Patient Protection and Affordable Care Act

The New York Times' Abby Goodnough and Robert Pear and The Washington Post's Kelsey Snell and Mike DeBonis both have pieces about how the Affordable Care Act is likely to endure to some extent despite the plans of President-elect Donald Trump and Congressional Republican leaders to repeal it.

The Washington Post reporters note that "Democratic opposition and complex Senate rules mean that core pieces of the 2010 health-care overhaul are likely to remain, including the legal framework for the individual mandate and pieces of the state exchanges the law created. Furthermore, President-elect Donald Trump has vowed to preserve other key aspects, such as a ban on insurers denying coverage because of preexisting conditions and a requirement that insurers cover children under 26 on their parents’ plans."

The New York Times reporters profiled a hospital system in Indiana where, because of Obamacare,  "its leaders have started moving away from fee-for-service medicine, where every procedure, examination and prescription fetches a price. The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community." The impact from the ACA on how medical care is delivered is not likely to change.

The New York Times' Abby Goodnough reports that Temple University Hospital in Philadelphia and other hospitals serving poor neighborhoods face a financial crisis if the Affordable Care Act is repealed. President-elect Donald Trump and Republican Congressional leadership have vowed to do exactly that.

The hospital industry predicts that "hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings."

Prior to the Affordable Care Act, the hospitals had to absorb the cost of caring for uninsured patients. Hospitals who serve a large number of poor and uninsured patients also agreed to funding cuts in exchange for getting more patients with Medicaid and other insurance coverage. If Medicaid expansion is rolled back, hospitals like Temple are hoping that supplemental funds to defray the costs of caring for the uninsured will be restored.

The U.S. Supreme Court is considering whether low-income taxpayers can only receive subsidies for health insurance if they purchased their policies on state-run insurance exchanges, not federal exchanges. The four words at issue in the Affordable Care Act? "Established by a state." The New York Times' Robert Pear reports that the two dozen Democrats and Republicans involved in writing the law say those four words were not meant to make tax subsidies in the law available only in states that established their own health insurance marketplaces.

For example, former Senator Jeff Bingaman, Democrat of New Mexico, said the words in dispute are a "'drafting error."' Christopher E. Condeluci, who was a staff lawyer for Republicans on the Finance Committee, told Pear that, when senators drafted a backup plan to allow the federal government to establish an exchange in any state that didn't have its own, it was an oversight to not include a cross-reference to the section of the tax code providing subsidies.

But Pear notes that some Supreme Court justices, including Justice Antonin Scalia, interpret laws based not on "'what Congress would have wanted, but what Congress enacted.”'

Half of the 17 state-run insurance exchanges set up under President Barack Obama's health law are struggling financially, The Washington Post's Lena H. Sun and Niraj Chokshi report. The exchanges are facing financial distress because of "surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers." Federal funding for state-run exchanges has ended and exchanges now have to require their own costs of operation.

Some states are considering handing exchange functions over to the federal government but they are holding off until the U.S. Supreme Court rules by the end of June on whether the only way subsidies for health insurance can be provided to taxpayers is through coverage bought on state exchanges.

As many as 45,000 more Montanans will be get health coverage after legislators have passed a bill to expand Medicaid, The Huffington Post's Jeffrey Young reports. Gov. Steve Bullock, a Democrat, supports expanding Medicaid. The expansion also must be approved by the federal government because it includes new requirements for enrollees, including monthly premiums.

Two years ago, the expansion failed because a supporter cast the deciding vote the wrong way accidentally, Young reports.

The U.S. Court of the Appeals for the Eighth Circuit has ruled that Missouri can't limit the ability of insurance navigators in helping consumers sign up for coverage through the federally run online exchange, the St. Louis Post-Dispatch's Samantha Liss reports. Missouri legislators passed legislation barring navigators from providing advice to consumers about health plans sold outside of the federally-run exchange.

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.

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.