Quote:

 

http://www.staradvertiser.com/news/breaking/20150409_Feds_may_seize_control_of_Hawaii_Health_Connector.html
•HAWAII: Feds may seize control of Hawaii Health Connector
The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly

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http://vtdigger.org/2015/04/09/lt-gov-phil-scott-senators-explore-alternative-to-vermont-health-exchange/
•VERMONT: Lt. Gov. Phil Scott, Senators explore alternative to Vermont Health Exchange
Lt. Gov. Phil Scott led a mini fact-finding mission to Rhode Island on Monday to learn more about components of the Connecticut health care exchange that could help Vermont save money.

The cost of fixing the dysfunctional Vermont Health Connect website will be roughly $200 million, and maintaining the state’s health care exchange on an annual basis will be about $51 million a year.

Gov. Peter Shumlin last month said he will pull the plug on the customized website if contractors can’t develop proper functionality for the site with deadlines at the end of May and in October. Since then, various alternatives have been floated, including moving the state’s system to the federal exchange

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http://www.abqjournal.com/566536/biz/biz-most-recent/plans-for-state-run-health-exchange-dropped.html
•NEW MEXICO: Plans for state-run health exchange dropped
The New Mexico Health Insurance Exchange board has decided to drop plans for building a state website for individual consumers and instead will continue using the federal website.

Forging ahead with the technical work for a wholly state-based operation would be more costly and would not provide the same level of customer support as the federal Healthcare.gov site is able to deliver, said health exchange CEO Amy Dowd.

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http://wpri.com/blog/2015/04/08/a-closer-look-at-how-raimondos-obamacare-tax-would-work/
•RHODE ISLAND: A closer look at how Raimondo’s Obamacare tax would work
Not that Rhode Island has been immune from the mixed emotions surrounding Obamacare; a significant number of state lawmakers, up to and including Democratic House Speaker Nicholas Mattiello, have questioned whether the state should bother keeping (and paying for) HealthSource RI rather than default back to HealthCare.gov. But the Raimondo administration has come down firmly in favor of retaining HealthSource RI.

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http://minnesota.cbslocal.com/2015/03/17/dayton-to-lawmakers-on-mnsure-look-before-you-leap/
•MINNESOTA: Dayton To Lawmakers On MNsure: ‘Look Before You Leap’
Gov. Mark Dayton says Republican lawmakers pushing major changes to the state’s health insurance exchange should look before they leap.

That’s why the Democratic governor has proposed creating a task force to study the future of MNsure and health care in Minnesota. Dayton included $500,000 for that study in his revised budget unveiled Tuesday.

The governor first made the suggestion in a letter to legislative leaders earlier this week. Some Republicans say that’s an admission that MNsure has been a bust. Dayton says that’s not the case.

A committee in the Republican-controlled House passed a bill Monday to scrap MNsure and move to the federal exchange. Dayton says that should be an option but wants to study MNsure’s economic viability before making any major changes to the exchange.

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http://www.washingtontimes.com/news/2015/apr/6/gop-lawmakers-propose-abolishing-nevada-health-exc/
•NEVADA: GOP lawmakers propose abolishing Nevada health exchange
Critics pointed to the major technical problems in the first few months of the program that prompted the state to prematurely cancel its $75 million agreement with contractor Xerox last year. Nevada then shifted from a state-run exchange to a federally supported exchange that uses the technical infrastructure of the federal HealthCare.Gov website, while the state is responsible for promoting the program to Nevadans and offering enrollment assistance.

Jones argued that with the shift, the state’s involvement is duplicative.

“We’re trying to get the state out of the business of what the federal government is already doing,” he said

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In 2009 President Obama gave assurances that he did not want any tax on health insurance plans he considered wasteful or too generous to affect average Americans. In one of his now famous talks broadcast on CNN, MIT economist Jonathan Gruber, "one of the men who helped draft the legislation, [explains] that is not only precisely what will happen - but that was the intention of the tax."

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Now, as the scheduled 2018 implementation of the tax gets closer and more and more colleges begin to adjust their health plans to deal with it, awareness of the impending pain is beginning to spread. In New Jersey, four of the state’s 11 public colleges and universities have dropped student health insurance, and three of Washington State’s 6 public institutions have done so as well. Here are a few more tax induced changes:

• George Washington University: “It no longer offers its most generous plan as to avoid paying the tax.”

• University of Virginia: “Major changes are coming to the University of Virginia health plan. With U.VA facing rising health care costs, spiking expenses of high-dollar claims and looming fees and taxes connected with federal health reform….”

