Quote:

 

http://www.usatoday.com/story/news/nation/2015/03/10/obamacare-enrollment-numbers-hhs/24710781/

More young people but fewer minorities pick ACA plans

More than 4.1 million people under age 35 picked Obamacare health insurance plans so far in this open enrollment period, a small increase compared with the end of the 2014 period, the Department of Health and Human Services said Tuesday.

And HHS Secretary Sylvia Burwell on Monday said nearly 11.7 million people enrolled in plans on state and federal exchanges through Feb. 22.

Those numbers run through the end of a one-week enrollment extension for those delayed by issues with Healthcare.gov and its call center. Next week, a new tax-related extension takes effect for those facing penalties for not having insurance last year.

The uptick from 3.3 million people ages 18-34 who enrolled in coverage for 2014 is good news for the law, which needs more younger people to offset costlier and less healthy older enrollees.

[..]

LTC8K6

Mar 11 2015, 08:49 PM

...Somewhere along the way, the worker bees at Connect for Health Colorado dragooned us into an Obamacare exchange plan offered by Rocky Mountain Health without our knowledge or consent. (How else has the White House inflated Obamacare enrollment figures? Things that make you go “hmm.”) Last month, we received an IRS 1095-A form, which, much to our shock and chagrin, indicated that we had paid Obamacare premiums every month during 2014

...We were finally able to un-enroll after being auto-enrolled in the Obamacare plan

Quote:

 

http://www.wsj.com/articles/officials-pressed-to-let-pregnant-women-enroll-in-healthcare-gov-plans-at-any-time-1426170663

U.S. Officials Pressed to Let Pregnant Women Enroll in Health-Law Plans at Any Time
Health-Care advocacy groups want pregnancy to be declared a ‘qualifying life event’

The Obama administration is under increasing pressure to allow uninsured women who become pregnant to obtain health coverage at any time of the year through the Affordable Care Act’s federal exchange.

More than 50 House Democrats delivered a letter Thursday to Health and Human Services Secretary Sylvia Mathews Burwell calling for immediate guidance that would classify pregnancy as a “qualifying life event.”

That designation would let uninsured women who become pregnant to sign up for coverage through HealthCare.gov within 60 days and outside the open-enrollment period.

More than 30 national health advocacy groups, including Families USA and Planned Parenthood, sent their own letter Thursday to HHS supporting the change. And over 50,000 people signed a petition endorsing the move that was delivered to the agency, according to the advocacy group Young Invincibles.

The letters and the petition mark the latest efforts to push HHS to change its rule. In a March 3 letter, 37 Senate Democrats urged Ms. Burwell to let pregnant women use HealthCare.gov to sign up for health care. The exchange’s open-enrollment period is generally about three months long, and the latest ended Feb. 15.

“These women are forced to either forgo critical prenatal care or face significant out-of-pocket costs,” the House Democrats’ letter said. “Special enrollment periods currently exist for qualifying life events like the birth of a child or the adoption of a child. We believe pregnancy should trigger a similar special enrollment period.”

In addition to a birth or adoption, other life events that trigger an enrollment period include moving to a new state, some changes in income and changes in family size, including marriage and divorce.

HHS said in regulations issued in February that it had no plans to allow a special enrollment period for women becoming pregnant. Federal officials said states could add such a period if they chose. The agency declined to comment further on Thursday.

Opponents of a special enrollment period for pregnant women, such as insurers, said that many women would forgo insurance until they become pregnant, potentially driving up premium costs.

“Health plans want to ensure women have access to the care that they need at all stages of their lives,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group. “But if individuals are incentivized only to sign up for coverage when they need care, then that has a significant impact on affordability for everyone.”

In the U.S., about 4 million women give birth each year. Among women and newborns with employer-provided commercial health insurance, the average doctor and hospital bills for a vaginal birth totaled $32,093, according to a January 2013 study by Truven Health Analytics, a provider of health-care data and consulting services. The cost rose to $51,125 for a caesarean birth.

Changing the rules would largely help young women. Eighty-three percent of new mothers are between the ages of 18 and 34, according to a report by Young Invincibles.

The health law requires insurance plans sold on individual and small group markets to include maternity care as one of 10 essential benefits. But some women lack maternity coverage because their plan is exempt from providing the essential benefits.

