Obamacare and you

[derspiess]

Hadn't read that take on it yet.  Thanks

[The Minsky Moment]

There is a pretty good summary of the Obamacare legal dispute at Scoutsblog for those interested:

http://www.scotusblog.com/2014/07/commentary-the-fate-of-the-obamacare-subsidies-in-the-supreme-court/

Goldstein is more generous about the statutory argument than I would be but it's a good description of the issues and some basic handicapping of the Supreme Court's likely take.

Goldstein regularly practices before the Court and so is a bit circumspect in how he talks about the justices but Scalia and Thomas are probably sure votes against the Act.  These issues about "glitches" in Congressional language are not entirely uncommon and their usual approach is highly literalistic and hostile to intent and purpose.

[alfred russel]

It doesn't say that.

The language is a little goofy because the way the Exchanges are set up and structured under ACA is goofy.  ACA doesn't say - a state can opt-out of creating exchanges.  The section which is directly referenced by the IRS code actually mandates each State to create an exchange.  There is no opt-out.  It defines "Exchange" somewhat self-referentially as the organ established in that state that facilitates the purchase of qualifying health plans.

A totally different section of ACA provides that if a particular State fails to comply that HHS is supposed to do it for them.  There is no such thing as a "federal exchange" in the law.  The term "federal exchange" is just a phrase that some people use to describe what happens when a State doesn't comply.  The actual word that ACA is uses to describe the thing that is created in that instance is simply "Exchange" - i.e. the very defined term used in the section about the State-mandated exchanges.  This ends up being an embarrassment for the DC circuit plurality - they keep using the phrase "federal Exchange" which doesn't exist in ACA and involves sticking a common adjective "federal" in front of a defined term "Exchange".

Is it possible to read this in the way the 2 DC circuit judges did?  Sure if you stand on your head, read it very selectively and grossly out of context, and completely ignore the purpose.  Problem is, the IRS usually gets lots of deference when writing its rules.  By law, their interpretation gets great deference and their reading of the statute can be upheld if it is "possible" reading of the statute.  The DC judges know this and so were forced to argue that not only is their reading correct, but that it is totally plain and unambiguous.  That doesn't pass the laugh test.

It seems there is a different point of view out there. A guy that supposedly played some role in crafting Obamacare in 2012 said:

"I think what's important to remember politically about this, is if you're a state and you don't set up an Exchange, that means your citizens don't get their tax credits."

http://www.forbes.com/sites/michaelcannon/2014/07/25/oops-gruber-did-it-again/

The implication being that the tax credits were in part an incentive to get states to act, and an exchange created by an entity other than a state (such as the federal government) is outside the scope of tax credit eligibility.

[derspiess]

That's a bit different from the recent narrative.

[The Minsky Moment]

It seems there is a different point of view out there. A guy that supposedly played some role in crafting Obamacare in 2012 said:

"I think what's important to remember politically about this, is if you're a state and you don't set up an Exchange, that means your citizens don't get their tax credits."

http://www.forbes.com/sites/michaelcannon/2014/07/25/oops-gruber-did-it-again/

The implication being that the tax credits were in part an incentive to get states to act, and an exchange created by an entity other than a state (such as the federal government) is outside the scope of tax credit eligibility.

Yeah that little quote has been flying around the blogosphere for about a week now.

Problem of course is context.   Forbes and lots of other folks are quoting that one line and assuming your implication.  But the line itself doesn't mention the federal exchanges.

The mystery is solved if you view the original video and listen to the immediately preceding lines.  He says the states are going to be "the place that people go to get their subsidies for health insurance.".  He then goes on to say:

" In the law it says if the states don't provide them the federal backstop will. The federal government has been sort of slow in putting up its backstop in part because I think they want to sort of squeeze the states to do it."

So in context the implication is quite different.  He is clearly indicating that the federal "backstop" will provide subsidies if the states don't but then notes that the feds have been dragging their feet.  He then speculates about a political motivation for the slow pace.  But the underlying assumption here is that people would get subsidies through the federal backstop if it was timely implemented.

Frankly I think Prof. Gruber is spinning here - the feds weren't dragging their feet as part of some brilliant political plot but because of poor implementation.  But in any case he wasn't saying what certain elements of the blogosphere are trying to attribute to him.

[The Minsky Moment]

The full DC Circuit has vacated the 3 judge panel decision and agreed to rehear the case "en banc" (as a full court). 

[Ideologue]

Obamacare and me--I probably ought to have signed up.

[citizen k]

Estimated Enrollees for 2015 Health Care Decrease


WASHINGTON—The Obama administration said Monday it expects up to 9.9 million people to have private coverage through the Affordable Care Act's insurance exchanges in 2015, millions fewer than outside experts had predicted.

The exchanges, which reopen Saturday for the law's second year of health-insurance enrollment, previously were expected to enroll 13 million people in private coverage for 2015, according to an April 2014 projection by the Congressional Budget Office.

Administration officials said they were basing the new enrollment targets on observations from the first enrollment window, which ended mid-April. They also said that over the years participation in health programs aimed at a broad population had taken longer than the CBO had assumed.

