I've written a lot about the impending King v. Burwell Supreme Court decision, and some of my ideas have been batted around by Very Serious People® here and there. However, I'm not a lawyer, nor am I a Constitutional scholar or a Supreme Court scholar, so I'm not the right person to talk to about the actual legal/procedural side of things.
Fortunately, Nicholas Bagley (an assistant law professor at U of M) and David K. Jones (an assistant public health professor at Boston University) have written a lengthy, comprehensive legal analysis of just what the options would be for the federal government and/or the states in the event that the King v. Burwell plaintiffs win their case.
Be warned: It's a long read that gets deep into the weeds, but is well worth it to understand the seriousness of a potential plaintiff win.
Gov. Scott: We Will Begin Working Immediately on a Budget to Continue Critical Programs & Start Conversation on Healthcare Access and Cost
On April 30, 2015, in News Releases, by Currie Dickerson
TALLAHASSEE, Fla. – Governor Rick Scott released the following statement today upon the adjournment of the Florida Senate upon the call of the President, and after the Tuesday adjournment of the Florida House:
“Now that the Florida Senate and House have adjourned, we must immediately turn our focus to how we can work together to craft a state budget before July 1st that continues funding for critical state services. There were no discussions about Medicaid expansion under Obamacare before the legislative session began. Today, it is clear that a thorough analysis of how healthcare can be reformed to improve cost, quality and access is needed, apart from the budget process.
There's not one, not two, not three but four articles I'm reading this morning centering around the same theme: GOP governors who are finally starting to at least consider expanding Medicaid under the Affordable Care Act, but only if the enrollees jump through various hoops in order to qualify:
In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.
The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.
Democratic Gov. Steve Bullock signed the Montana Health and Economic Livelihood Partnership (HELP) Act into law Wednesday in the Capitol rotunda as hundreds of people cheered.
The bill was introduced by Republican Sen. Ed Buttrey of Great Falls after lawmakers defeated the governor's expansion proposal.
Buttrey calls the plan the most conservative in the nation due to copays, premiums and other provisions. Because of those items, the state must seek a waiver from the federal government to put the program in place.
Assuming the vast majority of those eligible enroll (which seems to be the case in most states which have gone through with expansion to date), we should be able to chalk up another 35,000 - 70,000 Medicaid expansion enrollees over the rest of the year.
First, I have to clarify that while the data from the first and second (numeric) columns (and therefore, the third as well) are pretty solid, I'm still making a lot of assumptions for the 4th, 5th and 6th columns below.
The numbers in the first column (2014 EOY Total) come from the just-released Kaiser Family Foundation Data Note, which in turn is based on the Health Coverage Portal by Mark Farrah Associates. That's the total number of people enrolled in private, individual healthcare policies, regardless of whether they were purchased via the ACA exchanges or not.
The second column (2014 EOY Exchange (Estimate)) is my best estimate of how many people had effectuated enrollmentsthrough the ACA exchangesas of 12/31/14. Those are all important caveats. These numbers are based on the following:
A week or so ago I noted that the new Kaiser Family Foundation monthly tracking poll strongly (if indirectly) supports my estimate of roughly 8.5 million OFF-exchange QHP policy enrollees for 2015 (actually likely closer to 8.6 - 8.7 million by now).
As of the end of open enrollment in 2014, 8 million people had signed up for coverage through the Marketplaces. Accounting for the fact that some of those people did not pay their premiums or subsequently dropped coverage – and for signups through special enrollment periods throughout the year – 6.7 million people were insured through marketplace plans as of October 15, 2014. However, it has been unclear precisely how many of these Marketplace enrollees were previously uninsured or how many would have purchased individual coverage directly from an insurer in the absence of the ACA.
Kaiser Family Foundation analysis of recently-submitted 2014 filings by insurers to state insurance departments (using data compiled by Mark Farrah Associates) shows that 15.5 million people had major medical coverage in the individual insurance market – both inside and outside of the Marketplaces – as of December 31, 2014. Enrollment was up 4.8 million over the end of 2013, a 46% increase.
Testimony before the Senate Committee on Small Business and Entrepreneurship
by MICHAEL F. CANNON April 29, 2015
...If the Court sides with the challengers, its ruling will free more than 57 million employers and individuals in those federal-Exchange states from the ACA’s employer and individual mandates. Those 57 million Americans include Kevin Pace, a jazz musician and Virginia resident whose income fell by $8,000 when his employer cut his hours to avoid the IRS’s illegal taxes. They include small-business owners who would expand and hire more workers, but are prohibited from doing so by threat of illegal taxes. A ruling for the challengers would protect small businesses and their employees from an out-of-control IRS. Such a ruling would cause a smaller number of Americans —an estimated 6.7 million — to lose access to subsidies that no Congress ever authorized.
ALERT: Our call center has closed today due to the city disturbances. Find in-person help: http://t.co/HYoHhs8uRf
— MD Health Connection (@MarylandConnect) April 28, 2015
However, any impact on actual ACA enrollments should be nominal.
Maryland had 120,145 QHP selections during open enrollment. Assuming my combined #ACATaxTime + "normal" Off-Season enrollment rate estimate of roughly 10,500 people per day nationally (through Thursday the 30th, anyway) is accurate, MD's share of this should be roughly 1% of this, or around 108 people per day at the moment. Even then, only around 1/3 of the total would be specifically for the tax season special enrollment period (the others would presumably just be delayed by a few days).
From October 1, 2013 to April 26, 2015, 106,364 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
22,354 people enrolled in a private qualified health plan,
67,761 people have been determined eligible for Medicaid, and
16,249 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)
From October 1, 2013 to March 8, 2015, 89,852 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
MORE THAN 33,000 CONSUMERS UNAWARE OF TAX PENALTY FOR BEING UNINSURED HAVE ENROLLED IN HEALTH INSURANCE THROUGH COVERED CALIFORNIA SINCE FEBRUARY
Those Without Health Insurance Have Three Days to Enroll in Covered California to Minimize Penalty for Being Uninsured in 2015
SACRAMENTO, Calif. — With just two days until the April 30 deadline, Covered California urged consumers on Tuesday to enroll in health coverage and announced that more than 33,000 people who signed up since February indicated they were unaware of the tax penalty for being uninsured. The 33,000 enrollees were among more than 91,000 consumers who enrolled in coverage through special enrollment since open enrollment ended in February.