Pregnant women who meet income eligibility requirements can obtain maternity care through Medicaid, the federal-state program for the poor.

Quote:

 

http://www.washingtontimes.com/news/2015/mar/11/james-bovard-on-obamacare-justices-fret-over-state/print/

Saving Obamacare with supreme hypocrisy
Justices fret over coercing states while endlessly menacing individuals
By James Bovard - - Wednesday, March 11, 2015

At last week's Supreme Court oral arguments on the Affordable Care Act, several justices questioned whether a verdict against Obamacare would be "unconstitutionally coercive" to state governments that did not create health care exchanges. Justice Sonia Sotomayor fretted that such a ruling could result in "intruding on the federal-state relationship." The Supreme Court is sometimes hypersensitive about the rights of state governments at the same time it rubber-stamps the destruction of the rights of private citizens.

For instance, the Affordable Care Act trounces freedom by giving the Internal Revenue Service the right to heavily fine individuals who do not purchase federally approved insurance policies, canceling millions of individuals' insurance policies, entitling the Health and Human Service Department to outlaw many low-cost health insurance options, and compelling individuals and businesses to subsidize other people's abortions and contraception.

Unfortunately, this is typical of the oppressive practices the Supreme Court has countenanced in recent decades:

In 2005, the Supreme Court blessed condemning private homes under eminent domain authority so local politicians could redistribute the land to favored businesses. Previous Supreme Court rulings empowered local governments to raze entire neighborhoods based on shadowy aesthetic considerations with no relation to public safety.

Supreme Court decisions on asset forfeiture have helped police confiscate cars, cash and other property from scores of thousands of Americans without a criminal conviction. The nationwide epidemic of legalized looting became so embarrassing that Attorney General Eric Holder recently promised to curb the abuses.

In 1982, the Supreme Court entitled government agents to intrude onto private land without a warrant as long as they did not venture into areas where individuals were involved in "intimate activities" (i.e., nudist camps). The resulting "open fields" doctrine often makes it practically impossible to convict a government agent of trespassing.

The Supreme Court has failed to curb the federally funded militarization of police and the profusion of no-knock raids across the nation. Instead, the court has continually granted new powers to law enforcement, such as its 2001 decision sanctifying the arrest of a Texas mother whose only crime was that her child wasn't seat-belted during a short drive. Even though Texas law did not authorize arrests for seat -belt violators, the court upheld handcuffing the mother to avoid creating a "systematic disincentive to arrest" people for even "very minor criminal" offenses. Since almost everybody is violating some arcane government edict, the court practically gave lawmen the prerogative to jail whom they pleased.

The court has turned a blind eye to almost all the civil liberties abuses of the war on terror. The court has done nothing to curb the Obama administration's crackdown on journalists and whistleblowers. The court has refused to accept any case challenging the Transportation Security Administration's whole-body scanners that take explicit "birthday suit" photos of almost every airline passenger.

Nine years after revelations that the National Security Agency was illegally commandeering Americans' email and phone records, the court has done nothing to curb an abuse far worse than the British "general warrants" that helped provoke the American Revolution. In a 2013 decision, the court effectively absolved warrantless federal spying on citizens because the victims could not prove they had been spied on — a ludicrous precondition for objecting to a secret surveillance regime.

Even when the feds have clearly violated a statute such as the Anti-Torture Act, the court either refuses to accept key cases or effectively grants immunity to all the officials involved in breaking the law. The court's acquiescence makes it far easier for agencies to cover up outrageous conduct that would shock Americans if it was exposed.

Supreme Court decisions have helped Congress and multiple presidents camouflage the arbitrary federal fiats that increasingly domineer Americans' lives. The Supreme Court has granted federal agencies vast sway over private companies by pretending that racial hiring quotas are not coercive. Instead, they are merely "goals and timetables — regardless of whether bureaucrats ravage companies that fail to hire and promote by race and gender.

America's prisons are overflowing in part because the Supreme Court has objected to few of the 4,500-plus criminal statutes Congress enacted. Thanks to the threat of ruinous mandatory minimum penalties, 97 percent of defendants plead guilty. As Justice Antonin Scalia noted in a 2012 dissent, the current system "presents grave risks of prosecutorial overcharging that effectively compels an innocent defendant to avoid massive risk by pleading guilty to a lesser offense."

