The future of health care in America is on the table.

After more than an hour of arguments Wednesday, the Supreme Court seemed divided in a case concerning what Congress meant in one very specific four-word clause of the Affordable Care Act with respect to who is eligible for subsidies provided by the federal government to help people buy health insurance. If the Court ultimately rules against the Obama administration, more than 5 million individuals will no longer be eligible for the subsidies, shaking up the insurance market and potentially dealing the law a fatal blow. A decision likely will not be announced by the Supreme Court until May or June.

The liberal justices came out of the gate with tough questions for Michael Carvin , the lawyer challenging the Obama administration's interpretation of the law, which is that in states that choose not to set up their own insurance exchanges, the federal government can step in, run the exchanges and distribute subsidies. Arvin argued it was clear from the text of the law that Congress authorized subsidies for middle and low income individuals living only in exchanges "exstablished by the states." Just 16 states have established their own exchanges, but millions of Americans living in the 34 states are receiving subsidies through federally facilitated exchanges.

But Justice Elena Kagan, suggested that the law should be interpreted in its "whole context" and not in the one snippet of the law that is the focus of the challengers. Justice Sonia Soto mayor was concerned that the challenger's interpretation of the law could lead to "death spirals" in states that hadn't established their own exchanges. Justice Anthony Kennedy, another potential swing vote, asked questions that could be interpreted for both sides, but he was clearly concerned with the federalism aspects of the case. He grilled Carvin on the "serious" consequences for those states that had set up federally-facilitated exchanges. At one point he told Carvin that his argument raised "a serious constitutional question."

President Obama has expressed confidence in the legal underpinning of the law in recent days."There is, in our view, not a plausible legal basis for striking it down," he told Reuters this week. Wednesday’s hearing marks the third time that parts of the health care law have been challenged at the Supreme Court. In this case -- King v. Burwell -- the challengers say that Congress always meant to limit the subsidies to encourage states to set up their own exchanges. But when only 16 states acted, they argue the IRS tried to move in and interpret the law differently.

Republican critics of the law, such as Texas Sen. Ted Cruz, filed briefs warning that the executive was encroaching on Congress' "law making function" and that the IRS interpretation "opens the door to hundreds of billions of dollars of additional government spending."In a recent op-ed in the Washington Post, Orrin Hatch (R-Utah) and two other Republicans in Congress said that if the Court rules in their favor "Republicans have a plan to protect Americans harmed by the administration's actions."Hatch said that Republicans would work with the states and give them the "freedom and flexibility to create better, more competitive health insurance markets offering more options and different choices."

Via: http://www.cnn.com/2015/03/04/politics/obamacare-supreme-court-oral-arguments/index.html

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

Covered California offering ratings to most health insurance plans

Most health insurance plans offered on the state exchange will now feature quality ratings, giving consumers a better idea about their past performance.

Covered California, the state exchange, announced Tuesday that it recently incorporated the quality-rating system in its website, with marks ranging from four stars for the highest performers down to one star for the lowest.

Federal law requires the rating of plans, but officials here noted that the rating system's California debut comes about two years ahead of the mandate. Executive Director Peter V. Lee said his exchange is among the first in the nation to offer consumers a quality-rating system.

"We want to give consumers all the available tools to help them assess and choose plans in their regions," Lee said. "We are proud of the ratings in each of the exchange plans and recognize this is a preliminary look at exchange health plans."

Lee previously expressed concern that incorporating the ratings for some plans and not others would dissuade people from enrolling. His original recommendation called for implementing the ratings system for all plans offered on the exchange during open enrollment in 2015.

Health policy groups and highly-rated plans suggested the exchange simply add language to those plans explaining they had yet to receive any ratings. They sided with exchange board members who strongly recommended adding the ratings as soon as possible.

"We are pleased that those are in place and that folks can take advantage of it," said Anthony Wright, executive director of Health Access California. He also expressed gratitude that the exchange "didn't go down the path that everybody got four stars."