• William Patterson University: Dropping health insurance.

• University of Minnesota: “One of the state's largest employers is proposing to scale back its employee health plans to avoid a massive tax penalty under the new federal health care law.”

• Ohio University: “Ohio University employees might see their health care deductibles double and premiums rise because of a provision of the Affordable Care Act that taxes so-called 'Cadillac' health plans, officials have said.”

Quote:

 

http://www.washingtonpost.com/news/volokh-conspiracy/wp/2015/04/14/how-the-irs-repeatedly-rewrites-obamacare-tax-credit-provisions/

How the IRS repeatedly rewrites Obamacare tax credit provisions
By Jonathan H. Adler

The plaintiffs in King v. Burwell argue that an IRS regulation unlawfully extends tax credit eligibility beyond what is expressly authorized under Section 1401 of the Patient Protection and Affordable Care Act (PPACA). It appears that this sort of administrative rewrite of the PPACA may be more the rule than the exception, as there are at least two other instances of the IRS rewriting the PPACA’s tax credit eligibility requirements.

Section 1401 (which creates Section 36B of the Internal Revenue Code) authorizes tax credits for the purchase of qualifying health insurance in an exchange “established by the State under Section 1311″ of the Act. The IRS rule also authorizes tax credits for the purchase of health insurance in an exchange established by the federal government. The Supreme Court will rule on this challenge later this year.

In a series of posts at “Notice & Comment,” the blog of the Yale Journal on Regulation, Professor Andy Grewal documents two additional cases in which the IRS has rewritten the PPACA’s tax credit eligibility requirements so as to expand eligibility beyond what Congress authorized. Combined with other instances of the IRS and HHS disregarding the PPACA’s plain text, it appears the federal government has little regard for what the PPACA actually says.

In his first two posts, Professor Grewall explains how IRS regulations disregard the statutory text so as to extend tax credit eligibility to some low-income aliens not lawfully residing in the U.S. In this way, the IRS regulation “casts a wider net than the statute” by expanding the number of people eligible for tax credits. Yet the IRS never provided any rationale for this change. Indeed, if one had just read the IRS explanation for what its regulations accomplish — as opposed to the regulations themselves — one would not even be aware of what the IRS did.

In a second pair of posts, Professor Grewal explains how the IRS also issued regulations effectively disregarding the income requirements for tax credit eligibility. Under the PPACA, individuals are only eligibile for tax credits if they earn between 100 and 400 percent of the poverty line. Under the IRS regulations, however, the 100 percent threshold is disregarded in some instances. Writes Grewal:

• 
  
• Under the regulation, a person becomes an “applicable taxpayer” and therefore eligible for ACA tax credit if she gets health insurance on an exchange, the exchange estimates that her income falls with the 100-400 percent range, and she in fact gets advance payments, even though her annual household income is less than the 100 percent amount required by law. Being an applicable taxpayer carries significant consequences and can cause one’s employer to face severe penalties under Section 4980H. . . .
  
  It’s easy to come up with a policy supporting this re-write of Section 36B, but I can’t identify any statutory authority for doing so. Policy-wise, the regulation addresses a problem related to imperfections in the Exchange regime, under which differences between estimated household income and actual household income can lead to tax repayments. But authority-wise, Congress plainly and unambiguously limited the premium tax credit to persons who come within the 100 and 400 range; the Treasury lacks the authority to grant credits to persons outside that range.

Not only does this regulation flout the relevant statutory text, it also creates an incentive for taxpayers to misrepresent their income so as to receive tax credits for which they would not otherwise be eligible. Writes Grewal, “the regulation rewards those who inflate their income at enrollment time and offers no benefits for the cautious taxpayer who wants to claim a credit only at the end of the year.”

As with the regulatory change expanding tax credit eligibility to some unlawful aliens, the IRS cited no authority for making this change. It did, however, provide an interesting justification. As Grewal explains,

• 
  
• The Preamble to the regulation cites no statutory authority for re-writing Section 36B. It says only that the IRS is intending to “clarify” the statute, but I’m not sure what’s unclear about the 100-400 percent range. More confusingly, the IRS rejects extending the regulation to persons who end up above the 400 range, noting that that interpretation is “contrary to the language of Section 36B.” Apparently, it’s ambiguous whether 50 is less than 100, but unambiguous that 450 is greater than 400.