The Supreme Court will likely rule on the Obamacare case in June. Does the court believe that unlimited coercion of citizens is OK but that any pressuring of state governments is a cardinal sin? If the court saves Obamacare to avoid "unconstitutionally coercing" state governments, it will be another milepost on the Supreme road to serfdom.

Quote:

 

http://www.politico.com/magazine/story/2015/03/king-v-burwell-supreme-court-obamacare-subsidies-case-federalism-argument-115997.html#.VQMK72M3PIU

The Federalism Fallacy in King v. Burwell
A new interpretation claims to protect the states, but would actually hurt them

[...]

States were given perfectly clear notice by the plain language of the statute itself—which makes it clear that tax subsidies are available only to individuals who purchase insurance on an “exchange established by the State”—and which the states were perfectly capable of comprehending; to suggest otherwise, is an affront to the intelligence of state officials and lawyers. But the notice is also evidenced by the fact that in January 2012, seven states asked the Obama administration for a legal opinion or court declaration confirming whether the administration’s announced interpretation of the law—which extended subsidies to individuals purchasing insurance on federal-run exchanges—was correct. This indicates that states were both aware of, and concerned about, the dubious legality of the administration’s position extending subsidies to individuals in states without state-operated exchanges.

Moreover, a well-publicized lawsuit filed by Oklahoma challenged the Obama administration’s interpretation asserting that tax subsidies couldn’t be granted in Oklahoma precisely because Oklahoma had decided not to operate a state exchange. If nothing else, this lawsuit should reasonably have alerted other states to the possibility that citizens in states without state exchanges might not receive tax subsidies. And even so, multiple states decided not to operate a state exchange.

Assuming states were, in fact, aware that declining to operate a state exchange would result in lost tax subsidies for their citizens, this doesn’t mean that their choice to do so was a “coercive” one, forced on them by the federal government, and necessitating invocation of the clear statement rule. Even if Congress had been crystal clear about this consequence, there would be no state coercion triggering federalism concerns. Indeed, if it were otherwise, virtually any exercise of Congress’s taxing and spending power that depends on a state’s decision to opt in (or out) of federal largesse would be considered coercive if opting out would harm the state’s citizens. The entire Medicaid program would thus be unconstitutionally coercive, as would welfare programs such as Temporary Assistance for Needy Families (TANF), as these programs require an initial choice by states to either participate, or not participate. If states decline to participate, the poorest citizens in these states are undoubtedly harmed, in the sense that they will not be eligible for Medicaid or welfare benefits, as are citizens in other states. But no one has ever suggested, until now, that such harms to citizens renders states’ initial choice—to participate or not—coercive. This argument, if accepted, would render this country’s biggest social safety net programs unconstitutional.

Indeed, if the choice given to states under the ACA—to operate a state exchange or not—is coercive, presumably the correct remedy is for the court to strike down the Act’s individual tax subsidy, as it’s the seed from whence the unconstitutionally coercive choice sprouted.

[...]

While Oklahoma’s citizens lost tax subsidies, the state believed the benefits of declining to operate an exchange outweighed this cost. And its choice, while difficult, “was a choice the state was happy to make.”

States thus had good reason to decline operating a state exchange. The fact that declining to operate a state exchange would have negative consequences for some of those states’ citizens isn’t the same as a negative consequence for the state qua state. Even if it is—which would be a novel interpretation of the clear statement rule indeed—there is no reason to believe that the states made the choice to opt out with anything less than eyes wide open.

Invoking the clear statement rule in King would thus turn the Court’s federalism case law on its head, converting it from a principle that requires giving states a choice to one that forbids giving them a choice if they might make a “wrong” choice that hurts some of their citizens. The not-so-subtle insinuation is that states are incapable of making difficult choices and should be paternalistically protected from doing so. This would transform federalism and the clear statement rule from a shield designed to protect state sovereignty into a weapon that can be used to disregard state choices and impose a one-size-fits-all, top-down federal solution. This interpretation, in short, is a perversion of the clear statement rule and the federalism principle that animates it. It cannot be countenanced by anybody who is truly committed to federalism.

