A project of the Galen Institute

Issue: "Uninsured"

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.

Bolstered by Ruling, Republicans Attack Health Law

Robert Pear, NY Times
Thu, 2014-07-24
"WASHINGTON — Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved. “Time and time again,” said Representative Charles Boustany Jr., Republican of Louisiana, “the administration has chosen to ignore the law, and when it does implement the law, it does so incompetently.” Mr. Boustany presided over a hearing of a House Ways and Means subcommittee on Wednesday. An official from the Government Accountability Office, an investigative arm of Congress, testified at the hearing that undercover agents had obtained insurance coverage and subsidies using fake documents and fictitious identities."

Obamacare Help Was In High Demand, Survey Shows

Kaiser Health News
Wed, 2014-07-23
"Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans. Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them. Guess what? People looked for help on the decision. During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average.

Here’s What Obamacare’s Authors said They Actually Meant

Emily Badger, Washington Post
Tue, 2014-07-22
"The two contradictory appeals court decisions that cast the future of Obamacare into uncertainty Tuesday morning largely center on a question of intent: When the Affordable Care Act was conceived and drafted, did its creators mean to withhold health care subsidies from people living in states that refused to set up their own exchanges?. This latest legal challenge focuses on four words in the mammoth law authorizing tax credits for individuals who buy insurance through exchanges "established by the States." Thiry-six states declined to set up their own exchanges — far more than the law's backers anticipated — and in those states, consumers have been shopping for health care on exchanges run instead by the federal government. Now the D.C.

After Health Law Rulings, Here Are Possible Next Steps

"Margot Sanger-Katz, NY Times
Tue, 2014-07-22
"We now have two federal appeals courts that have issued conflicting rulings on a major provision of the Affordable Care Act. Those decisions are not the final word on whether residents of some states will be able to continue receiving financial assistance to buy health insurance. Here are some possible next steps:"

BREAKING: D.C. Appeals Court Overturns Subsidies For Federal Exchange

Sandhya Somashekhar, Washington Post
Tue, 2014-07-22
"A federal appeals court panel in the District struck down a major part of the 2010 health-care law Tuesday, ruling that the tax subsidies that are central to the program may not be provided in at least half of the states. The ruling, if upheld, could potentially be more damaging to the law than last month’s Supreme Court decision on contraceptives. The three-judge panel of the D.C. Circuit Court of Appeals sided with plaintiffs who argued that the language of the law barred the government from giving subsidies to people in states that chose not to set up their own insurance marketplaces. Twenty-seven states, most with Republican leaders who oppose the law, decided against setting up marketplaces, and another nine states partially opted out. The government could request an “en banc” hearing, putting the case before the entire appeals court, and the question ultimately may end up at the Supreme Court.

How Obamacare’s Progress Makes Expanding Coverage Harder

Drew Altman for Wall Street Journal
Mon, 2014-07-21
"The Affordable Care Act’s success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach. Recent surveys show, roughly in line with expectations, that 8 million to 9.5 million fewer adults are uninsured compared with last year before the Affordable Care Act went into effect. Specific data are not yet available for uninsured children who probably got covered as well, and an earlier provision of the health-care law that allowed people to stay on their parents’ insurance up to age 26 is thought to have lowered the number of uninsured young adults by as many as 3 million. But tens of millions of Americans are not yet covered. Those who enrolled last year during the first open-enrollment season were more likely to want coverage and were best able to navigate the process to get it.

New challenge for Obamacare: Enrollees who don’t understand their insurance plans

Lena Sun, Washington Post
Thu, 2014-07-17
"Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage. Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don’t understand how health insurance works, that could hurt their ability to use their benefits — or to keep their coverage altogether. Community organizations are scrambling to keep up with the larger-than-anticipated demand, but they are stretched thin.

The Administration Just Took Obamacare Away From the Territories

Jason Millman, Washington Post
Thu, 2014-07-17
"Looking for a place where Obamacare doesn't exist? Try moving to the U.S. Territories, where the Obama administration just provided a pretty big waiver from the law's major coverage provisions. The Affordable Care Act's design dealt a pretty big problem to the territories. It required insurers there to comply with the law's major market reforms — guaranteed coverage, mandated benefits, limits on profits, etc. — without requiring residents to get coverage or providing subsidies to help them afford coverage. The territories — Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam and the Northern Mariana Islands — have been warning for years that would destroy their insurance markets.

California Releases Proposal For Clearing Medicaid Backlog

Helen Shen, Kaiser News Service
Wed, 2014-07-16
""Responding to inquiries from federal officials, the California health department has released a plan it says will dramatically slash its backlog of Medi-Cal applications within six weeks. For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems. In a letter to the Centers for Medicare & Medicaid Services on Monday, the California Department of Health Care Services said that it had reduced its application backlog to 600,000 by the start of this month. State officials also outlined a plan for technology fixes and administrative workarounds that they project will nearly halve that figure by the end of August—with most of those applications being processed within the allowed 45-day window. The letter was made public Tuesday."

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