These IRS rewrites have potential consequences beyond the extension of tax credits beyond what Congress authorized. As with the tax credit regulation at issue in King, the latter of these changes has the potential to expose employers to penalties that are not authorized by the text of the PPACA. Put more plainly, by expanding eligibility for tax credits the IRS is also expanding employer exposure to the employer mandate and its associated penalties. Will this produce additional litigation? Who knows. Whether or not it does, it is further evidence that the IRS is intent on implementing the law some wish Congress enacted as opposed to what was actually signed into law.

These administrative rewrites of plain statutory language should be troubling whether or not one supports the PPACA. As Professor Grewal concludes:

• 
  
• A complex regime cannot be fairly administered when the words of the law are routinely flouted, especially when the granting of benefits to one group potentially triggers penalties for others.

Fairly administering this law requires implementing it as written, and seeking legislative revision of those provisions now understood to be unworkable or unwise. Congress has already made over one dozen changes to the PPACA that have been signed into law, and there is no reason it could not make others. If more changes are necessary (and I suspect most think they are), it is a job for Congress, not the IRS.

• 
  
• America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, by Steven Brill, Random House, 528 pages, $28
  
  
• Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care, by Philip Klein, Washington Examiner, 112 pages, $9.99

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http://www.huffingtonpost.com/2015/04/16/workplace-wellness-eeoc_n_7083506.html

Big Business Gets A Big Win On Controversial Workplace Wellness Plans

Businesses that want to penalize workers and their families hundreds, even thousands of dollars for not participating in workplace wellness programs may finally get clear legal authority to do so.

If so, they will have the Obama administration to thank for it.

On Thursday, the federal agency in charge of enforcing employment discrimination laws -- the Equal Employment Opportunity Commission, or EEOC -- proposed new rules for workplace wellness plans. Those are the schemes in which employees fill out questionnaires about medical conditions and lifestyle; get counseling on how to improve their health; and, in some cases, undergo testing to establish whether they are improving their health status.

[...]

Consumer groups worry about the potential of wellness plans to violate employee privacy, to expose workers with medical problems to discrimination, or to shift an ever-higher share of health insurance costs onto people with chronic conditions. Consumer groups say that the Affordable Care Act isn't supposed to supersede the Americans With Disabilities Act, which prohibits employers from asking employees to divulge medical information, except when it’s clearly related to job performance or purely voluntary. And with large financial consequences for employees who don't participate, the wellness programs are voluntary in name only, consumer advocates say.

[...]

But it was a set of legal disputes that finally put this on the agenda in Washington. A few months ago, following lawsuits against companies operating wellness plans, the EEOC announced that it would propose new guidelines to clear up the confusion over what the law actually allows. Groups representing both employers and consumers made their cases to the commission -- as well as to Congress, where the Republican majority signaled an interest in establishing business-friendly guidelines via legislation.

Business and consumer groups also lobbied the White House, which seemed similarly receptive to business concerns. One day after business executives met with President Barack Obama and raised this very issue, White House press secretary Josh Earnest told reporters that "we know that wellness programs are good for both employers and employees.” (He was careful to note that the EEOC is an independent agency.)

On Thursday, the EEOC posted its proposal -- and, on the question of financial incentives, it looks an awful lot like the standard that employers sought, with Incentives worth up to 30 percent of health insurance premiums permissible.

Among those unhappy with the announcement was Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law. She told The Huffington Post that the EEOC decision seemed like a sharp break with past rulings. “The EEOC in the past has said that for these questions to be ‘voluntary,’ you can’t impose penalties. Now they seem to be saying, 'yes you can,'” she said.

[...]

Quote:

 

https://cei.org/content/no-spoof

No Spoof
States Still Await Answers about Obamacare Exchanges

By the end of June, the Supreme Court will rule on the issue of Obamacare insurance exchange subsidies in King v. Burwell, a case that could have significant ramifications for the Affordable Care Act (ACA). In implementing the law, the Internal Revenue Service (IRS) made individuals purchasing health insurance on both state and federally facilitated exchanges eligible for tax credits to offset part of the cost of the insurance. That rule violates the plain text of the Act, which makes such subsidies available only for insurance purchased on exchanges established by the states.

At the Supreme Court’s March 4 hearing on the case, Justice Anthony Kennedy asked whether the denial of subsidies might constitute federal coercion of the states:

• 
  
• [F]rom the standpoint of the dynamics of Federalism ... there is something very powerful to the point that if [the challenger’s] argument is accepted, the States are being told either create your own Exchange, or we’ll send your insurance market into a death spiral.