Quote:

 

http://jurist.org/forum/2015/03/timothy-jost-king-burwell.php#.VQSmWA-4CtQ.twitter

Another Perspective On King v. Burwell

• 
  
• JURIST Guest Columnist Timothy Jost of Washington and Lee University School of Law discusses how interpreting the ACA in King v. Burwell affect Medicaid and CHIP recipients ...

An important issue flagged in the March 4 Supreme Court oral argument in King v. Burwell has until now been largely ignored. For those who have not been following the case, King v. Burwell challenges the availability of federal premium tax credits for individuals who purchase insurance through federally facilitated marketplaces under the Affordable Care Act. More than 8.4 million Americans have enrolled in health plans through the federally facilitated marketplaces, which serve two thirds of the states under the ACA. Eighty-seven percent of these enrollees receive premium tax credits. These tax credits reduce premiums an average of 72 percent for those who qualify for the tax credits, reducing their average net cost of insurance to about $101 a month.

The plaintiffs in King v. Burwell argue that the ACA limits premium tax credits to "Exchanges established by the State," which they argue means state-operated marketplaces and not the federally facilitated marketplaces (called exchanges in the statute). Their claim is based on the fact that this phrase appears twice in the formula for calculating premium tax credits in § 36B of the Internal Revenue Code, added by § 1401 of the ACA. They contend, therefore, that the IRS rule authorizing the federally facilitated marketplaces to issue premium tax credits is invalid.

There is no evidence in the extensive record of congressional committee hearings or debates that this is what Congress intended. The members of Congress who in fact drafted the legislation have represented [PDF] to the Supreme Court that this claim is false. Moreover, the states [PDF] did not understand that premium tax credits would be limited to state-operated exchanges when they were deliberating as to whether to operate their own exchange or elect to let the federal government do it. More than fifty other provisions [PDF] of the ACA do not make sense if the statute is read as the plaintiffs would read it. And six of the nine federal judges who to date have considered this claim have rejected it, finding [PDF] either [PDF] that the statute clearly authorizes the federally facilitated exchange to grant premium tax credits or that the statute is ambiguous [PDF], and thus the courts should defer to the IRS rule. The judgment [PDF] of the two DC appellate court judges who found for the plaintiffs was subsequently vacated [PDF] by the full DC Circuit.

Nevertheless, the issue is now before the Supreme Court and at least two of the justices, Scalia and Alito, seemed sympathetic to the plaintiffs' claims at oral argument.

One issue that has received little attention, however, is that the phrase "Exchange established by the State" in fact appears ten times in the ACA. The Competitive Enterprise Institute, which brought the King v. Burwell case, focused on two of the places where the phrase appears in Title I, the private insurance reform title of the ACA. But most of the sections where the phrase appears are in Title II, the Medicaid and CHIP Title.

Section 2201 of the Affordable Care Act (codified at 42 USC § 1396w-3) provides that as a condition of having a state Medicaid program and receiving any federal financial assistance under Medicaid, a state must, as of January 1, 2014 have in place procedures for enrolling in Medicaid and CHIP eligible individuals who are identified through an "Exchange established by the State." Section 2201 further requires that states have procedures in place for establishing a secure interface between their Medicaid and CHIP Programs and an "Exchange established by the State" and for linking their websites to the website of an "Exchange established by the State." The phrase "Exchange established by the State" appears four times in § 2201.

If the plaintiff's argument as to the premium tax credits is accepted, then the statute says, in plain language, no exchange established by the state, no state Medicaid program, no federal Medicaid funding. And when the section says no Medicaid funding, it is not just referring to funding for the Medicaid expansion population, it covers the entire state Medicaid program: old people in nursing homes, kids in facilities for the mentally or physically disabled, seniors who receive help with their Medicare premiums or cost sharing, over half of the persons with AIDS in the United States.

Similarly, § 2101 (codified at 42 USC § 1397ee(d)(3)(C)) provides that, as a condition of approval of a state CHIP program, HHS must, not later than April 1, 2015, review the benefits offered and cost sharing imposed under the CHIP program and the benefits offered by qualified health plans through an "Exchange established by the State" and certify that they are least comparable. As of April 1, 2015, the CHIP Plans in 34 states must close down If the CEI's interpretation of the ACA is correct.