Ratings are a key tool for customers and an important signal to insurers, Wright said. As the exchange and insurers begin negotiations for next year's plans, insurers know that the exchange will look at consumer ratings as well as price, he said.

The ratings, based on consumer experiences, will be familiar to users of Amazon and Yelp where customers assign grades to products, movies and restaurant experiences. In this case, each insurance plan in the marketplace is compared with plans across the western region of the country.

Scores come from the Consumer Assessment of Healthcare Providers and Systems. Four-star plans placed in the top 25 percent of all of those rated. Three, two and one stars were awarded to plans ranking 50-to-75 percent, 25-to-50 percent and 0- to-25 percent, respectively.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1, 2013. The Sacramento Bee/Randall Benton.

Read more here: http://blogs.sacbee.com/capitolalertlatest/2014/01/california-offering-4-star-ratings-to-most-health-insurance-plans.html#storylink=cpy

This Christmas, give the gift of ... health insurance?

Forget the Xbox One, Ugg boots or that "Keep calm and kill zombies" hoodie.

California officials are urging you to consider gifting that special young adult in your life something a bit less tangible: Obamacare.

Covered California, the state health insuranceexchange, on Thursday launched its "Give the Gift of Health" campaign aimed at families, principally mothers and grandmothers (for the latter, apparently a $5 bill no longer cuts it).

Officials estimate roughly 1.8 million residents aged 18 to 29 are eligible to obtain health insurance through the exchange or qualify for free or reduced Medi-Cal, the government program for the poor and disabled. About 2.6 million Californians - many of them under 30 - will qualify for a federal subsidy reducing their monthly premium.

The holiday campaign - Wednesday was the last night of Hanukkah - includes a website atCoveredCA.com/pledge, where one can "pledge" to cover the cost of insurance; e-cards containing information about covered options and tips for starting a discussion about the importance of getting insured.

Claire Lipschultz, the mother of two twenty-somethings, acknowledged parents can't force medical decisions on their adult children. But they can help get them affordable insurance, said Lipschultz, the state policy advocate for the National Council of Jewish Women-California.

"Young adults tend to think that nothing will harm them," she said. "Moms know you are healthy until you are not. So, be sure your loved ones are covered."

Editor's Note: Post updated at 3 p.m. to reflect the last day of Hanukkah.

PHOTO: Emanuel Jumatate of Chicago, hugs his new Xbox One after he purchased it at a Best Buy in Evanston, Ill on Nov. 22, 2013. Microsoft is billing the Xbox One, which includes an updated Kinect motion sensor, as an all-in-one entertainment system rather than just a gaming console. AP Photo/ Nam Y. Huh

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/12/this-christmas-give-the-gift-of-obamacare.html#storylink=cpy

Uninsured Find More Success via Health Exchanges Run by States

WASHINGTON — Robyn J. Skrebes of Minneapolis said she was able to sign up for health insurance in about two hours on Monday using the Web site of the state-run insurance exchange in Minnesota, known as MNsure. Ms. Skrebes, who is 32 and uninsured, said she had selected a policy costing $179 a month, before tax credit subsidies, and also had obtained Medicaid coverage for her 2-year-old daughter, Emma.

“I am thrilled,” Ms. Skrebes said, referring to her policy. “It’s affordable, good coverage. And the Web site of the Minnesota exchange was pretty simple to use, pretty straightforward. The language was really clear.”

The experience described by Ms. Skrebes is in stark contrast to reports of widespread technical problems that have hampered enrollment in the online health insurance marketplace run by the federal government since it opened on Oct. 1. While many people have been frustrated in their efforts to obtain coverage through the federal exchange, which is used by more than 30 states, consumers have had more success signing up for health insurance through many of the state-run exchanges, federal and state officials and outside experts say.

Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, credited the relative early success of some state exchanges to the fact that they could leap on problems more quickly than the sprawling, complex federal marketplace.

“Individual state operations are more adaptable,” Mr. Weil said. “That does not mean that states get everything right. But they can respond more quickly to solve problems as they arise.”