Oklahoma Attorney General Scott Pruitt, in a Wall Street Journal op-ed, responded to Justice Kennedy as follows:

• 
  
• In other words, Justice Kennedy was asking, if Congress did in fact condition ObamaCare’s tax credits on a state having set up an exchange, does that amount to an unconstitutional coercion of the states? In short: no.

Pruitt cited a January 2012 letter by insurance and health officials from seven states—Kentucky, Maine, New Mexico, North Dakota, Tennessee, Utah and Virginia—that asked the U.S. Department of Health and Human Services (HHS) for a formal legal opinion explaining the federal government’s authority to administer tax credits for insurance premiums on federally facilitated exchanges.

As the letter indicates, these states questioned whether the IRS had the power to issue tax credits in states that decided not to set up their own exchanges. But five of these states—Virginia, Maine, North Dakota, Tennessee, and Utah—nonetheless decided not to set up their own exchanges.

Pruitt’s point is especially clear when one considers the background to that letter, as described in my November 2014 CEI paper, “Beyond Gruber: How HHS Flip-Flopped on Federal Exchange Subsidies.” For two years after Obamacare’s enactment, HHS helped several states set up their own exchanges, but did almost nothing to establish the federal one. In particular, HHS moved quickly after the law was passed to help state governments develop the tax credit calculators needed to make tax credits available through state-based exchanges. Meanwhile, for nearly two years, it developed its own HealthCare.gov website without any effort to offer tax credits on the federal exchange or to develop a tax credit calculator for its site.

It was only after many states appeared to be leaning against setting up exchanges that the Obama administration changed course and began claiming that the Affordable Care Act allows tax credits for both state and federally facilitated exchanges. Only then did HHS begin developing a tax credit calculator for HealthCare.gov.

But as the deadline for states to set up their own exchanges drew near, they still needed a determination as to whether their residents would receive tax credits through federally facilitated exchanges if the states did not set up their own exchanges. This led to a standoff, as states did not want to decide whether to set up exchanges until they knew HHS’ decision, while HHS did not want to decide the federal exchange subsidy issue until it knew the states’ decisions. It was against this background that in January 2012 the seven states wrote to HHS, requesting a formal opinion on federal exchange tax credits

Was the letter serious or a prank? On March 16, Ian Millhiser of the Center for American Progress (CAP) attempted to discredit this letter, claiming it was “satirical,” a “prank,” “joke,” and “spoof,” because it closely resembled a letter HHS had sent to the states requesting information on their plans for state exchanges. Millhiser claims that “no state questioned the legality of these tax credits during an Internal Revenue Service rulemaking process.” He appears to base these allegations primarily on statements by a “state official who signed the letter, who spoke to ThinkProgress [CAP’s blog] on condition of anonymity.” And more recently, the Huffington Post claimed that Alabama state officials never realized that the state might be giving up subsidies when it decided against setting up its own exchange.

However, a close examination of the development of the letter shows that the signing states had serious questions about the availability of subsidies through federal exchanges, and that the letter was a careful effort by them to get answers from HHS.

Shortly after Millhiser made his claims, I requested from the Utah Department of Health all records related to the seven-state letter. I received more than 20 emails written by or to Norman K. Thurston, who was Director at the Utah Department of Health when the letter was written. According to these emails, Thurston initiated, drafted, coordinated and sent the letter on behalf of Utah and the six other states. (See email 1 in the appendix.)

These emails, several of which are excerpted and numbered in the appendix for easy reference, show a serious and coordinated effort by numerous states to obtain the same type of information from HHS regarding federally established exchanges as they had requested for state-established exchanges. They sought comparable information regarding the state and federal exchanges because of, as the states’ letter put it, the “complex nature of the policy decision process at the state level” between the two options. Notably, the states explicitly asked HHS to explain what authority it had to administer tax credits on federally established exchanges.

A few highlights from Thurston’s email exchanges demonstrate the seriousness of the letter. Highlights are referenced by the number of the individual email as it appears in the appendix:

• 
  
• An initial email outlining the concept of the letter was made available by Thurston to most if not all of the states (2).
  
  
• The letter was not quickly thrown together but rather was developed, revised and finalized over a period of several weeks, beginning in late November and ending in early January.
  
  
• States were becoming increasingly concerned that HHS had “not provided ANY details to the states about the federal model” (5).
  
  
• Seven states signed the letter, and according to one email, officials in at least seven other states supported it to some extent—Arizona, Idaho, Ohio, South Carolina, South Dakota, West Virginia, and Wisconsin (6). Other states also took an interest in it. One executive at the Kansas Insurance Department, for example, said: “[W]e had a call with several HHS people on Monday afternoon and told them we were totally in support of the issues raised in your memo” (7).
  