The officials added that of 32 million uninsured people currently in the U.S., they expected about 17 million of them to be eligible for Medicaid, the federal-state insurance program for the poor, which has been expanded in some states as part of the law.

The administration also revised downward the number of Americans who had private coverage through the law's exchanges on the eve of the second round of coverage. The administration said Monday that around 7.1 million people across the country who picked plans during the current year's open-enrollment period were still paid up for their coverage. That is down from the eight million who the administration said had picked plans as of this spring, and from the figure of 7.3 million paid-up enrollees in mid-August.

Health and Human Services Secretary Sylvia Mathews Burwell said Monday the administration was aiming for 9.1 million paid-up enrollees by the end of 2015, though the range could extend to 9.9 million, according to the agency's analysis. Ms. Burwell said she respected the work of the CBO and its projections, but that she believed HHS figures were based on the best and most up-to-date information.

"I came in and said to the team, let's analytically build it, and this is where it's come out," she said in a public appearance at the Center for American Progress, a Democratic-leaning think tank.

The figures were part of a batch of updates released Monday on the health law's progress as the HealthCare.gov website prepares to reopen on Saturday.

HHS officials also said they had cut off tax credits for December for 120,000 households that hadn't responded to requests for more information about their income. Another 112,000 people have had their coverage terminated because the federal government couldn't confirm they were legally residing in the U.S. That number is down slightly from an earlier announcement from the federal government that it was cutting off 116,000 people over immigration and citizenship status issues.

A new window-shopping tool on the federal insurance website that made its debut late Sunday is giving consumers the first glimpse of health-insurance prices for next year. Many people who bought insurance plans through HealthCare.gov will see their premium increase in 2015 unless they are willing to switch insurance carriers.

Consumers won't be able to switch or buy plans until HealthCare.gov and state exchanges reopen Saturday. The exchanges allow consumers to buy plans under the Affordable Care Act and, for lower earners, access subsidies that offset the cost of their insurance premiums.

A scan of the rates posted late Sunday shows that in Florida, Georgia, Missouri and North Carolina, for instance, the monthly premium for the least-expensive midrange "silver" health plan available to people in the state capital area will go up by a few dollars. In Arizona and New Jersey, it will fall. But for customers in all those states, there is one important caveat: To get the lowest price, they will have to switch insurance carriers.

Proposed rates filed by insurers with state regulators over the past six months suggested that big carriers that snapped up a lot of customers last year are raising their rates for 2015, and new market entrants and plans that got fewer sign-ups in 2014 are slashing prices in a bid for more market share. The final rates, posted late Sunday on HealthCare.gov, have followed a similar pattern.

As a result, most people who bought coverage through the site last year will see their premiums increase for 2015, at the same time that the lowest rate available on the site remains relatively steady.

Federal officials want all of the people who currently have coverage to return to exchanges to shop around in the next month to see if they can get a better deal.

"We are strongly encouraging people to come back to HealthCare.gov," said Kevin Counihan, chief executive of the site, on Sunday.

In Tallahassee, Fla., the lowest-cost silver plan available to a 26-year-old nonsmoker for 2014 was sold by Florida Blue, or Blue Cross and Blue Shield of Florida, with a premium of $228 a month. For 2015, the cost would rise about 20% to $273, according to the premium information displayed on HealthCare.gov. The same 26-year-old could pay a $236 monthly premium for a United Healthcare plan that wasn't available for 2014.

The small increases in premiums for the lowest-cost plans are likely to calm supporters of the law who fear it was permanently damaged by its bumpy rollout last year.

The federal government and insurers may have to wrestle with additional paperwork problems if many people do decide to shop around. Gaps in the site's behind-the-scenes technology mean that the system doesn't yet have a way to tell insurers when a customer leaves them to switch to a new plan, insurance-industry officials have said. That increases the likelihood that some people who switch plans may find themselves enrolled in two insurance policies at the start of the new year.

http://online.wsj.com/articles/healthcare-gov-rolls-out-lineup-of-2015-health-plans-1415628091

[CountDeMoney]

As a result, most people who bought coverage through the site last year will see their premiums increase for 2015, at the same time that the lowest rate available on the site remains relatively steady.

Mine is going up, but I'm not switching plans.

[Admiral Yi]

How much subsidy do you qualify for?

[CountDeMoney]

Roughly $60 a month, but I didn't take it.  Just wanted to purchase it outright, without any additional bullshit.  May try it this year, though.

[Berkut]

They just told us that our premiums were going up $480 this year, so $20 per pay period for family coverage.

Turns out that with this change I will be paying $2900/year, and my employer will be paying $19,355/year. So I guess I am doing ok.

[KRonn]

I haven't heard anything yet about premium increases. I work for a health care org that offers several plans, one being its own plan which is administered by an insurance company and that's the one I have. I'm assuming we'll see price increases but haven't heard as yet.

[The Minsky Moment]

The Supreme Court is taking the challenge to the subsidy provisions of ACA, even though the DC circuit case is still pending.  Which is probably not a good sign, at it might suggest at least 4 justices are ready to gut the law.  Although it could be one or more voted to grant cert to get the issue resolved faster and remove any cloud.

[Admiral Yi]

What's argument about the unconstitutionality of the subsidy?