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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

2014 California Ballot Measure Results!

California voters on Tuesday approved billions in borrowing for water projects, the creation of a tighter budget reserve fund, and lighter penalties for drug crimes and theft while rejecting measures to regulate health insurance rates and to drug test doctors while raising a cap on medical malpractice payouts.

Two ballot initiatives passed by the Legislature and promoted by Gov. Jerry Brown more vigorously than he campaigned for his own re-election – a water bond and a measure creating a rainy day reserve fund for state budgets – passed handily. You can read more about the water bond here.

A pair of health-related measure that ignited massive spending lost by large margins.

Proposition 45 sought to empower California’s elected insurance commissioner to oversee health insurance rates, prompting a well-funded opposition campaign by the insurance industry. Proposition 46 was the latest flareup in a long-smoldering fight between doctors and lawyers over California’s medical malpractice laws. In addition to lifting a $250,000 cap on pain-and-suffering damages recoverable in malpractice lawsuits, the measure would have imposed mandatory physician drug testing.

Proposition 45 lost by nearly 20 points. The gap for Proposition 46 was close to 35 points.

With California in the midst of a years-long effort to reduce prison overcrowding, proponents of Proposition 47 said the measure would improve criminal justice efforts by converting petty theft and drug possession from felonies to misdemeanors, while targeting savings at programs to reduce truancy and substance abuse. Despite law enforcement warnings that the measure would reduce penalties for possession of date-rate drugs and gun theft, Proposition 47 led by 17 percentage points in unofficial returns.

Voters rejected Proposition 48, a referendum that targeted a single casino but carried a broader context.

The “no” vote on the measure blocks a pact with the state to allow the North Fork Rancheria of Mono Indians to operate a Vegas-style casino miles from the tribe’s existing land. Opponents of the facility warned that the deal would lead to a spike of new casinos near urban areas. Some tribes with nearby casinos poured millions of dollars into the campaign to defeat Propositio 48.

Read more here: http://www.sacbee.com/news/politics-government/capitol-alert/article3577731.html#storylink=cpy

California Proposition 45, the Public Notice Required for Insurance Company Rates Initiative

California Proposition 45, the Public Notice Required for Insurance Company Rates Initiative, is on the November 4, 2014 ballot in California as an initiated state statute. This initiative “requires Insurance Commissioner’s approval before health insurer can change its rates or anything else affecting the charges associated with health insurance, provides for publicnotice, disclosure, and hearing, and subsequent judicial review, and exempts employer large group health plans."

If approved by voters, the initiative would:

Require changes to health insurance rates, or anything else affecting the charges associated with health insurance, to be approved by the California Insurance Commissioner before taking effect

Provide for public notice, disclosure, and hearing on health insurance rate changes, and subsequent judicial review

Require sworn statement by health insurer as to accuracy of information submitted to Insurance Commissioner to justify rate changes

Exempt employer large group health plans under any circumstances

Prohibit health, auto, and homeowners insurers from determining policy eligibility or rates based on lack of prior coverage or credit history. Premiums for health insurance are at an all time high, benefits are going down, and many Californians cannot even get health insurance at any price. The public should expect a certain level of accountability and transparency for the skyrocketing rates being charged, especially when rates have been rising five times faster than the rate of inflation.

To read more about the bill, visit:

  http://ballotpedia.org/California_Proposition_45,_Public_Notice_Required_for_Insurance_Company_Rates_Initiative_(2014)

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

Obamacare Met With Confusion, Relief At Start Of New Year

SACRAMENTO, Calif. (AP) — The new year brought relief for Americans who previously had no health insurance or were stuck in poor plans, but it also led to confusion after the troubled rollout of the federal health care reforms sent a crush of late applications to overloaded government agencies.

That created stacks of yet-to-be-processed paperwork and thousands — if not millions — of people unsure about whether they have insurance.

Mike Estes of Beaverton, Ore., finally received his insurance card on Dec. 27 after applying in early November. Still, the family was thrilled to have insurance through the Oregon Health Plan, Oregon's version of Medicaid, because their previous $380-a-month premium "literally crushed our family's finances," Estes said.

Obama administration officials estimate that 2.1 million consumers have enrolled so far through the federal and state-run health insurance exchanges that are a central feature of the federal law. But even before coverage began, health insurance companies complained they were receiving thousands of faulty applications from the government, and some people who thought they had enrolled for coverage have not received confirmation.

Tens of thousands of potential Medicaid recipients in the 36 states relying on the federal exchange also are in limbo after the federal website that was supposed to send their applications to the states failed to do so.

