Posts Tagged ‘Supreme court to rule on ACA’



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The New York Times (3/11, Pear, Subscription Publication) reports the Obama Administration said Tuesday that 11.7 million Americans now have health coverage through the Federal and state exchanges, with 86 percent receiving government subsidies. A new report showed that about three-fourths “of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the federal insurance exchange.” HHS Secretary Sylvia Burwell “underlined the importance of subsidies for people in states using the federal exchange — subsidies that could be withdrawn if the Supreme Court rules against the Obama administration in a pending case.”

According to the Los Angeles Times (3/11, Levey), the report from HHS showed that up to 7.7 million could be affected if the Supreme Court rules against the ACA’s subsidies. In many states that rely on the Federal marketplace, “consumers are getting subsidies that top $300 a month on average, according to the data.” The AP (3/11, Alonso-Zaldivar, Vineys) adds that the 7.7 million Federal marketplace customers receiving subsidies “are getting an average of $263 a month to help pay premiums.” According to the AP’s estimates, that “works out to around $2 billion a month.”

McClatchy (3/11, Pugh, Subscription Publication) reports that 53 percent of people who selected plans on the Federal marketplace “were new consumers who didn’t have marketplace coverage last year.”

USA Today (3/11, O’Donnell) reports that more than 4.1 million people under age 35 “picked Obamacare health insurance plans so far in this open enrollment period, a small increase compared with the end of the 2014 period, the Department of Health and Human Services said” yesterday. The increase from 3.3 million people ages 18-34 who enrolled last year “is good news for the law, which needs more younger people to offset costlier and less healthy older enrollees.”

However, the percent of black and Latino Americans “signing up for ObamaCare remained largely the same as 2014,” The Hill (3/11, Ferris) reports.

Blogfinger Medical Commentary:   By Paul Goldfinger, MD, FACC

It’s important for everyone to try and understand what is at stake when the Supreme Court rules on its latest case regarding Obamacare.

Although the legalities that are being considered by the court seem like they are straight forward, if you get into the weeds you will find out why the court is closely divided.

But getting past the legalities, it is interesting that the average subsidy is nearly $300 per month per each person who receives a subsidy and it is also revealing that 86% who are covered through federal exchanges get subsidies.  So this decision will have huge implications for the future of the ACA.

Also, regarding affordability of insurance,  keep in mind that many of those who have gotten subsidies through ACA exchanges are facing more daunting financial challenges other than paying monthly premiums.  Many of them have deductibles that could be $5,000.00 or more per year which is out-of-pocket spending that some will not be able to afford.  The dropout rates may become substantial.

It’s also interesting that many who had no insurance before still have no coverage because they still can’t afford the costs despite the subsidies. but they do not qualify for Medicaid, which is free insurance provided by the states together with the feds.  Obamacare has been expanding Medicaid eligibility, and some states are resisting that expansion because eventually it will put a significant dent in their budgets.

If the Supreme Court rules against Obamacare, the government will have to come up with a “fix” to prevent loss of coverage for millions who are now covered through the federal exchanges.  Maybe the law could be changed to allow subsidies on all exchanges.



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“The Los Angeles Times (2/25, Levey) reports that the US uninsured rate “plummeted last year, with the improvement driven by states that have fully implemented the Affordable Care Act, a new nationwide Gallup survey indicates.” The survey found that the rate of uninsured adults nationwide fell from 17.3 percent in 2013 to 13.8 percent last year.

“Ten of the 11 states with the largest declines “implemented both pillars of the federal health law: expanding Medicaid coverage to low-income adults and setting up a fully or partially functioning state-based marketplace.”

“In a report detailing the new findings, Gallup’s Dan Witters wrote, “While a majority of Americans continue to disapprove of the Affordable Care Act, it has clearly had an impact in reducing the uninsured rate in the U.S., which declined to its lowest point in seven years in 2014.”

CBS News (2/25) reports that states with the lowest uninsured rates “are clustered in the Northeast and upper Midwest, while those with the highest rates of uninsured Americans are mostly in Southern states such as Georgia and Louisiana, according to a new study from Gallup.”

Blogfinger Medical Commentary  by Paul Goldfinger, MD, FACC

Ultimately, it would be ideal if we could have universal health insurance, but such a huge federal entitlement would have to be affordable and Constitutional, and it should be implemented without compromising quality care–a theme which I have consistently emphasized.  I remain skeptical that the ACA, as currently designed, will be successful in achieving those conditions.

It is not surprising that the rates of uninsured have dropped, and that is potentially a good thing.  But what will the cost be in terms of quality?     For example, the hoped-for benefits of EMR’s  (electronic medical records ) have not yet been realized.  In fact,  from the perspective of doctors, it has reduced quality by distracting physicians from properly interacting with their patients, and the cost savings and error reducing  benefits have not yet occurred.

The Supreme Court will take on a case next month which is about the constitutionality of ACA subsidies in states which are using Federal exchanges instead of state organized ones.   If these subsidies are not upheld by SCOTUS, the HHS Secretary predicts “massive damage” to the new healthcare system.  Millions of people will lose their insurance because it will become unaffordable.

The administration denies having any contingency plans if that occurs, but most likely they are working on ways to fix the situation by pushing non-participating states to get on board.

Even though this Supreme Court challenge seems like using a sledge hammer on the ACA, it cannot be avoided because we need our laws to be constitutional.


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