Thursday, September 4, 2014

Subsidies for ACA Might Be Saved

(PR) - Today’s D.C. Circuit Court of Appeals Order to Rehear En Banc the Halbig v. Burwell Case Has Enormous Significance. Rehearing Provides Temporary Protection for Millions of People Who Receive Health Insurance Premium Subsidies and Reduces Likelihood of Supreme Court Review.

Today, the Court of Appeals for the D.C. Circuit set aside a previous 2-1 decision by a three-judge court in Halbig v. Burwell, and it scheduled a rehearing by all eleven court judges for December 17, 2014. The following is the statement of Ron Pollack, Executive Director of the consumer health organization Families USA (which filed a friend-of-the-court brief in the case) about today’s court order: 

“Today’s Court of Appeals order is very significant both because of its impact on people needing help to afford health insurance premiums and because it reduces the likelihood that the Supreme Court will hear the only remaining case that could severely undermine the Affordable Care Act.

The Court’s order provides at least temporary protection for the almost five million people who are receiving premium subsidies that make health insurance affordable. It also enables many millions of others who are eligible for those subsidies, but are not yet receiving, them to apply for such help starting on November 15.

Of potential long-term significance, today’s order substantially reduces the likelihood that the U.S. Supreme Court will accept an appeal of the Fourth Circuit Court of Appeals that unanimously upheld the legality of premium subsidies in 36 states where those states delegated the administration of health insurance marketplaces to the federal government.

The Supreme Court is usually reluctant to hear cases that raise no constitutional issues and where there are no conflicting rulings by Courts of Appeals. With today’s order vacating the three-judge split decision in Halbig v. Burwell, there is no longer a ruling split among the Circuit Courts of Appeals.

Even though these cases are specious from a legal standpoint, the Supreme Court’s recent history on politically volatile matters make these cases the largest threat to the Affordable Care Act’s purpose of extending affordable health coverage to people who currently can’t afford it."

As such, today’s court order is a very significant and welcome development.”


On Monday August 18, Affordable Care Act opponents’ legal champion, Michael Carvin, filed a little-noticed brief with the District of Columbia Circuit Court of Appeals, forbiddingly entitled “Opposition to Petition for Rehearing En Banc,” in the ongoing litigation challenging the legality of tax credits and subsidies for health insurance purchasers on federally operated exchanges. The D.C. Circuit’s decision on this procedural issue could play an outsized role in deciding the ultimate fate of the litigation, and determine whether those exchanges—currently covering several million Americans in 36 states—will continue their currently impressive growth, or collapse outright. 

Unlike the 2012 case, the latest dispute doesn’t present a sweeping constitutional question. The issue instead is a phrase concerning the online marketplaces, or exchanges, where people can buy insurance. The law says people qualify for tax credits if they buy insurance on an exchange “established by the state.”

Carvin and his allies say that language means people get subsidies only if they buy insurance on a state-run exchange—and not if they use the federal exchange operating in the 36 states that haven’t set up their own marketplaces.

His approach would mean that 4.6 million people—more than half the 8 million who have used the exchanges to buy policies—aren’t entitled to the subsidies they are receiving.

A ripple effect would follow. Many of those people would no longer be obligated to get insurance because they would fall under an exemption in the law for those who can’t afford coverage.

Profound Consequences

“If the ACA means what it says, as the D.C. Circuit held, the consequences are profound,” Carvin said in Supreme Court papers filed in July. “It means millions of people are ineligible for subsidies and exempt from the ACA’s individual mandate penalty. It means a fundamental change in the health-insurance market in two-thirds of the country.”

It also might mean that only the sickest and most desperate people would get insurance through the individual market. That could raise coverage costs for insurers and send the market into what the administration says would be a “death spiral.” It would also force hospitals to foot the bills for more uninsured patients.

Opponents “see this as an attempt to destroy the Affordable Care Act,” said Timothy Jost, a health-law professor at Washington and Lee School of Law in Lexington, Virginia. “That’s why they brought these lawsuits.”

The Obama administration says the rest of the statute makes clear that lawmakers intended for subsidies to be available to consumers across the U.S., regardless of whether they buy on a federal or a state-run exchange.

While Democrats are struggling with whether to embrace the law or push for changes, Republicans are reminding voters that since they took control of the House in 2011, they've voted 54 times to undo, revamp or tweak the law.

Refusal to Expand Medicaid is Bad for Georgians

Georgia is one of the 36 states that haven’t set up its own marketplace “established by the state.”

According to Moral Monday Campaign Georgia is home to the fith largest uninsured population in the country- nearly 2 million Georgians lack health coverage.

This lack of coverage creates higher costs for uninsured patients in the form of increased insurance premiums and hospitals.

According to the Georgia Hospital Association, rejecting Medicaid expansion is destabilizing hospitals, causing three to close, and as many as seven more in danger, mostly in rural areas. 

A growing number of doctors, health and human service organizations, and public policy advocates have called Governor Nathan Deal to drop his opposition to expanding Medicaid as provided by the Affordable Care Act. 

—>  Edited by Anibal Ibarra

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