King v. Burwell has been criticized because of the breathtaking damage it would inflict on the American health care system if successful. Millions of people will lose premium tax credits; millions more will lose coverage in the nongroup market outside of the exchanges; hospitals will lose billions of dollars. But obviously the ambitions of the right-wing organization that had brought his litigation have been much too modest. Had the proponents read Title II of the ACA as well as Title I, they could have shut down the programs that have for 50 years provided health care to America's poor in 37 states.

The plaintiffs in this litigation claim that Congress intended to withhold premium tax credits from states that failed to operate their own exchanges because Congress wanted to force the states to operate their own exchanges. There is no evidence to support this theory—indeed I believe that no member of the 111th Congress has ever represented to a court that he or she believed this to be true at the time the statute was adopted. But it is simply inconceivable, and no one has yet argued, that Congress intended to deny Medicaid and CHIP funding to every state that decided not to operate its own exchange. Such a threat to the states would clearly raise constitutional questions, both as to whether the states were on notice of the threat and whether it was constitutionally coercive. But if you take seriously the plaintiff's argument as to Title I, it must also apply to Title II. The government's brief [PDF] makes this point, which was also affirmed by Solicitor General Verrilli at oral argument.

So how can we avoid shutting down the Medicaid and CHIP programs, and destroying the individual insurance markets in two thirds of the states? It is simple. The court should read carefully all of the provisions of the law relevant to the federal exchange and premium tax credits so as to achieve a "harmonious whole," the way the court has often said statutes should be read. It should begin with the definition of exchange found in §1563 (42 USC § 300gg-91(d)(21)). Under that definition, an Exchange, including a federally facilitated exchange is a 1311 (42 USC § 18031) exchange. States are asked by § 1311 to establish exchanges. If they do not do so, § 1321 (42 USC § 18041(c)) directs the Department of Health and Human Services to establish "such Exchange", the 1311 exchange, the required state exchange. Section 1413 (42 USC § 18083(a)) requires HHS to ensure that a system is available in each state for issuing premium tax credits. Section 1312 (42 USC § 18032(f)(1)) defines "qualified individuals" as those who reside in the state that established the exchange, but federal exchanges must be able to enroll qualified individuals or they are completely pointless.

The court must either decide that the word "by" in § 1401 is the only word that matters in the ACA, and ignore over 50 provisions that support the contention that the federal marketplace can be, given the way the term is used in the statute as a term of art, an exchange established by the state. But it must realize that this will not only deprive millions of Americans of access to private health insurance, but also close down the Medicaid and CHIP programs in two thirds of the states. Alternatively, it can take the route that Justice Kennedy seems to have been contemplating—use the doctrine of constitutional avoidance to rule for the plaintiffs since otherwise the threat to the states would raise constitutional coercion and notice requirements. As yet another alternative, it can simply affirm the Fourth Circuit's decision to defer to the IRS's interpretation of the statute under Chevron. But if it rules for the plaintiffs based on a blinkered reading of one word, it must realize that the damage it will inflict may affect millions of Americans on Medicaid or CHIP whose fate has so far been largely ignored.

Professor Timothy Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of a casebook, Health Law, used widely throughout the US in teaching health law, and of a treatise and hornbook by the same name.

• 
  
• ensuring that the State agency responsible for administering the State plan under this title (in this section referred to as the ‘State Medicaid agency’), the State agency responsible for administering the State child health plan under title XXI (in this section referred to as the ‘State CHIP agency’) and an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act utilize a secure electronic interface sufficient to allow for a determination of an individual’s eligibility for such medical assistance, child health assistance, or premium assistance, and enrollment in the State plan under this title, title XXI, or a qualified health plan, as appropriate;

• 
  
• "that . . . the State agency responsible for administering the State plan under this title (...‘State CHIP agency’) . . . utilize(s] a secure electronic interface.”
  
  AND
  
  
• "that . . . the State agency responsible for administering the State child health plan under title XXI . . . utilize(s] a secure electronic interface.”
  
  AND
  
  
• "that . . . an Exchange established by the State under section 1311 . . . utilize(s] a secure electronic interface”

• 
  
• Cuomo’s new budget calls for tax on health-insurance policies
  Gov. Andrew Cuomo’s new budget includes a nearly $69 million tax on health-insurance policies to pay for the administrative costs of continuing New York’s ObamaCare health exchange, The Post has learned.
  
