Patient Protection and Affordable Care Act

Virginia Gov. Terry McAuliffe is cutting back on his efforts to expand Medicaid healthcare coverage for poor Virginians in the face of strong opposition from Republican legislators, the New York Times reports. The governor has called it '''unconscionable' that such a wealthy state could not provide health care for its needy." The state constitution forbids spending without legislative approval, leading the governor to issue modest orders Monday to cover 20,000 people with severe mental illness and 5,000 kids of low-income state workers.

In huge healthcare news, Pennsylvania Governor Tom Corbett has relented on expanding Medicaid to cover more poor Pennsylvanians under Medicaid, the Huffington Post reports: "Federal regulators accepted a modified proposal from Gov. Tom Corbett (R) that will offer an estimated 500,000 low-income individuals subsidies to purchase private insurance. The plan allows some low-income individuals to be charged premiums for coverage, and permits the number of available benefit plans to be reduced from 14 to two -- a 'high-risk' option and 'low-risk' options -- according to the Pittsburgh Post-Gazette." This makes Pennsylvania the ninth state run by a Republican governor to accept the Medicaid expansion.

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.

Premiums for health insurance sold on the Obamacare's exchanges are going to be lower than expected, the Congressional Budget Office projects, according to the Wall Street Journal. The federal government is expected to spend $165 billion less than projected on subsidizing health-insurance plans, the WSJ further reports.

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."