Tag: Obamacare

Categories
Politics

Obamacare repeal continues to confront obstacles

House Republicans on Thursday passed a bill to repeal the Affordable Care Act, but that doesn’t mean the law will be scrapped any time soon.

To win support of conservatives, the GOP leaders added provisions that allow states to gut benefits that insurers must provide and slash spending on Medicaid, which provides care for the needy. (If you’re wondering, the savings will fund a tax cut for people who earn more than $200,000 a year.)

Now the legislation moves to the Senate, where Republicans, who hold 52 seats, can only afford to lose one vote and where Democrats are united in their opposition to repeal.

The math doesn’t favor repeal along lines passed by the House. Among the GOP, Senators Rand Paul, Ted Cruz, Rob Portman, Lindsey Graham, Lisa Murkowski, Cory Gardener, Shelly Moore Capito, Bill Cassidy and Susan Collins all have expressed concerns with the legislation that emerged from the other chamber.

“Although I will carefully review the legislation the House passed today, at this point, there seem to be more questions than answers about its consequences,” Collins said following the House vote.

Unlike House Republicans, senators likely will wait for the Congressional Budget Office to assess what the bill – or any legislation for that matter – will do. When CBO last scored the legislation, it found that repeal of Obamacare would cause 24 million Americans to lose their health insurance over the next decade. Any estimate of the revised legislation that’s remotely close will leave Republicans concerned about the effect of repealing Obamacare on their prospects for re-election.

Elements of the House bill that likely will raise Republican objections in the Senate include the loss of coverage caused by the rollback of Medicaid and concerns that the House did not go far enough to preserve coverage for people with preexisting conditions.

But efforts to restore those protections in the Senate could jeopardize support from conservatives. Sen. John Cornyn, the Senate’s number two Republican, conceded as much following the House vote. “There is no timeline,” he told reporters. “When we get 51 senators, we’ll vote.”

Congress can send only one version of a bill to the president for his signature. So even if the Senate also passes a bill, congressional Republicans almost certainly will be left to negotiate among themselves. That means the Republican leadership in both chambers would appoint lawmakers to a conference committee, which would meet to reconcile the two versions. As the Congressional Research Service explains:

For a conference to reach agreement, a majority of the House conferees and a majority of the Senate conferees must sign the conference report. Once reported, the conference report must be approved by both chambers. Conference reports are privileged and debatable in both the House and Senate, but they may not be amended.

If both chambers approve the conference report, the legislation would be sent to the president for his signature. But for now hurdles remain. “This bill is going nowhere fast in the United States Senate,” Chuck Schumer, the chamber’s top Democrat, said on Wednesday.

Categories
Law

The Obamacare ruling shows that context matters

The Supreme Court on Thursday ruled that subsidies for health insurance should be available to Americans wherever they reside.

At issue was a section of the Affordable Care Act (ACA) that authorizes tax credits for those who purchase coverage in marketplaces “established by the state.” Four policyholders from Virginia sued, charging that those four words meant the law did not authorize credits for taxpayers in states, like theirs, that rely on the federal health-insurance marketplace. Without subsidies, the petitioners charged, they could neither afford health insurance nor be required by law to purchase it.

That ambiguity presented the Court with the need to interpret the ACA and marked the second time since the law was enacted in 2010 that its fate fell to the justices.

A trial court dismissed the suit after finding that the ACA provided subsidies for plans purchased through either the state or federal exchanges. The 4th U.S. Circuit Court of Appeals affirmed but the Court of Appeals for the D.C. Circuit ruled, in a separate case, that the ACA limited tax credits to state exchanges only.

By a vote of 6 to 3, the Court sided with the 4th Circuit. As Chief Justice John Roberts wrote for the majority:

“If the statutory language is plain, we must enforce it according to its terms. But oftentimes the ‘meaning—or ambiguity—of certain words or phrases may only become evident when placed in context.’ So when deciding whether the language is plain, we must read the words ‘in their context and with a view to their place in the overall statutory scheme.’ Our duty, after all, is to ‘construe statutes, not isolated provisions.'” [citations omitted]

The majority agreed with the petitioners that the language of the phrase at issue was ambiguous, in that one can read it as limited to state exchanges or as applicable to both state and federal exchanges.

The ambiguity prompted the majority to look to the broader structure of the law. Congress put in place subsidies as part of a push to maximize the pool of people who are insured, the majority noted. That lowers premiums by avoiding an alternative whereby only people who need health insurance—those who are less healthy and presumably consume more health care—buy it.

The alternative, which would have denied subsidies to roughly 6.4 million people in 34 states that use the federal exchange, could upend the market for health insurance irreparably. In that event, the Chief Justice wrote:

“One study predicts that premiums would increase by 47 percent and enrollment would decrease by 70 percent… It is implausible that Congress meant the Act to operate in this manner… Petitioners’ arguments about the plain meaning of [the law] are strong. But while the meaning of the phrase ‘an exchange established by the state’ may seem plain ‘when viewed in isolation,’ such a reading turns out to be ‘untenable in light of [the statute] as a whole.’ In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” [citations omitted]

Congress passed the ACA “to improve health insurance markets, not destroy them,” wrote Roberts. “If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.

Categories
Law

Fate of Obamacare to turn on four words

The Supreme Court is expected to decide as soon as this week whether a main part of the Affordable Care Act (ACA) can survive.

Four residents of Virginia contend they were forced by the ACA to buy coverage because of subsidies they receive from the federal government. Their appeal rests on the words “established by the state,” a phrase in the law that the challengers say means that only people who buy coverage through marketplaces established by states—not through the federal health care marketplace—qualify for subsidies.

Virginia is among 34 states that use the federal marketplace. Absent the subsidy, the challengers charge they would be neither able nor required to buy health insurance. If the Court agrees, 6.4 million people could lose tax credits that help them afford coverage and, in most instances, keep them on the rolls.

The government calls the interpretation advanced by the challengers strained. Congress never intended to distinguish between federal and state exchanges in setting up subsidies, proponents of the law say.

Instead, the four words at issue constitute a vestige of an assumption—abandoned during the legislative process—that each state would establish an exchange. It later became apparent that some states would decline to set up exchanges, in which case the federal government made coverage available through HealthCare.gov.

More than 11 million Americans have signed up for health coverage since the ACA passed five years ago. In all, 48% of Americans say the law is working well or needs minor improvements, while 50% say it needs to be overhauled or eliminated, according to the latest NBC News/Wall Street Journal poll.  That’s down from December 2013, when 57% of adults said the law needed to be recast.

Not surprisingly, support for the ACA divides along party lines.  A survey last February by the Pew Research Center found that 87% of Republicans opposed the law while 78% of Democrats supported it.

According to the latest Gallup poll, people between the ages of 18 and 29, those who earn less than $24,000 a year, and black and Hispanic voters are most likely to say the law has helped them and their families.