utah and Florida. The state senate in New Hampshire last week reached a tentative deal to expand Medicaid. In Virginia, newly elected Democratic Gov. Terry McAuliffe hopes to get legislators to reverse his Republican predecessor's stance against expansion," according to WSJ.

The Washington Post editorialized this week that Virginia should expand Medicaid because "people above and below them get help from other federal health-care provisions — and while Virginia’s citizens pay federal taxes to fund the coverage expansion but get none of those dollars back."

The Chicago Tribune reports on how a "little-known" provision in the Medicaid health-insurance expansion is going to increase the practice of the government asserting liens on patients' assets to recoup expenditures on medical costs: "The issue arises because of a provision in the long-standing laws governing Medicaid that compel states to recoup certain medical costs after a person dies, either via liens placed on an individual's home or claims on their assets." Liens are not asserted in private insurance policies bought on state-based insurance exchange.

The Tribune reports that new Medicaid patients could face liens even if they don't seek medical care: "In another twist, all new Medicaid patients in Illinois were placed into so-called managed-care programs, in which the state pays insurers on a per-member per-month basis. That means people like Rosato will be racking up health care costs even if they don't seek any medical care. In theory, that money could all come out of their estates once they die."

Some states, included Oregon and Washington, have tweaked their regulations to apply recovery efforts only to long-term care, The Tribune further reports. However, Illinois has not.

The Centers for Medicaire & Medicaid Services said it will provide guidance to states sometime soon.