  The levy is intended to make up for federal funds no longer available to the states as of this year. Adding up to about $25 per person insured under the plan, the cost is almost certainly going to be passed on to consumers.
  
  The tax is being called a bait-and-switch by opponents of Cuomo’s decision to start a state-run ObamaCare health exchange in New York. Had he not done so, they argue, there would have been no need for the tax.
  
  “There was no indication that there would be a new tax to pay for this. We had plenty of debate on ObamaCare. I never heard this mentioned,” said Assemblyman Steve McLaughlin (R-Troy).
  
  The Affordable Care Act requires that state-based health benefit exchanges be self-sustainable beginning this year after they got federal seed money to launch....

Quote:

 

http://www.washingtontimes.com/news/2015/mar/14/obamacare-cancellations-feared-nearly-200000-color/print/

Nearly 200K Coloradans face Obamacare cancellations by 2016
By Valerie Richardson - The Washington Times - Saturday, March 14, 2015

DENVER—Nearly 200,000 insured Coloradans will lose their health-care plans next year under the state's embattled Obamacare exchange, Connect for Health Colorado.

State insurance commissioner Marguerite Salazar touched off an outcry Friday by confirming to news outlets that health-care policies covering 190,000 people will be dropped in 2016 because they fail to comply with the Affordable Care Act.

Colorado Senate Majority Leader Bill Cadman called the action "a huge blow to another 190,000 Coloradans who will be forced out of their existing healthcare plans."

A year ago, President Obama extended the deadline on policies that failed to meet Obamacare's heightened coverage requirements, allowing policyholders to renew their old coverage through 2016, but Ms. Salazar decided that a one-year extension was enough, said her spokesman, Vincent Plymell.

"She gave people the extra year last year to continue these plans and just felt that it was time now. The ACA passed in 2010 and it's time to move people to better coverage," Mr. Plymell told Health News Colorado.

Those holding non-compliant health-care policies will have 90 days' notice to switch plans, he said, but Republicans were nonetheless furious to learn of the cancellations.

Sen. Cory Gardner, Colorado Republican, urged state officials to reconsider and allow the non-compliant policies to stay in effect for another year, pointing out that "Coloradans were promised by supporters of this healthcare law that if they liked their plans, they could keep their plans."

"I am utterly appalled by this announcement. After all of the glitches, the increased costs and premiums, and the plan cancellations that Coloradans have already endured, the idea that the Division of Insurance would choose to cancel the healthcare plans of hundreds of thousands more people is unconscionable," Mr. Gardner said in a statement.

More than 340,000 Coloradans have seen their policies cancelled since the glitch-ridden Obamacare rollout in 2013. The cancellations dogged Democrats in the 2014 election, contributing to the defeat of former Democratic Sen. Mark Udall by Mr. Gardner.

Democratic Gov. John Hickenlooper, who won reelection in November, was consulted on the decision, Ms. Salazar told 9News in Denver.

The Democrat-led state House gave preliminary approval Friday to a bill for a comprehensive audit of Connect for Health Colorado. The Republican-controlled state Senate has already approved the bill, which follows a scathing limited audit released in December that faulted the exchange for sloppy financial controls and oversight.

Rep. Mike Coffman, Colorado Republican, said he has a personal stake in the issue: He signed up for health insurance on the state exchange and knows "firsthand how terrible the Obamacare coverage is."

"President Obama lied to the American people when he said 'if you like your plan you can keep your plan' and now Colorado families are being forced to bear the burden of that lie," Mr. Coffman told 9News.

Quote:

 

http://kaiserhealthnews.org/news/new-report-health-law-has-helped-insure-16-4-million/

HHS: Health Law Has Helped Insure 16.4 Million

A total of 16.4 million non-elderly adults have gained health insurance coverage since the Affordable Care Act became law five years ago this month – a “historic” reduction in the number of uninsured, the Department of Health and Human Services said Monday.

Those gaining insurance since 2010 include 2.3 million young adults aged 18 to 26 who were able to remain on their parents’ health insurance plus another 14.1 million adults who obtained coverage through expansions of the Medicaid program, new marketplace coverage and other sources, according to HHS’ report ....