  
• Virginia’s signature is particularly noteworthy because it is directly at odds with a Supreme Court amicus brief filed by 22 states and the District of Columbia in support of HHS. That brief stated: “[c]onspicuously absent is evidence that States contemplated the dramatic consequence of depriving their residents of tax credits …” Virginia was the lead state on the brief, but its position is directly contradicted by its signature on the Jan. 2012 letter (1, 8).
  
  
• The emails confirm that the states’ letter was based, in part, on a letter that HHS first sent to them. However, the states’ letter was not as a “spoof” of that letter, but rather “a fairly polite request that CMS [the federal Centers for Medicare and Medicaid Services] put forward a plan to tell us the same information about the federal exchange that they are requesting from us on the state exchanges” (9, 5).

The states were not the only ones with questions. On March 1, 2012, a few weeks after the states sent their letter, then-HHS Secretary Kathleen Sebelius testified before the House Subcommittee on Health of the Energy and Commerce Committee. Rep. Joseph Pitts (R-Penn.) submitted several questions to Sebelius, for inclusion in the hearing record, regarding HHS authority to allocate subsidies on federal exchanges. Her answers did little more than reference the IRS. Regardless of whether one views her answers as satisfactory, the fact that she was questioned about the federal exchange subsidies makes it clear they were already an issue for many of the states at that time.

Conclusion. Several states and Members of Congress continued to question the validity of federal exchange tax credits. Some commenters now argue that this question never really came up. But it did, and it is up to the Supreme Court to finally answer it.

• 
  
• ...a January 2012 letter...from...Virginia—that asked the U.S. Department of Health and Human Services (HHS) for a formal legal opinion explaining the federal government’s authority to administer tax credits for insurance premiums on federally facilitated exchanges.

• 
  
• ...“[c]onspicuously absent is evidence that States contemplated the dramatic consequence of depriving their residents of tax credits …”

Quote:

 

http://news.yahoo.com/florida-governor-says-hell-sue-obama-over-hospital-165049814.html

Florida governor says he'll sue Obama over hospital money

Florida Gov. Rick Scott said Thursday he is suing the Obama administration for withholding federal money for hospitals that serve the poor, saying they are doing so because the state won't expand Medicaid.

The announcement is another twist in what has been a gritty yearlong battle with the feds over roughly $1 billion in funds for Florida hospitals. The fight has come to a head as the state Legislature works to finalize a state budget before May 1.

"Florida is the first and only state to sue the federal government on this issue. There are only a handful of states that even have anything like" the hospital funds, said Joan Alker, executive director of the Georgetown University Center for Children and Families.

The hospital funds, known as the low-income pool, give federal money to hospitals that serve large numbers of uninsured and Medicaid patients. Florida's funds were negotiated under Gov. Jeb Bush when he was governor.

Federal health officials have warned states for more than a year the program would end in June because the president's health law was intended to provide insurance to more people, meaning the hospitals would have more paying customers. But the Supreme Court decision allowing states to decide whether or not to expand Medicaid has complicated the hospital funds.

That 2012 ruling bars the federal government from coercing states into expanding Medicaid. Yet, that's what the Republican governor says the Centers for Medicare and Medicaid Services is doing because the agency insists that the hospital funds and Medicaid expansion should be part of the same discussion.

"It is appalling that President Obama would cut off federal health care dollars to Florida in an effort to force our state further into Obamacare," said Scott, who recently reversed course, saying he no longer supports Medicaid expansion.

Florida Attorney General Pam Bondi, who said her office will handle the lawsuit, said the state has not yet decided when and where the lawsuit would be filed.

The Florida House and Senate remain gridlocked with rival budgets $4 billion apart. The House is refusing to expand Medicaid and the Senate vows not to pass a budget that includes deep cuts to hospitals.

The Senate proposed a compromise that initially expands Medicaid but then transitions to a program that uses federal funds to let consumers purchase private health insurance for themselves. Scott and the House are against it, warning the federal government can't be trusted to foot the bill.

Legal experts say the Supreme Court case Scott is using in his defense doesn't apply here. CMS has broad discretion on whether to grant pilot projects like the one in Florida. But the case Scott mentions refers to state's ability to participate in Medicaid, not optional pilot programs, said Washington D.C.-based attorney Ken Choe, who served as deputy general counsel for the U.S. Department of Health and Human Services.

