Quote:

 

http://www.kaiserhealthnews.org/Stories/2014/October/21/Michelle-Andrews-more-plans-setting-spending-limits-for-some-medical-services.aspx
More Plans Setting Spending Limits For Some Medical Services

...The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems. More than three years ago, the agency began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, CalPERS’ deputy executive officer for Benefit Programs Policy and Planning.

Working with Anthem Blue Cross, the agency set $30,000 as the reference price for those two surgeries in its preferred provider organization plan....

Quote:

 

http://www.washingtonpost.com/politics/federal_government/gop-governors-dont-see-obamacare-going-away/2014/10/20/9da73928-58bb-11e4-9d6c-756a229d8b18_story.html
GOP governors don’t see ‘Obamacare’ going away

While Republicans in Congress shout, “Repeal Obamacare,” GOP governors in many states have quietly accepted the law’s major Medicaid expansion. Even if their party wins control of the Senate in the upcoming elections, they just don’t see the law going away.

Nine Republican governors have expanded Medicaid for low-income people in their states, despite their own misgivings and adamant opposition from conservative legislators. Three more governors are negotiating with the Democratic administration in Washington.

Rather than demanding repeal, the governors generally have sought federal concessions to make their decisions more politically acceptable at home. That approach is in sharp contrast to the anti-Obamacare fervor of their party in Congress.....

Mason

Oct 21 2014, 02:22 AM

. O-Admin pays for study (for the courts), Study says Obamacare will quickly go into Death spiral if tax subsidies are not upheld.
http://dailycaller.com/2014/10/21/hhs-funded-study-obamacare-will-suffer-death-spiral-if-subsidies-fail/.

I tweeted a link to Michael F. Cannon of my response to this study, asking him if he had anything more on it. His response was a link to:




That's probably a better response to the study than actually picking apart the BS within it!

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Edited by kbp, Oct 21 2014, 12:14 PM.

Quote:

 

http://www.forbes.com/sites/michaelcannon/2014/10/21/insurers-demand-for-a-halbig-contingency-plan-demonstrates-need-for-immediate-scotus-review/

Insurers' Demand For A 'Halbig' Contingency Plan Demonstrates Need For Immediate SCOTUS Review
By Michael F. Cannon

This is significant. Ideological critics pooh-pooh Halbig v. Burwell and related cases as “nuisance lawsuits…frivolous.” The health-insurance industry is not so sanguine. Amy Lotven of the trade publication Inside Health Reform reports that before insurers agreed to sell coverage through the Patient Protection and Affordable Care Act’s health-insurance Exchanges in 2015, they demanded that the federal Centers for Medicare and Medicaid Services explicitly agree to let them cancel policies if any of the Halbig cases succeed in blocking the subsidies that carriers had been receiving in the 36 states whose ObamaCare Exchanges were not, as the PPACA’s requires before subsidies can flow, “established by the State.” This is the first indication ObamaCare supporters are worried the Halbig cases could actually succeed, and further demonstrates why the Supreme Court should grant certiorari and expedited consideration to the related case King v. Burwell.

[...]

As beneficiaries of those illegal subsidies, insurance carriers are spooked. Lotven explains they demanded that CMS change the agreements the agency signs with Exchange-participating carriers for 2015 to include what we might call a Halbig contingency plan:

• 
  
• “The agreements to participate in the federally-facilitated marketplace (FFM) that CMS sent to issuers last week include a new clause assuring issuers that they may pull out of the contracts, subject to state laws, should federal subsidies cease to flow. CMS did not say if the clause is meant as a safeguard against the potential impact of various high-profile lawsuits — including Halbig v. Burwell – that could end up in the Supreme Court next year, but stakeholders assume that is the point.
  
  The agency tells Inside Health Policy that the new clause was inserted at the request of issuers, and that both parties believe the clause is critical. Agreements must be signed and returned to CMS by Wednesday (Oct. 22).
  
  Plaintiffs in the suits argue that the ACA subsidies are limited to people enrolled through state-based exchanges and that the IRS overstepped its authority in allowing people enrolled through the FFM access to subsidies. Because the courts have split in their decisions, plaintiffs in one of the cases – King V. Burwell – petitioned the Supreme Court to take up the issue. It is therefore possible that the court could agree to examine the case during the plan year.
  
  The language in the clause says that CMS acknowledges that the issuer has developed its products for the FFM “based on the assumption that (advanced payment tax credits) and (cost-sharing reduction payments) will be available to qualifying (e)nrollees.”
  
  “In the event that this assumption ceases to be valid during the term of this Agreement, CMS acknowledges that Issuer could have cause to terminate this Agreement subject to applicable state and federal law,” the contract says.

[...]

Quote:

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/10/21/how-the-supreme-court-could-still-wreak-havoc-on-obamacare/
How the Supreme Court could still wreak havoc on Obamacare

...About 87 percent of people who signed up for coverage through federal-run insurance marketplaces, or exchanges, in 2014 received financial assistance to pay for premiums, according to the Department of Health and Human Services.
Was 83%.

...Since the ACA's other insurance reforms would remain in effect — like guaranteed coverage and out-of-pocket spending caps — the higher-risk patients would have the greatest incentive to purchase coverage. You wouldn't get the healthier mix of enrollees to balance out the risk pool to keep insurance costs down. So the individual market would essentially become a high-risk pool on a much smaller scale. That's hardly what was envisioned by the law's drafters.
That's where the young and healthy subsidize the less fortunate, putting a load on the backs of the future home buyers....

