A project of the Galen Institute

Issue: "Premiums/Costs"

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.

Barone: Dems lose health exchanges bet

Michael Barone
Mon, 2014-07-28
Words mean what they say. That’s the basis for the decision of the U.S. Court of Appeals for the D.C. Circuit in Halbig v. Burwell invalidating the Internal Revenue Service regulation approving subsidies for Obamacare consumers in states with federal health insurance exchanges. The law passed by Congress, Judge Thomas Griffith explained, provided for subsidies in states with state-created exchanges, but not in states with federal exchanges. That’s factually correct, and under the Constitution, the government can’t spend money not authorized by Congress. This has not prevented Democrats from calling the decision “judicial activism,” which makes as much sense as the claims that the Supreme Court decision overturning the Obamacare contraception mandate cuts off all access to contraception. “We reach this conclusion,” wrote Judge Griffith, “with reluctance.” Judge Roger Ferguson, writing for the Fourth Circuit whose King v.

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."

Federal officials cap fines for not buying health insurance

The Associated Press
Sat, 2014-07-26
"Federal officials have capped the amount of money scofflaws will be forced to pay if they don't buy insurance this year at $2,448 per person and $12,240 for a family of five. The amount is equal to the national average annual premium for a bronze level health plan. But only those with an income above about a quarter of a million dollars would benefit from the cap. Those making less would still have to pay as much as 1 percent of their annual income. The penalty for the first year starts at $95 per adult or $47.50 per child under 18. The penalty for not buying insurance increases to 2 percent of income or $325, whichever is higher, for 2015. The fines are due when people file their 2014 taxes. The figures, released late Thursday, are important because the White House has only provided theoretical caps in the past.

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.

Halbig Decision Puts Obamacare Back on the Front Burner and Will Give Republicans a Huge Political Headache

Bob Laszewski, Health Care Policy and Marketplace Review
Thu, 2014-07-24
"Today's 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law. The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do not set up exchanges––at least the 27 states that completely opted out of Obamacare.

Implementing Health Reform: Appellate Decisions Split On Tax Credits In ACA Federal Exchange

Timothy Jost, Washington and Lee University
Thu, 2014-07-24
"July 22, 2014 was arguably the most important day in the history of the implementation of the Affordable Care Act since the Supreme Court issued its ruling in the National Federation of Independent Business case in June of 2012. As no doubt most readers of this blog know by now, shortly after 10 a.m. the United States Court of Appeals for the District of Columbia Circuit handed down its decision in Halbig v. Burwell. Two judges ruled over a strong dissent that an Internal Revenue Service rule allowing federally facilitated exchanges to issue premium tax credits to low and moderate income Americans is invalid. Approximately two hours later the Fourth Circuit Court of Appeals in Richmond, Virginia, unanimously upheld the IRS rule in King v. Burwell. Combined, the cases contain five judicial opinions, three in the Halbig case and two in King. Four of the six judges voted to uphold the rule, two to strike it down."

Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits

Kaiser Health News
Wed, 2014-07-23
"The essential health benefits (EHBs) countdown is on for 2016. That’s when this provision of the Affordable Care Act, which sets out 10 specific health services that must be covered by plans sold on the exchanges, will likely be reviewed by the Department of Health and Human Services. Business interests and consumer advocates are already making their positions clear – the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers’ coverage. During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums. Current policy requires plans cover emergency services, pre- and post-natal care, hospital and doctors’ services, and prescription drugs, among other things.

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