A project of the Galen Institute

Issue: "Exchanges"

Warner-Gillespie debate offers look at the politics of health care

Markus Schmidt, Richmond Times-Dispatch
Mon, 2014-07-28
"When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed. But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure. “I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward.”"

U.S. attorneys turn up heat on healthcare fraud

The Associated Press
Mon, 2014-07-28
"The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight healthcare fraud. U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases. "My advice to the medical community is to stay away from gray areas or outright fraud that wastes tax dollars, because we will be watching," Johnson told the Sioux Falls Argus Leader. "The end result in many of these cases will be that the taxpayers get their money back with interest and penalties, and the medical professional loses their license." Johnson's office recently settled an alleged fraud case involving two doctors at Dakotas-based Sanford Health.

New Mexico to continue with federally operated health insurance exchange

The Associated Press
Mon, 2014-07-28
"New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans. The state's health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins. A majority of board members worried that New Mexico wasn't ready to switch to a state-run online system for individuals. Any technical failures could delay enrollment and discourage consumers from trying to obtain health coverage, they said. Continuing with the federal system for another year is the "safest, most risk-free" way of enrolling New Mexicans, New Mexico Health Connections CEO Martin Hickey said."

States want more time on ACA funds

Kyle Cheney and Sarah Wheaton, Politico
Mon, 2014-07-28
"States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren’t asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair. The viability of state exchanges became more urgent this week after conflicting court rulings created uncertainty about whether Affordable Care Act subsidies would be available through the federal exchange — or whether the state market would be the only legal route. A POLITICO survey of the 15 state-run exchanges (including Washington, D.C.) found that 11 are thinking about using federal dollars in 2015 — and four of those states have already applied."

Limitations Of New Health Plans Rankle Some Enrollees

Julie Appleby, Kaiser Health News
Mon, 2014-07-28
"Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. “They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, Calif. In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him. Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces.

Republicans Will Run On An Obamacare Replacement in 2016 – Will Democrats?

Ben Domenech for Morning Consult
Sat, 2014-07-26
"The decision in the Halbig v. Burwell case this week was an unexpected legal boon to opponents of Obamacare. Spearheaded by the Cato Institute’s Michael Cannon and law professor Jonathan Adler, the case will almost certainly lead this debate about the text of the Affordable Care Act back to the Supreme Court. My colleague Sean Davis has written a comprehensive piece on the case, particularly on the nature of the supposed “drafting error” at its core. But whatever the ultimate outcome for Halbig, the case serves as a reminder of the uneven ground on which Obama’s health care law is likely to be standing over the next two years.

Varying health premium subsidies worry consumers

Kelli Kennedy, The Associated Press
Sat, 2014-07-26
"MIAMI (AP) -- Linda Close was grateful to learn she qualified for a sizable subsidy to help pay for her health insurance under the new federal law. But in the process of signing up for a plan, Close said her HealthCare.gov account showed several different subsidy amounts, varying as much as $180 per month. Close, a South Florida retail worker in her 60's, said she got different amounts even though the personal information she entered remained the same. The Associated Press has reviewed Close's various subsidy amounts and dates to verify the information, but she asked that her financial information and medical history not be published for privacy reasons. "I am the kind of person the Affordable Care Act was written for: older, with a pre-existing (condition) and my previous plan was being cancelled. I need it and I'm low income," said Close, who has spent more than six months appealing her case. "The government pledged to me that original tax credit amount. It's crazy."

The Stakes Beyond the Halbig Lawsuit

Drew Altman for Wall Street Journal
Fri, 2014-07-25
"A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. One of the cases, Halbig v. Burwell, also adds uncertainty to the enrollment process set to begin this fall, when millions more people are expecting to get tax credits–and wondering if they may be taken away. Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics. The plaintiffs paint this as a case about statutory language and intent.

Oregon feels the strain after health care overhaul floods the system with Medicaid enrollees

The Associated Press
Thu, 2014-07-24
"PORTLAND — Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. However, an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid. The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion."

Two Americas on Health Care, and Danger of Further Division

Margot Sanger-Katz, NY Times
Thu, 2014-07-24
"For decades, the United States has had a fragmented health policy. States called the shots on major elements of how health care and health insurance were financed and regulated. The result: a hodgepodge of coverage and a wide variance in health. The Affordable Care Act was intended to help standardize important parts of that system, by imposing some common rules across the entire country and by providing federal financing to help residents in all states afford insurance coverage. But a series of court rulings on the law could make the differences among the states bigger than ever. The law was devised to pump federal dollars into poorer states, where lots of residents were uninsured. Many tended to be Republican-leaning. But the court rulings, if upheld, could leave only the richer, Democratic states with the federal dollars and broad insurance coverage.

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