Republican Senate President Andy Gardiner said the federal government has no obligation to provide the hospitals funds.

"It is difficult to understand how suing CMS on day 45 of a 60-day session regarding an issue the state has been aware of for the last 12 months will yield a timely resolution to the critical health care challenges facing our state," said Gardiner, who is also a hospital executive.

The Centers for Medicare and Medicaid Services declined comment on the pending lawsuit. But the agency did issue a statement asking the state to prove how relying on federal funds to pay hospitals caring for those without insurance is a more effective use of taxpayer money than purchasing Medicaid or other health insurance directly for those patients.

Quote:

 

http://www.reuters.com/article/2015/04/16/usa-florida-medicaid-idUSL2N0XD22O20150416

UPDATE 1-Florida governor fights Obama administration over healthcare funding

Florida Governor Rick Scott said on Thursday he would sue to stop U.S. health leaders from ending more than $1 billion in federal funding for low-income patients, arguing it stemmed from the state's refusal to expand Obamacare for the working poor.

The dispute between Florida's Republican leaders and President Barack Obama's administration is entangled in Florida's rejection, so far, of about $51 billion available over 10 years to expand Medicaid coverage to some 1 million Floridians under the Affordable Care Act, known as Obamacare.

Scott singled out a letter in which federal officials acknowledged this week a connection between Medicaid expansion and negotiations over the state's "Low Income Pool." Florida stands to lose about $1 billion annually in federal funding to pay hospitals for treating needy patients.

The Democratic president is "crossing the line into a coercion tactic" in violation of a 2012 Supreme Court ruling allowing each state to decide on expansion, Scott contended.

"It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into Obamacare," he said in a statement.

Medicaid expansion has been deadlocked in Florida's Republican-controlled Legislature. State senators want the money, but the more conservative House of Representatives remains opposed.

Conservatives have blocked efforts to expand Medicaid in several Republican-leaning states this year.

Medicaid expansion would provide health insurance to working adults who fall into a coverage gap under Obamacare, being too poor to purchase plans under health insurance exchanges, but unable to qualify for traditional government Medicaid programs.

"It's all politics," Democrat Mark Pafford, Florida's House minority leader, said of Scott's threatened suit.

The pool, launched in 2006, supports hospitals serving large numbers of poorer and uninsured patients. Expanding Medicaid would reduce the burden of uncompensated care, federal officials said.

Medicaid expansion and the low-income funding "are linked in considering a solution for Florida's low income citizens, safety net providers, and taxpayers," an administrator with the U.S. Centers for Medicare and Medicaid Services wrote the state.

"Florida, like all states, is free to implement Medicaid expansion or not," agency spokesman Aaron Albright said in a statement on Thursday.

Florida's request to extend the optional program, expiring in June, raises questions given alternatives available, he said.

Scott, once a tepid supporter of expanding Medicaid under Obamamare, recently changed course.

Uncertainty over healthcare funding has stalemated negotiations over Florida's more than $80 billion budget. (Writing by Letitia Stein; Editing by Doina Chiacu and Peter Cooney)

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http://kaiserhealthnews.org/news/whats-at-stake-in-the-supreme-court-obamacare-case/

What’s At Stake In The Supreme Court Obamacare Case

The Affordable Care Act mandates that all Americans get health coverage or pay a penalty. To help people pay for that insurance, the federal government subsidizes insurance premiums for millions of Americans.

In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could leave millions without insurance.

Attorney Tom Goldstein, who runs SCOTUSblog, has been following the case and says the law is ambiguous. “This is a real, serious question,” he says. “The law doesn’t tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange or whether Congress wanted everybody who needed the help to be able to get the subsidies.”

Louisiana is a state where a lot of people could be affected. It runs healthcare.gov and about 186,000 people there have used the site to buy health insurance. Nearly 90 percent of them in Louisiana get subsidies.

We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. Here are our first three profiles:
[three personal stories follow]

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http://thehill.com/policy/healthcare/239404-obamacare-fight-escalates-as-texas-backs-florida-lawsuit

ObamaCare court fight escalates

The fight over ObamaCare’s Medicaid expansion escalated Monday, as Texas’s Republican governor backed a lawsuit from Florida against the Obama administration.

"When the federal government exceeds its constitutional authority, the States must take action,” Texas Gov. Greg Abbott said in a statement. “[I) commend Governor Rick Scott’s decision to take legal action to protect these important constitutional principles.”

Last week, Scott announced he would sue the Obama administration over what he called an effort to illegally force Florida into expanding Medicaid under the Affordable Care Act.

