April 16, 2015
Today the Competitive Enterprise Institute (CEI) released a report by finance expert Scot Vorse that shows many states knew as early as 2011 that they might not receive tax credits if they opted out of establishing a state-based health insurance exchange. Whether nonparticipating states had adequate knowledge that they were putting their Obamacare subsidies at risk is a critical question in CEI’s Supreme Court case, King v. Burwell.
Vorse obtained emails related to a January 2012 letter sent by seven states to the U.S. Department of Health and Human Services (HHS). While Obamacare supporters have dismissed this letter as a “spoof,” these state emails show the letter was a carefully crafted and coordinated effort by the states to get detailed information about the exchanges from HHS.
“Notably, the states explicitly asked HHS to explain what authority it had to administer tax credits on federally established exchanges,” Vorse writes.
via New Report Shows States Had Serious Questions about Obamacare Tax Credits in 2011 | Competitive Enterprise Institute.
April 15, 2015
University of Miami Business Law Review.
Full text: http://business-law-review.law.miami.edu/wp-content/uploads/2015/04/Miller-Unfair-Coercion-or-Greater-Deference.pdf
April 2, 2015
If the insurer offers no other plan in a state’s individual market, then the law bars the insurer for five years from offering individual market coverage in that state. Should an insurer actually exit the market in this way, it must give those enrolled in the plan 180 days (six months) notice, and anyone losing coverage would be allowed to choose replacement coverage from among the other plans offered by the other insurers in that state’s individual market—regardless of whether those plans are offered inside or outside the exchange.
The bottom line? Anyone affected by the Court’s ruling will have options for maintaining coverage or choosing a different plan.
via How King v. Burwell Could Affect Obamacare Enrollees.
March 31, 2015
Prior to the ACA most states had little or no restrictions on insurance rates taking account of enrollees’ health risks. In the 1990s a small number of states imposed community rating and guaranteed issue in their health insurance markets, as the ACA has done, but without any subsidies, exactly the same situation that will result on the federal exchanges from a plaintiffs’ victory in King v. Burwell. It was widely predicted these states would experience an adverse selection death spiral. A 1999 National Bureau of Economic Research (NBER) paper by Thomas Buchmueller and John Dinardo compared New York, which had imposed community rating and guaranteed issue, with neighboring states. They “found no evidence for the conventional wisdom that the imposition of pure community rating tends to an adverse selection death spiral.” Similarly, another 2006 NBER paper by Bradley Herring and Mark V. Pauly compared states with community rating and guaranteed issue to states with no such regulations. They found a small increase in the number of uninsured, but did “not observe a strong positive relationship between risk status and the likelihood of being covered, that would be consistent with so-called death spirals.”
via A King v. Burwell ruling for the plaintiffs may not equal death spirals – AEI.
March 29, 2015
Everything in the legislative history that sheds light on what Congress intended supports the plain meaning of the language limiting premium subsidies to those who obtain coverage “through an Exchange established by the State.”
- The lead author of the ACA, then-Senate Finance Committee Chairman Max Baucus, D-Mont., had proposed — and even gotten Congress to enact — other health-insurance tax credits and subsidies that were conditioned on states taking certain actions.
- Senate Democrats similarly considered letting individual states opt out of the Democrats’ cherished “public option.”
- Congressional Democrats considered other bills in 2009 that explicitly did authorize subsidies in federal exchanges. But they discarded that language in favor of the ACA’s approach.
- More than a dozen Senate Democrats championed a bill that explicitly conditioned exchange subsidies on states implementing that bill’s employer mandate. Those senators discarded that condition in favor of the ACA’s approach of explicitly conditioning premium subsidies on states implementing exchanges.
- Eleven House Democrats from Texas recognized and even complained that states could prevent their residents from receiving “any benefit” under the ACA, including premium subsidies, simply by refusing to establish exchanges. In early January 2010, they pleaded for House Speaker Nancy Pelosi and President Barack Obama to support one of the bills that explicitly authorized subsidies in federal exchanges. Yet all 11 of them ended up voting for the ACA, despite their reservations.
- One of the ACA’s architects and a paid consultant to the Obama administration, Massachusetts Institute of Technology health economist Jonathan Gruber, repeatedly described the ACA by saying: “If you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.”
via Why the Supreme Court will overrule the IRS – Richmond.com: Guest-columnists.
March 21, 2015
Rep. Paul Ryan urged state lawmakers to resist setting up state insurance exchanges if the Supreme Court rules that key parts of the Affordable Care Act can only continue if they do so.
“Oh God, no…The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law,” the Wisconsin Republican told state legislators Thursday during a conference call organized by the Foundation for Government Accountability, a conservative think-tank. The foundation provided a recording of the call.
via Paul Ryan Urges State Lawmakers Not to Set Up Health-Insurance Exchanges – WSJ.
March 16, 2015
Something odd has been happening with the Supreme Court battle over the legality of subsidies for Obamacare’s federally-organized health insurance exchange. The Obama administration has been claiming—beyond credulity—that it has no “Plan B” should the Court side with the administration’s challengers. “We don’t have an administrative action that we believe can undo the damage,” said Health and Human Services Secretary Sylvia Burwell at a recent Congressional hearing. But contrary to those claims, sources familiar with HHS’ thinking say that the agency does, indeed, hope it has a way around the Court and the law.
via Sources: HHS’ Obamacare Contingency Plan Is To Ask States To Contract Exchange Work To The Feds.