Reports of complications were scattered around the country.

In Burlington, Vt., the state's largest hospital had almost two dozen patients seek treatment with new health insurance policies, but more than half of those did not have insurance cards. Minnesota's health care exchange said 53,000 people had enrolled for coverage through its marketplace, but it was unable to confirm the insurance status of an additional 19,000 people who created accounts but did not appear to have purchased the plans.

In Connecticut, officials were pleading for patience as call centers fielded calls from people who are concerned because they had yet to receive a bill for premiums or an insurance identification card.

"This is an unprecedented time, because there are a record number of people who have applied for coverage with an effective date of Jan. 1," said Donna Tommelleo, a spokeswoman for the Connecticut Department of Insurance.

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

Blue Shield gives California policyholders three-month reprieve

Roughly 113,000 Californians whose individual health plans were set to expire at the end of the year will be given the option to extend their coverage though the end of March.

Those with individual plans issued by Blue Shield of California Life & Health Insurance Company will be allowed to retain their plans for an extra three months regardless of whether they purchased coverage before the March 2010 passage of the federal health care law - the cutoff for "grandfathered" policies.

State officials estimate upward of 1 million Californians were receiving cancellation notices. Nearly 600,000 residents who buy their own health insurance are bracing to pay more for new plans in large part because of the federal health care overhaul. Blue Shield had given a three-month notice to 119,000 subscribers that their plans would be withdrawn from the market and replaced with new compliant policies.

Insurance Commissioner Dave Jones suggested the cancellations required a six-month warning and threatened legal action if existing policyholders were not allowed to retain their plans until March 31.

"Our action today is solely related, as it should be, to the question of whether Blue Shield complied with the notice requirement. They did not," Jones said. "We told them they needed to comply, and we reached this agreement with them."

The cancellations have enraged customers nationwide and caused headaches for President Barack Obama, who last week was forced to walk back repeated assertions that Americans who were satisfied with their health plans could keep them.

Stephen Shivinsky, a spokesman for the company, said it was able to accommodate Jones' request because the insurance plans in question are regulated by the Department of Insurance. New plans offered on the state insurance marketplace, Covered California, are regulated by the Department of Managed Health Care and are bound by the model contract between the exchange and insurance companies.

Blue Shield is mailing letters to 80,000 households informing them of the change and letting them know that they would have to ask to extend their coverage in their current plan. The deadline to retain current coverage is Dec. 6.

Still, Shivinsky said the company is warning customers that an extension is not without complications. Significant risks include: Having to pay a deductible twice in one year; missing tax credits and cost-sharing subsidies for plans that meet new requirements of the federal health care overhaul and are purchased via the exchange; and needing to enroll in a new plan by March 15, 2014 to avoid a gap in coverage after March 31.

"We are providing a lot of cautions to our subscribers if they choose to extend their coverage," Shivinsky said.

PHOTO: Then-Assemblyman Dave Jones, D-Sacramento, holds a news conference to announce legislation on March 13, 2009. The Sacramento Bee/Brian Baer.

Editor's Note: Updated at 11:30 a.m. to reflect comments from Jones.

Read more here: http://blogs.sacbee.com/capitolalertlatest/#storylink=cpy

via http://blogs.sacbee.com/capitolalertlatest/

Shutdown, or not - California launching health law Tuesday

California will forge ahead with the launch of its health insurance marketplace Tuesday, regardless of whether Congress fails to reach a last-minute deal to avert a federal government shutdown.

A possible shutdown would not stop the state because it has already received federal funding to implement the law. Much of the health care law, including federal subsidies for lower-income customers, was established through mandatory spending and not tied to annual appropriations.

On Friday, President Barack Obama promised that the insurance exchanges would open for business even if there's a government shutdown.

"That's a done deal," he said.

Indeed, Covered California - the state's version of the federal health care law - is preparing to begin enrolling customers in its health insurance exchange on Tuesday. Parts of the government would close on the same day if lawmakers in Washington don't act on legislation to extend discretionary spending.

Congressional Republicans have been working to stop the health law in its tracks.

On Monday, Senate Democrats tabled two House-approved amendments to a spending bill that would delay for one year implementation of the health law as well as repeal a medical-device tax designed to help pay for its implementation. Obama and Senate Democrats are urging the House to pass the Senate-approved spending bill with no provisions on the health care law.

California, one of 14 states rolling out its own marketplace, will mark opening day with a series of events in Sacramento, Fresno, San Francisco, Los Angeles and San Diego. The federal government will oversee the launch in the remaining states.

