Obamacare

Even though the Third Circuit has held that "secular, for-profit companies aren't afforded religious protection and the constitutional rights of their owners don't pass through to the corporate entity," a district-court federal judge sided with employers that are challenging Obamacare's contraceptive-coverage mandate on the grounds that it violates their freedom of religion, The Legal Intelligencer, Pennsylvania's legal newspaper, reported. The Legal also reported that U.S. District Chief Judge Joy Flowers Conti of the Western District of Pennsylvania denied a request from the Obama administration for an indicative ruling on the application of the Third Circuit case when Conti had granted an injunction for a plaintiff from the contraception mandate.

The issue is being primed for the U.S. Supreme Court. A circuit split is present on the issue between the Third Circuit and the Tenth Circuit.
 

Five Democratic senators have introduced legislation to better define who as American Indians are eligible under Obamacare to not face IRS tax penalties for not carrying coverage. Prince William Sound's Cordova Times' also reported the legislation would rectify "the several definitions of 'Indian'  which led to conflicting interpretations of eligibility for benefits and requirements for coverage."

The New York Times reports on why the health-insurance exchanges have been so buggy: one factor was that the biggest contractor wasn't given specifications right away and only started writing software code this spring. Another factor was not rolling out a piece of the portal instead of the whole shebang at once. A third factor was that the Centers for Medicare and Medicaid Services "assumed the role of project quarterback, responsible for making sure each separately designed database and piece of software worked with the others, instead of assigning that task to a lead contractor." Sources told the NYT that CMS did not have the capacity to take on that role.

The result: "Many users of the federal exchange were stuck at square one. A New York Times researcher, for instance, managed to register at 6 a.m. on Oct. 1. But despite more than 40 attempts over the next 11 days, she was never able to log in. Her last attempts led her to a blank screen."

The Washington Post has a great explainer on why the exchanges for American consumers to buy health insurance policies are buggy and having problems since they opened. One issue: "the site needs to interact with a large number of databases operated by various federal and state agencies. If these back-end systems are poorly designed, it could take months or even years to straighten out the mess," The Post reports.

After the U.S. Supreme Court ruled states could not be forced to expand their Medicaid programs for the poor as part of the Obamacare health reform law, that is leaving many of the most impoverished Americans still without health care, The New York Times reports after a detailed analysis of census data. Among its findings: "The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides."

On a personal note, I still have hope the states that resisted expanding Medicaid will do so in the future. I attended a health law conference last winter, and a Pennsylvania lobbyist for health care pointed out that all the states eventually adopted programs like Medicaid and Medicare, when first created, even if they resisted for several years. He also arged that healthcare providers will lobby to get the expansions in order to control their costs. This is no consolation for any one person who can't get coverage today, but it's systemic hope for the success of correcting the healthcare marketplace.

Now that American consumers can start shopping for private health insurance through exchanges, the Washington Post has a great explainer on how the exchanges will work. 

Some things I learned that I didn't know:

1. If folks can't find an affordable plan, they don't have to buy coverage if it's more than 8% of their income.

2. The proportion of people who won't be affected by the law is higher than I thought. Only 20% of Americans don't get insurance from employers or the government and will need to access the exchanges.

3. Smokers have to disclose their tobacco use and will be charged extra for their health insurance.

The clash over the requirement that most employers, as well as insurers for religious institutions that are not directly associated with houses of worship, cover female employees' contraception is primed for the U.S. Supreme Court, UPI reports. The Sixth and Third Circuits ruled against challenges to the insurance mandate to cover contraception, but the 10th Circuit has ruled in favor of a challenge by two private, secular companies, UPI also reported. The Solicitor General has asked the Supreme Court to grant certiorari on the issue, and such requests tend to be granted by the justices, UPI also reports.

Rather than expanding Medicaid to cover more Pennsylvanians when the mandate to have health insurance kicks into effect, Pennsylvania Tom Corbett proposed yesterday that funds for the expansion instead be used to help state residents get private health insurance. The pitch will need federal approval.

When the US Supreme Court upheld the constitutionality of the insurance mandate under Congress' taxing power, the court separately rejected making the expansion of Medicaid mandatory upon the states. Some Republican governors have accepted the expansion, while others like Corbett have not.

 The Harrisburg Patriot News editorial board welcomed Corbett's efforts to expand insurance coverage for poorer Pennsylvanians but said requiring participants to look for work in exchange for coverage and imposing a modest co-pay might make the plan unworkable. Read the full piece here: http://www.pennlive.com/opinion/index.ssf/2013/09/corbett_rolls_the_dice...

In closing the board said: "The insurance gap remains one of the most pressing public policy questions of our time. The first and only priority should be closing that gap. Ideology, if it is a factor at all, should finish a distant second."