“It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into ObamaCare,” Scott said last week.

At issue is the Obama administration's move to link Florida’s rejection of the Medicaid expansion to separate federal funding that helps hospitals care for the uninsured.

The administration says some Florida hospital funding will not be extended in its current form past the June expiration date, arguing that the money should not go toward costs that would otherwise be covered by an expansion of Medicaid under ObamaCare.

The administration has left the door open to providing some healthcare funding for Florida, however.

The White House is pressuring the state to expand the healthcare program for the poor, while referring questions on the details of the dispute to the federal Medicaid agency, the Centers for Medicare and Medicaid Services (CMS).

"It's difficult to explain why somebody would think that their political situation and their political interest is somehow more important than the livelihood and health of 800,000 people that they were elected to lead," White House press secretary Josh Earnest said Thursday when asked about the Florida lawsuit.

Aaron Albright, a spokesman for CMS, said the principles given to Florida apply in Texas and other states as well.

“We will also use these principles in considering similar proposals in other states, but discussions with each state will also take into account state specific circumstances,” he said.

CMS communicated that message directly to Texas in a call on Thursday.

Scott argues the funding threat is a clear violation of the U.S. Supreme Court’s 2012 ObamaCare decision, which struck down mandatory expansion of Medicaid.

Since that ruling, states have had a choice of whether to expand Medicaid by making more of their residents eligible for the program. Twenty-eight states have accepted the increase in federal funding so far, including 10 with Republican governors. Montana is poised to become the 29th, as the legislature sent a bill to the governor's desk on Saturday.

Abbott made clear in his statement Monday that he remains firmly against Medicaid expansion and also objects to the Obama administration’s tactics.

“Medicaid expansion is wrong for Texas,” he said.

John Wittman, an Abbott spokesman, said it is “fair” to say that the prospect of losing the separate federal funds would not sway the governor from his opposition to Medicaid expansion.

The stakes are high.

Texas spends about $29 billion over five years on programs for the uninsured and underinsured, the state said. Almost 60 percent of those costs are covered by the federal government.

Without the federal funding, "the first thing you would see is the collapse of the rural healthcare system," said Lance Lunsford, vice president of the Texas Hospital Association. "They would start to have trouble to keep those hospitals afloat."

The Texas Hospital Association is pushing for a compromise Medicaid expansion, such as using the money to allow people to purchase private insurance, as Arkansas has done.

Florida and Texas are the two largest prizes for advocates seeking to boost Medicaid enrollment.

Around 800,000 people would gain healthcare coverage in Florida under the expansion of Medicaid, while more than 1 million new people would be enrolled in Texas.

Dear SCOTUS,



Sincerely,

Barry
.

Quote:

 

http://dailysignal.com/2015/04/20/incompetence-mismanagement-plague-californias-obamacare-insurance-exchange/

Incompetence, Mismanagement Plague California’s Obamacare Insurance Exchange

Sharyl Attkisson

[...]

Disappointing Enrollment

It’s against that backdrop that Covered California finds itself now grappling with a big disappointment: low enrollment growth. California ranked near the bottom in overall growth, with a scant 1 percent increase over last year.

“It’s a tiny fraction of the growth they were expecting,” says an official who helped implement the Affordable Care Act and examined California’s numbers.

As recently as last fall, the official says, California hoped to increase enrollment by 500,000 this year. But only an additional 7,098 have “selected a plan” for 2015.

“Their total enrollment is a step in the right direction but nowhere near what anyone thought it would be for the largest state in the country.”

Covered California would not answer our questions about enrollment figures.

Another telling statistic is Covered California’s poor retention rate. Even though people are required by law to have health insurance, only 65 percent of Covered California’s 2014 customers reenrolled in 2015. The rest dropped off.

Covered California would not address our questions about lackluster retention and growth.

Last month, the agency issued a press release touting a younger and more diverse mix of customers.

“New enrollment for 2015 coverage is strong and has brought in consumers who our marketing and outreach targeted,” said Covered California Executive Director Peter Lee, overlooking the fact that his organization’s retention of last year’s customers was among the lowest in the country.

Hoping for a bump, California followed the lead of the federal HealthCare.gov effort and repeatedly extended this year’s enrollment deadline. The Feb. 15 cutoff was pushed back to Feb. 20 and then Feb. 22. Now, it’s been extended to the end of this month.

[...]

>>> This is the first of two parts in The Daily Signal’s series, “Uncovering Covered California.” Tomorrow, in part two, insiders expose Covered California’s “culture of secrecy” and allegations that it promoted egregious waste of taxpayer dollars.