A couple of points on the Rand study, which was sponsored by an office within HHS. The study projects what would happen if the subsidies were eliminated in every state — the lawsuits are challenging just subsidies in the 36 states with federal-run marketplaces. Still, those states accounted for about 68 percent of total marketplace enrollment in 2014. Also, Rand projections are based on assumptions about costs and don't try to predict how insurers would react to this scenario. And states do have some options that could blunt the impact of such a ruling from the courts....

Walt-in-Durham

Oct 23 2014, 06:38 AM

Pricing is out for the 2015 Obamacare plans in NC. It's not good news. I have a blog post about it at: http://walt-in-durham.blogspot.com/2014/10/if-you-like-your-plan-you-can-keep-it.html

Walt-In-Durham

Quote:

 

http://www.libertylawsite.org/2014/10/22/halbig-and-the-nonchalance-of-six-small-words/

Halbig and the Nonchalance of Six Small Words

The psychology of legislative draftsmanship involved in the six words at stake in Halbig v. Burwell—“an exchange established by the State”—reflects a short-odds gamble that did not hit. The bettors first wanted the IRS to rescue them from the consequences, and now they want the courts to do it.

The gamble was that states, enticed by subsidies for their citizens or intimidated by the threat of losing Medicaid funds, would establish healthcare exchanges. The Obama administration is surely right that the whole idea of the Affordable Care Act (ACA) was that such subsidies be provided, and that the consequences that have ensued from those six small words were probably unintended.

On the other hand, the authors of those words—and words, after all, are the stuff of laws—placed their bet at a casino called federalism, a device that is not incidental to the constitutional design. That is what is at stake in this case, and that is why even those who believe the courts should give majorities a wide berth may be compelled to support judicial intercession to empower majorities—as expressed through the states—in Halbig.

The American regime features multiple majorities operating at multiple levels: federal and state; legislative, executive and judicial. They largely feature the same majorities—what Madison called, in the case of federalism, “common constituents”—reconstituting themselves from different perspectives.

As Steven Calabresi has noted, it is thus misleading to say the people spoke definitively and finally when Congress passed the Affordable Care Act. It was not definitive, since majorities of the same people acting through the states declined to behave as anticipated on the issue of implementation. Nor was it final, since the U.S. House of Representatives flipped in an immediately subsequent election in which the law was prominently featured as a campaign issue.

Of course, inviting the states to serve as censors of federal legislation is a dicey business on which John C. Calhoun did not get his way. The problem in this case is that federal legislators, ever eschewing the direct approach of simply enacting and financing what they meant to enact and finance, chose to pursue their goal through the mechanism of state legislation.

That makes the views of majorities as expressed through the state governments inescapably pertinent. Thus the significance of the ACA’s reference to exchanges “established by the State.” Its very nonchalance, which the ACA’s defenders say is why it should not be seen as frustrating the law’s design, is in fact the key to grasping phrase’s importance. It shows that the drafters simply assumed states would get with the program. That they did not reflected acts of majority will in 34 states, whose residents make up nearly 60 percent of the population.

Even for those uncomfortable with judicial resolution of policy disputes, Halbig therefore presents difficult choices. The Treasury regulation permitting federal subsidies—released two years after the law’s passage, in the interregnum between the argument in NFIB v. Sebelius and the Supreme Court’s decision striking down the Medicaid coercion by a vote of 7 to 2—can be seen as an executive measure designed to frustrate the will of majorities as expressed through states that were explicitly invited (indeed, were intended to be dragooned) to participate in this aspect of otherwise national legislation.

Incidentally, the Department of Health and Human Services’ web page on the law declares that the Supreme Court “rendered a final decision to uphold the health care law” in NFIB. What about that very much pending dispute at the center of the Halbig case—did HHS not get the memo? To invoke psychology again, it looks to be a case of denial (unless the issue is an inability to maintain this website, too).

Granted, in addition to federalism, important issues of legislative supremacy interior to the national government are involved in Halbig. As a panel of the D.C. Circuit noted, the question is whether the First Branch retains legislative authority as opposed to the Executive. For this reason, the courts ought not entertain the administration’s invitation to anoint themselves the technical editors even of poorly drafted legislation.

Nor are administration officials the interpreters of electoral results, such as the Republican takeover of the House in 2010 or President Obama’s reelection in 2012, either of which can plausibly be seen as a referendum on Obamacare. The will of national majorities is expressed under the constitutional order through their intermediary, Congress, subject to the President’s authority to sign or veto bills. The ACA, as precisely written—including the phrase at issue in Halbig—stands as the deliberate will of the public until it is dislodged or rewritten.

But so does the will of majorities expressed by the same people, through a different means: state legislatures that have declined to establish exchanges and whose assumed but unforthcoming participation was part of the architecture of the law. The six words at issue are the tipoff to that assumption. That makes Halbig a federalism case—and a rare one in that judicial intervention could empower rather than obstruct majorities.

Mason

Oct 23 2014, 03:31 PM

.


MEDICAID MIGRATION NOT CONTEMPLATED BY OBAMA ADMINISTRATION

Skyrocket!



http://www.foxnews.com/politics/2014/10/23/companies-try-to-escape-health-laws-penalties/


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Barry's crew must be thankful that SCOTUS allowed some states to not EXPAND the eligibility for Medicaid.