Third Party Resources
Posted on March 9, 2015
A new Health Affairs blog examines the oral arguments in King v. Burwell, focusing on the plantiffs’ reading of the Affordable Care Act (ACA) regarding states establishing their own exchanges for the benefit of federal subsidies. Under this interpretation,the law was intended to encourage states to create their own exchange, or else receive no federal subsidy funds, which may be viewed as coercive by the Court. The blog draws parallels between the Medicaid coercion argument in NFIB v. Sebelius, where the Supreme Court ruled that requiring states to expand Medicaid under the ACA at the price of withdrawing federal funding would be unconstitutionally coercive, and the similar argument of coercion brought up in the King case. The author contends that potentially the Court will realize the deeper constitutional implications of upholding the plantiffs’ reading of the law and allow federal subsidies to continue flowing through federally facilitated exchanges.
Posted on March 4, 2015
A perspective piece published in the New England Journal of Medicine predicts potential fallout from a ruling in favor of King in the King v. Burwell case currently being decided by the Supreme Court. If the challengers prevail, the U.S. Treasury will likely have to stop issuing tax credits to users of federal exchanges. Enrollees who are unable or unwilling to pay the full cost of their insurance premiums could see their coverage terminated. The authors suggest that states could choose to set up their own exchanges and delegate some responsibilities to private contractors, in order to avoid some of the technological challenges. However, the authors also note that some states may be unwilling to set up their own exchanges, in the same way they chose not to expand Medicaid. This could lead to substantial coverage gaps for many Americans.
Posted on January 14, 2015
Consulting firm Leavitt Partners released a white paper outlining several scenarios that Congress, the states, and the administration could take should the Supreme Court rule against the administration in the King v. Burwell case. Under the first scenario Congress could amend the Affordable Care Act (ACA) in a way that establishes the subsidies were meant for all Americans regardless of who establishes the exchange. In the second proposed scenario Congress would pair a fix to the ACA with “material concessions”, such as the employer mandate or premium tax credit thresholds. In the third scenario outlined in the white paper, Congress would take no action regarding the Court’s decision, leaving it up to states to create their own contingency plans. The Leavitt white paper also suggests several fall-back ideas that may be under consideration by the administration as well as potential state reactions.
Posted on January 13, 2015
Two studies by the Robert Wood Johnson Foundation (RWJF) and the RAND Corporation came up with similar findings regarding the Supreme Court’s potential decision in the King v. Burwell case. RWJF speculates that a ruling in favor of King, eliminating subsidies in federal exchanges, would shrink the nongroup insurance market by 9.7 million nonelderly adults and increase the number of uninsured Americans by 8.2 million in 2016. The RAND study also predicts that a ruling in favor of King could cause a 47 percent increase in premiums in federally facilitated marketplaces (FFM). The implications of the court’s decision could ricochet beyond those directly losing subsidies, affecting higher income individuals and even people who obtain coverage outside of the marketplaces.
Posted on December 18, 2014
A study by the Urban Institute finds that the Affordable Care Act (ACA) may reduce, but not eliminate health care coverage disparities. The report projects that under the ACA uninsurance rates will fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If, however, all states were to expand their Medicaid programs, researchers predict that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction.
Posted on December 5, 2014
The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published its annual health care spending report in the policy journal, Health Affairs. The report shows that total health care spending in the U.S. increased 3.6 percent in 2013. However, this increase was slower than that of 4.1 percent in 2012, and the share of GDP devoted to health care spending has remained at 17.4 percent since 2009. The deceleration in health care spending growth can be attributed to a slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care may also contribute to the low overall increase.
Posted on November 12, 2014
A new American Medical Association (AMA) policy encourages policymakers of all levels to focus their efforts on working together to identify realistic coverage options for adults currently in the coverage gap, especially in states that are not expanding Medicaid under the Affordable Care Act (ACA). Given their concern with the high number of low-income adults who remain uninsured in states that have opted not to expand their Medicaid programs, the AMA suggests that these states consider using waivers to expand coverage. The organization also urges states to publicly report annually on efforts to cover the uninsured.
Posted on October 23, 2014
A new report from University of Pennsylvania researchers, funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the Affordable Care Act (ACA) essential health benefits (EHB), which insurers must cover to offer plans on the exchanges. 45 states consider chiropractic care an EHB, 26 states include autism spectrum disorder services in their EHB package, and only five states considered weight loss programs and acupuncture as EHBs. The report states that the variation in EHB requirements is mostly a result of allowing states to determine their own essential health benefit package by using a “benchmark plan” already offered in the state as a model.
Posted on October 14, 2014
A new poll conducted by the The Associated Press and the NORC Center for Public Affairs Research suggests that high deductibles remain a significant barrier to health care for many privately insured Americans. The survey finds that of privately insured adults under age 64, about one in five said they don’t go to a doctor when they are sick despite having health coverage. A similar number of survey respondents reported going without preventive care and cutting back on retirement savings, or having to use all their savings for care. These issues were particularly acute among the 26 percent of respondents with high deductible plans. Consequently, about half of those surveyed said they preferred higher premiums over higher out-of-pocket costs.
Posted on September 23, 2014
Researchers at Georgetown University’s Center on Health Insurance Reforms (CHIR) conducted a six-state case study to assess changes in the network design of plans offered through the health insurance marketplaces, as well as the response of state officials in the face of consumer and provider concerns. The report finds that insurers have narrowed their networks, relative to what they offered in the past, however states and insurers reported few consumer complaints about the ability to obtain medically necessary care in-network. Most of the study states are unlikely to take action to change their standards for network adequacy, however, half of the states studied will require insurers to provide better, up-to-date provider directories, so that consumers can better understand which providers are in which plan networks before they buy.