Monday Short Cuts

The Alabama House of Representatives on Wednesday narrowly approved a deep cut to the state's Medicaid program as lawmakers continue to deadlock on a solution to the budget shortfall.

The budget cut came out of frustration over the stalemate and is largely seen as a way to build pressure on lawmakers to find some sort of compromise. But opponents called it a dangerous gamble with the health care of the state's most vulnerable people.

Rebecca Santiago clutched a stack of papers about Obamacare and chatted up strangers at the health fair, set up on a Hartford street within view of two homeless shelters. She wanted to know if they had health insurance and, perhaps more importantly, if they’d used it.

One was Darin Zollarcoffer, 48. He had coverage, but no primary care doctor.

“Why not?” Santiago asked.

“Honestly?” Zollarcoffer replied. “I have a fear of doctors and hospitals. When you go there, that’s when you start getting sick, and things start falling apart.”

In a lawsuit filed with the District of Columbia Court of Appeals on Monday, Judicial Watch alleges that Congressis illegally spending millions of Washington, D.C.'s municipal tax dollars on its own health care.

This is accomplished, the nonprofit watchdog says, by having more than 12,000 congressional staff and their dependents acquire health care through the District's Small Business Exchange, which local law explicitly limits to organizations with 50 employees or fewer. "Congress obviously has far more than 50 employees," Judicial Watch dryly notes. Indeed, the thousands of staffers and their families taking advantage of the ObamaCare market "represent an astonishing 86 percent of the Small Business Exchange's total enrollment."

Three health insurance companies that launched in 2013 to win the business unleashed by Obamacare have been swimming in red ink ever since. In 2014, they lost a collective $138 million.

Yet one, Oscar Health Insurance, is valued at $1.5 billion.

Which is curious: The startup lost $27.5 million last year and an additional $11.4 million in the first quarter of 2015. Moreover, it has only about 40,000 members.

About half the states that have expanded Medicaid as part of health reform have enrolled more people than they expected, generating bigger health coverage gains but also prompting fears among some policymakers that states will thus bear higher-than-expected future costs.  In reality, many states are enjoying net budget savings — due to how the expansion works — and such savings should continue into the future.

Kentucky, for example, has saved $109 million and Washington has saved $465 million through June, according to a recent report from the State Health Reform Assistance Network.  By the end of 2015, Colorado expects its expansion to save $308 million while Oregon projects $275 million in savings.  Medicaid expansion has had similar impacts in other states, as we’ve shown.

Californians got a double dose of good health care news late last month. The number of Californians who have trouble finding a doctor or paying their medical bills has sharply declined since the Affordable Care Act took effect. And premiums charged by private insurers have risen only modestly, contrary to warnings that insurers were likely to get double-digit premium increases.

In its latest survey tracking the experiences of California’s previously uninsured residents, the Kaiser Family Foundation reported that two-thirds of the uninsured had gained coverage through various programs, including the state’s Medicaid plan, employer-sponsored insurance and private policies bought on the new insurance exchange established by the state under the Affordable Care Act.

The full scale of Vermont’s health care train wreck continues to become evident as the state approaches a deadline for fixing the online health care exchange, Vermont Health Connect.

Last week, Lawrence Miller, chief of health care reform, told legislators in a memo that the state might have to come up with an extra $3.5 million if an Oct. 1 deadline passes without a remedy for the troublesome change-of-circumstance function on the exchange. A change of circumstance happens when someone has a baby, gets married, gets divorced, gets a new address, loses a job — changes that affect their health insurance policies. The extra money would be needed to pay for workers who would enter those changes manually into the system.

Last June, the Supreme Court handed down its decision in King v. Burwell, shutting down the latest attack on the Affordable Care Act to reach the justices in the process. Yet while the law’s supporters — and the thousands of Americans who could die if Obamacare is repealed — celebrated this decision, another threat to the law waited in a powerful appeals court.

On Friday, however, four Republican federal appeals court judges, including at least one of the most conservative judges in the country,laid that threat to rest in an opinion signaling that federal courts will no longer give comfort to lawyers seeking to wipe out Obamacare.

The health care provider Blue Shield of California will soon be paying tens of millions of dollars back to its members, the result of a technical error the company made in 2014.

Large health care providers collect money from premiums that individuals, who’ve enrolled in a plan through Covered California, and businesses who provide health care packages to their employees pay.

Under the federal rules of the affordable care act, health care providers like Blue Shield of California have to spend at least 80 percent of that money they collect on medical care for enrollees.

Blue Shield of California only spent 76.8 percent of the money it brought in on its enrollees.

The Shumlin administration may need to hire up to 200 employees in October and November to help Vermonters manually change their insurance policies for next year.

The announcement is part of the three-part contingency plan that Gov. Peter Shumlin announced in March to fix more than two years of problems surrounding Vermonters’ ability to buy health insurance through Vermont Health Connect.

Now in second year, a new infrastructure of consumer assistance in health insurance continues to develop. The Affordable Care Act (ACA) provided for new publicly funded consumer assistance entities to help people on an ongoing basis as they apply for health coverage and subsidies and resolve questions and problems with their insurance once covered. Nearly all Marketplace Assistance Programs established for the first year returned this year to continue helping consumers. These assistance professionals have unique insights into how ACA implementation is progressing, what is changing and what challenges remain. How Assister Programs develop in their own right will also likely impact whether consumers can continue to get the help they need.

Back in July 2014, a panel of three D.C. Circuit judges on the rejected Sissel v. HHS, the big Origination Clause challenge to the Affordable Care Act. In the plaintiffs’ view, the ACA didn’t comply with the Origination Clause, which requires all bills for raising revenue to “originate” in the House of Representatives. As such, the plaintiffs said, the ACA is null and void.

All was quiet until last Friday, when the D.C. Circuit issued an order refusing to rehear the case before the full court. By itself, that wasn’t surprising. The court takes very few cases en banc. What was surprising was a lengthy dissent from the court’s four Republican-appointed judges explaining why, in their view, the full court should rehear the case.