Court Ruling on Health Care Subsidies Risks Loss of Coverage
ALEXANDRIA,
Va. — Even with a federal subsidy to help cover the cost, Gloria
Spottswood has had to squeeze her household budget to afford the health insurance she bought this year through the Affordable Care Act.
Ms.
Spottswood, who is 56 and works in food service, signed up for a
CareFirst Blue Cross Blue Shield plan to cover herself and her
17-year-old son. She gets a subsidy of $181 a month toward the $663
premium, and pays the remaining $482. She manages, she said, but just
barely.
So when a federal appeals court panel found Tuesday that subsidies cannot be used
in states like Virginia that rely on the federal insurance exchange —
even as a different appeals court in Virginia found the opposite in a
separate case — Ms. Spottswood flinched.
The conflicting court rulings left much unresolved — both cases will be appealed further, and additional cases challenging the subsidies in federal exchange states are still making their way through trial courts in Indiana and Oklahoma.
But
the ruling in Halbig v. Burwell, in which a panel of the United States
Court of Appeals for the District of Columbia found that subsidies could
be awarded only in states that set up their own insurance exchanges,
raised the possibility that many of the 4.5 million people who were
found eligible for subsidized insurance through the federal exchange
would drop their new coverage.
Mary
Katzke is one. An independent filmmaker in Anchorage, Ms. Katzke, 60,
said she was paying $267 toward her $1,167 monthly premium and relied on
a $900 subsidy to cover the rest. Ms. Katzke, a single mother whose
silver-level plan covers her and her teenage son, said there was “no
way” she could continue to pay for the policy without her subsidy.
Nor is she optimistic that the Alaska Legislature, which is led by Republicans who oppose the health care law,
would establish a state exchange to allow residents to keep receiving
health insurance subsidies if they could no longer get them through the
federal marketplace. About 13,000 of a total 730,000 Alaskan resident
signed up for coverage through the exchange, according to the Obama
administration, but Ms. Katzke said she doubted they could persuade
state lawmakers to keep the subsidies flowing. “There will probably be
some outcry,” she said, “but I don’t know how powerful we are.”
In
the 36 states that used the federal insurance exchange this year, about
87 percent of people who signed up for private plans had incomes low
enough to qualify for premium subsidies, according to the Department of Health and Human Services.
The average monthly subsidy amount was $264, an analysis by the
department found, and the average cost to consumers after the subsidy
was $82.
To
be sure, there are people who never wanted to buy insurance but did so
only because the Affordable Care Act required it, under threat of fine.
But the law exempts people from the mandate if the cost of coverage is
greater than 8 percent of household income. So some of those opponents
of the mandate may well celebrate losing their subsidies — if it
exempted them from having to buy insurance.
Bolstered by Ruling, Republicans Attack Health Law
WASHINGTON
— Republicans in Congress resumed their campaign against the Affordable
Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal.
Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved.
“Time
and time again,” said Representative Charles Boustany Jr., Republican
of Louisiana, “the administration has chosen to ignore the law, and when
it does implement the law, it does so incompetently.”
Mr.
Boustany presided over a hearing of a House Ways and Means subcommittee
on Wednesday. An official from the Government Accountability Office, an
investigative arm of Congress, testified at the hearing that undercover
agents had obtained insurance coverage and subsidies using fake
documents and fictitious identities.
“The
federal marketplace approved coverage for 11 of our 12 fictitious
applicants who initially applied online or by telephone,” said the
official, Seto J. Bagdoyan, acting director of the forensic audits and
investigative team.
Consumers
have submitted millions of documents to the government to show
identity, citizenship, immigration status and income. But, Mr. Bagdoyan
said, the contractor that collects the papers for the government “does
not seek to detect fraud and accepts documents as authentic unless there
are obvious alterations.”
House
Republicans seized on the findings to attack Democrats who voted last
year against legislation to require more extensive verification of
income and other data used to compute subsidy payments.
Democrats brushed aside the criticism.
“Multiple
reports from Gallup, the Commonwealth Fund and the Urban Institute have
provided Congress with a truth that cannot be denied, explained away or
disputed,” said Representative John Lewis, Democrat of Georgia. “Today,
more Americans have health insurance than they did one year ago.”
Sylvia
Mathews Burwell, the secretary of Health and Human Services, estimated
that 10.3 million uninsured adults had gained health coverage from
September 2013 to April of this year. The estimate, based on research by
her department, did not distinguish new Medicaid beneficiaries from
people who purchased coverage on the health insurance exchanges, which
accepted applications from October to mid-April.
Dr.
Benjamin D. Sommers, an assistant professor at the Harvard School of
Public Health who worked on the study, said, “The biggest gains in
coverage occurred among Hispanics, blacks and adults 18 to 34 years of
age.”
Details
of the research were published online by The New England Journal of
Medicine. The analysis was based on telephone survey data collected for
the Gallup-Healthways Well-Being Index.
A conservative judiciary run amok
By E.J. Dionne Jr.
Retired Supreme Court Justice John Paul Stevens captured our ideal when he wrote of the judge as “an impartial guardian of the rule of law.”
By effectively gutting the Affordable Care Act on Tuesday, two members of a three-judge panel on the D.C. Circuit Court of Appeals showed how far right-leaning jurists have strayed from such impartiality. We are confronted with a conservative judiciary that will use any argument it can muster to win ideological victories that elude their side in the elected branches of our government.
Fortunately, the D.C. Circuit ruling is unlikely to stand. On the same day the D.C. panel issued its opinion, a three-judge panel from the 4th Circuit ruled unanimously the other way, upholding the law.
There is a good chance that the 11-judge D.C. Circuit will take the decision away from its panel — something it is usually reluctant to do — and rule as a full court to affirm the ACA as commonly understood. It is virtually certain that a majority of the court’s members disagrees with the panel’s convoluted reading of the law and wants to avoid creating a needless conflict in jurisprudence with the 4th Circuit.
When Congress wrote the health law, it envisioned that the states would set up the insurance exchanges where individuals could purchase coverage. But knowing that some states might not want to set up these marketplaces themselves, it also created a federal exchange for those that bowed out. There are 36 states under the federal exchange.
No comments:
Post a Comment