Photo: Samuel Butler inquires at a Covered California booth last weekend at the George Sim Center in Sacramento. Lezlie Sterling/The Sacramento Bee

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/09/shutdown-or-not---california-launching-obamacare-tuesday.html#storylink=cpy

California's working poor would lose a lot if health reform law dies

A bill to create a federally funded Basic Health Plan for about 720,000 low-income residents would go for naught if the Supreme Court tosses out the law.

If the healthcare reform law is thrown out by the U.S. Supreme Court — as many fear could happen based on the comments of conservative justices — more than 700,000 low-income Californians could lose a once-in-a-lifetime chance to obtain affordable health insurance.

At stake is what's known as a Basic Health Plan. This is a system provided for by the reform law, fully funded by the federal government, that would extend coverage to people who may not be able to afford conventional insurance policies but don't qualify for Medi-Cal.

 

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate health committee, is the author of legislation that would create a Basic Health Plan in California beginning in 2014. It would provide coverage to about 720,000 people for as little as $30 a month.

But that's only if the reform law remains intact, providing up to $3 billion in federal funds needed annually to make the program a reality.

"If the court throws out the entire law, that's the nuclear option," Hernandez told me. "The Basic Health Plan would lose all funding. It's what I'm afraid of most."

Critics of the healthcare reform law focus primarily on its requirement that most people buy insurance or face a modest tax penalty, which is the trade-off for a separate requirement that insurers provide coverage to everyone, regardless of medical condition.

These critics seldom acknowledge other aspects of the law aimed at helping insure some of the roughly 50 million people in this country who now lack coverage.

That's an act of pure selfishness (even though we'd all benefit from having fewer people relying on emergency services for treatment). It's also a display of heartlessness unbefitting a country that claims to define itself by love-thy-neighbor Judeo-Christian values.

I wrote this month about another program in jeopardy, the Pre-Existing Condition Insurance Plan, or PCIP, which relies on nearly $350 million in federal funds to provide a safety net for Californians who have been turned away by private-sector insurers because of a medical disorder.

The PCIP is intended to protect such people until so-called insurance exchanges are created by the reform law in a couple of years. But if the Supreme Court rules the entire law unconstitutional, the exchanges would almost surely collapse and funding for PCIP would vanish.

Hernandez's Basic Health Plan faces the same prospect.

"The beauty of the plan is that it's completely funded by the federal government," he said. "When we can help this many people get access to the affordable, quality healthcare they need without putting additional strain on California's budget, we need to act."

Hernandez's bill, SB 703, would target people earning $30,000 to $46,000 a year. Such people would probably find the policies offered by insurance exchanges too pricey, although it remains to be seen how much coverage under the system would cost.

 

At the same time, these people would be largely ineligible for Medi-Cal because their incomes are above the near-poverty levels required by the program.

"The Basic Health Plan is coverage for the working poor," Hernandez explained.

The drafters of the healthcare reform law anticipated a need for such coverage, he said, because many people fall between the cracks of the existing healthcare system. So funding for Basic Health Plans was included in the law for any state choosing to establish such a program.

"It is clear, even at this early stage, that the BHP option deserves serious consideration by states seeking to provide their low-income residents with affordable and continuous coverage while improving state fiscal circumstances in 2014 and beyond," the nonpartisan Urban Institute concluded in a recent report.

Hernandez's bill creating a Basic Health Plan in California was approved by the state Senate last year. It's now making its way through the Assembly.

The key question before the Supreme Court, meanwhile, is whether Congress has the authority to impose a tax penalty if people choose not to buy health insurance.

Although many constitutional scholars say this power is well-established under a number of judicial precedents, the court's conservative justices made clear during three days of hearings that they think lawmakers may have overstepped.

Justice Antonin Scalia indicated that if the so-called mandate is ruled unconstitutional, the entire law would have to be scrapped. "My approach would be to say that if you take the heart out of this statute," he said, "the statute's gone."

With it would go the requirement that insurers provide family coverage to young people up to age 26, which has extended insurance to about 2.5 million people. With it would go the requirement that insurers cover anyone who applies, no questions asked.

With it would go the Pre-Existing Condition Insurance Plan, which is currently the only affordable way many people can obtain coverage. With it would go the exchanges that would provide a marketplace for millions of people who lack insurance.

And with it would go the Basic Health Plans that, as Hernandez observed, may be the only recourse for the working poor — people who are striving mightily to participate in the economic benefits of American society but all too frequently are left out in the cold.

The stakes are so very high.

Republican politicians can criticize the healthcare reform law all they want. But at least offer an alternative that accomplishes as much.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com.

via LA Times