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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

California health insurance enrollment spikes as deadline nears

More than 150,000 people have signed up for Covered California health insurance in the past week, bringing total state enrollment to roughly 1.2 million and slowing the online portal to a crawl as residents rush to beat a midnight deadline. 

Meanwhile, Medi-Cal has enrolled approximately 1.5 million new members though mid-March.

Covered California Executive Director Peter V. Lee said the number of household accounts opened since last week totaled about 390,000, including 123,787 on Saturday and Sunday.

"We are seeing more accounts open than any day ever. And we are seeing that today with a huge amount of interest on the site, and it is causing the website to be quite slow," Lee said.

The exchange is working on several ways to accommodate the spike. With about 12 hours left in the first open-enrollment period, the state exchange is placing a high priority on allowing people to begin their applications and then return to complete them by April 15.

Some customers will get a "congratulations" note telling them they have started the application process but because of the high demand they will not be able to finish the process Monday, Lee said. Officials have switched off the "preview plan" tool because of lagging performance but will retain the "shop and compare" function.

Despite hiring on 250 additional people, wait times at customer service call centers averaged 42 minutes in the last week and about 70 minutes over the weekend. A number of enrollment events are taking place across the state, including in Sacramento, Oakland and Los Angeles.

The SEIU-United Healthcare Workers West union is hosting two "enroll-a-thons" Monday at its Sacramento office, 1911 F St., from 7 a.m. to midnight.

Affordable Care Act sign-ups: Where to get help before March 31 deadline

Covered California's website and call centers also will have extended hours, from 8 a.m. to 8 p.m.

In addition, consumers can call a licensed insurance agent or go to health care websites, such as eHealthInsurance.com, which is extending its call center hours through midnight Monday (800) 977-8860.

What You'll Need: Whether enrolling by phone, online or in person, every individual family member should have: proof of identity (photo ID, driver's license, passport); proof of address (utility bill or postmarked mail); income information (two paystubs or recent tax return); proof of citizenship (birth certificate, permanent resident card, or naturalization certificate).

Each person enrolling also must provide date of birth, Social Security number and ZIP code.

PHOTO: Karla Sanchez, 31, of North Highlands holds her son, Luis Marcial, 4, who naps in her arms while she makes her choice for insurance coverage at the SEIU union hall on Monday. The Sacramento Bee/Randy Pench

via: http://blogs.sacbee.com/capitolalertlatest/2014/03/california-health-insurance-enrollment-spikes-as-deadline-nears.html

Read more here: http://blogs.sacbee.com/capitolalertlatest/2014/03/california-health-insurance-enrollment-spikes-as-deadline-nears.html#storylink=cpy

Read more here: http://blogs.sacbee.com/capitolalertlatest/2014/03/california-health-insurance-enrollment-spikes-as-deadline-nears.html#storylink=cpy

California senator unveils bill to give health care to undocumented immigrants

A plan to provide undocumented immigrants in California access to subsidized health care has been spelled out in Senate Bill 1005 by Sen.Ricardo Lara, a Democrat from Bell Gardens.

Undocumented immigrants are excluded from the federal Affordable Care Act that is now offering legal residents the ability to purchase health insurance through government-run marketplaces.

Lara's bill would create two avenues for Californians who are in the country illegally to seek health care. The state would expand Medi-Cal to include undocumented immigrants whose incomes are under 138 percent of the poverty level -- about $32,000 a year for a family of four. And for undocumented immigrants who make more than that, the state would create a marketplace to sell insurance products.

The marketplace would be similar to Covered California -- the state's exchange that was created to sell insurance under the federal Affordable Care Act, also known as Obamacare.

The bill does not spell out a cost for California to extend health insurance to undocumented immigrants.

"We are doing the number crunching now," said Anthony Wright, executive director of the Health Access advocacy group that is supporting Lara's bill.

He said the goal is to provide health insurance for roughly 3 million Californians who don't have health insurance and cannot get it under the federal health program because of their immigration status.

"The idea under this bill is to extend the same level of help that the Affordable Care Act provides but to all Californians," Wright said. "It's about fairness and inclusion for all Californians."

Currently some California counties provide health care to undocumented immigrants but the offerings vary greatly among counties.

PHOTO: Senate President Pro Temp Darrell Steinberg, D-Sacramento, speaks with Senator Ricardo Lara, D-Bell Gardens, in the Senate chambers in March 2013. The Sacramento Bee/Hector Amezcua

Read more here: http://blogs.sacbee.com/capitolalertlatest/2014/02/california-senator-unveils-bill-to-give-health-care-to-undocumented-immigrants.html#storylink=cpy

via: http://blogs.sacbee.com/capitolalertlatest/2014/02/california-senator-unveils-bill-to-give-health-care-to-undocumented-immigrants.html

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.