In addition, some states allow consumers to shop for insurance, comparing costs and benefits of different policies, without first creating an online account — a barrier for many people trying to use the federal exchange.

The state-run exchange in New York announced Tuesday that it had signed up more than 40,000 people who applied for insurance and were found eligible.

“This fast pace of sign-ups shows that New York State’s exchange is working smoothly with an overwhelming response from New Yorkers eager to get access to low-cost health insurance,” said Donna Frescatore, the executive director of the state exchange.

In Washington State, the state-run exchange had a rocky start on Oct. 1, but managed to turn things around quickly by adjusting certain parameters on its Web site to alleviate bottlenecks. By Monday, more than 9,400 people had signed up for coverage. TheWashington Health Benefit Exchange does not require users to create an account before browsing plans.

“The site is up and running smoothly,” said Michael Marchand, a spokesman for the Washington exchange. “We’re seeing a lot of use, a lot of people coming to the Web site. If anything, I think it’s increasing.”

Other states reporting a steady stream of enrollments in recent days include California, Connecticut, Kentucky and Rhode Island.

In Connecticut, a spokesman for the state-run exchange, Access Health CT, said users have generally had a smooth experience with the Web site other than “a couple of bumps and hiccups on the first day.”

By Monday afternoon, the Connecticut exchange had processed 1,175 applications, said the spokesman, Jason Madrak.

Daniel N. Mendelson, the chief executive of Avalere Health, a research and consulting company, said: “On balance, the state exchanges are doing better than the federal exchange. The federal exchange has, for all practical purposes, been impenetrable. Systems problems are preventing any sort of meaningful engagement.”

“By contrast,” said Mr. Mendelson, who was a White House budget official under President Bill Clinton, “in most states, we can get information about what is being offered and the prices, and some states are allowing full enrollment. All the state exchanges that we have visited are doing better than the federal exchange at this point.”

In California, Peter V. Lee, the executive director of the state-run exchange, said that more than 16,000 applications had been completed in the first five days of open enrollment. Mr. Lee said that while the consumer experience “hasn’t been perfect,” it has been “pretty darn good.”

Some state-run exchanges have run into difficulties because they rely on the federal marketplace for parts of the application process, like verifying an applicant’s identity. Minnesota, Nevada and Rhode Island are among the states that have reported problems with the “identity-proofing” process, which requires state-run exchanges to communicate with the federal data hub.

Brandon Hardy, 31, of Louisville, Ky., was one of the first to sign up for health insurance through Kentucky’s state-run exchange, working with an application counselor who guided him through the process last Wednesday. Mr. Hardy, who is uninsured and has epileptic seizures that land him in the hospital every few months, spent about 45 minutes filling out the online application, and learned that he would be eligible for Medicaid under the health care law.

“It was pretty easy,” Mr. Hardy said of the process. “What I really need is a neurologist, and now hopefully that will happen. This is like a huge relief.”

Attempts to sign up for coverage through the federal marketplace have often proved more frustrating.

Bruce A. Charette, 60, of Tulsa, Okla., said he had been trying to log onto the Web site for the federal exchange since last Wednesday, but had not been able to see the available plans or their rates.

Mr. Charette said he was asked verification questions that did not appear to match his identity. One question, he said, asked about the name of a pet for which he had purchased health insurance two years ago. “I don’t have any pets,” he said.

“It’s obvious that the site is overloaded,” said Mr. Charette, an electrician who works in the aviation industry and said he did not have health insurance. “I am not going to stare at a computer screen for 45 minutes, waiting for a response. It looks as if the Web site is freezing up.”

Still, some groups helping people sign up for insurance through the federal marketplace said they were finally able to complete applications on Tuesday, a week into open enrollment.

“This was the first day that I have been able to get onto the Web site and sign people up,” said Laura Line, corporate assistant director for Resources for Human Development in Philadelphia, which has a contract to help people in Southeastern Pennsylvania enroll in health plans through the federal exchange. “We have been setting appointments and answering a ton of phone calls now that we are able to do something.”

Katie Thomas and Jennifer Preston contributed reporting from New York.