• 
  
• “I really believe that we’ve created a monster—and it’s an unaccountable monster,”
  one former Covered California senior manager told me.

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http://kaiserhealthnews.org/news/tennessee-and-kansas-also-get-warning-expand-medicaid-or-risk-losing-hospital-funds/

Tennessee, Kansas Also Get Warning: Expand Medicaid Or Risk Hospital Funds

Add Tennessee and Kansas to the list of states that have been warned by the Obama administration that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay hospitals and doctors for treating the poor.

The Centers for Medicare & Medicaid Services confirmed Tuesday that it gave officials in those states the same message delivered to Texas and Florida about the risk to funding for so-called “uncompensated care pools” — Medicaid money that helps pay the cost of care for the uninsured.

The letter to Florida officials last week drew the ire of Republican Gov. Rick Scott who said the federal government should not link the $1.3 billion in uncompensated care funding with the state’s decision not to expand Medicaid. He has threatened a lawsuit against the Obama administration if it cuts off the funding, which is set to expire June 30.

The Texas funding is scheduled to end in September 2016. Officials there have also expressed indignation at what they perceive to be coercive pressure and talked about joining Scott’s lawsuit.

Kansas Medicaid officials said they received about $45 million this year in federal funding for their state uncompensated care program, which began in 2013 and is slated to continue through 2017.

Tennessee Medicaid spokewoman Kelly Gunderson said her state gets over $750 million in federal funding to cover uncompensated care.

The first message was delivered in an April 14 letter from Vikki Wachino, acting director of the Center For Medicaid and CHIP Services, to Florida Medicaid officials. She said that expanding Medicaid coverage is a better way to help patients and providers get access to health care than an “overreliance on supplemental payments” to providers through a program called the Low Income Pool, or LIP.

“Medicaid expansion would reduce uncompensated care in the state, and therefore have an impact on the [Low-Income Pool], which is why the state’s expansion status is an important consideration in our approach regarding extending the LIP beyond June,” she wrote.

CMS spokesman Aaron Albright said Tuesday the Obama administration wants to apply similar principles to all the states that receive such funding, whether or not they expanded Medicaid.

“We’ve been in contact with those states that have uncompensated care pools and reiterated that we look forward to an ongoing dialogue to develop a solution that works for patients, hospitals and the taxpayer,” he said. “We told states that our letter to Florida articulates key principles CMS will use in considering proposals regarding uncompensated care pool programs in their states, but that discussions with each state will also take into account state-specific circumstances.”

CMS officials confirmed they have also reached out to states that expanded Medicaid about the future criteria for the funding, including California, Massachusetts, Arizona, Hawaii and New Mexico.

Each state has negotiated its own program with the federal government to pay providers for treating the uninsured. But the programs differ in scope, funding and length of time remaining.

Judy Solomon of the left-leaning Center on Budget and Policy Priorities said the special federal funding that some states negotiated for uncompensated care was never supposed to last indefinitely. The need for the funding changed dramatically as millions of people gained health coverage under the health law, she said.

“These demonstration programs are at the discretion of the Secretary of HHS and there is no entitlement to any state or providers to continue these funding arrangements when they expire,” Solomon said, adding, “The need for uncompensated care funding is changing dramatically.”

Arizona Medicaid spokeswoman Monica Higuera Coury said her state, which did expand Medicaid, was also told that the special funding would begin to be phased out this year. Arizona receives a maximum $137 million a year to offset uncompensated care costs at Phoenix Children’s Hospital. “We are looking forward to working with …CMS to put a transition plan together that moves us away from total reliance on the [funding] while still protecting this very important safety net for our children,” she said.

Some experts were surprised the Obama administration linked Medicaid expansion to the special funding because of the potential legal issues.

“No one would be shocked to hear that states don’t need the money because uncompensated care has dropped … but saying you are taking away this money because you are not expanding is trickier,” said Charlene Frizzera, a senior advisor at consulting firm Leavitt Partners. “People are shocked that CMS has done that.”

But Joan Alker, executive director of Georgetown University’s Center For Children and Families, said the administration was simply acting as a steward of taxpayer money.

“I wouldn’t call it hardball, but rather responsible policy and fiscal oversight to ensure that federal tax dollars are spent in the most effective way,” she said. “When coverage is available to reduce the number of uninsured people … and states refuse those funds, why should the federal government provide them with unauthorized funding to put a Band-Aid on it?”