Obamacare Sign-ups Surpass Official Goal

The Hill: “A total of 10.2 million people bought ObamaCare during the most recent sign-up period, federal officials announced Tuesday. The Obama administration is now officially on track to meet its self-stated 2015 target of 9.1 million customers, the second year in a row that it has achieved a revised enrollment goal.”

“The figure is a drop-off from the 11.7 million people who signed up for coverage during this year’s sign-up period, though that tally had been expected to fall after some people did not make premium payments.”

“The new figures also highlight the stakes for the looming Supreme Court case that could eliminate ObamaCare subsidies for people in the 37 states using the federal marketplace. A total of 6.4 million people who bought ObamaCare in those states could lose the federal aid that helps them pay their premiums, according to the report.”

Most Not Paying Attention to Pivotal Obamacare Lawsuit

Drew Altman: “The Supreme Court’s King v. Burwell ruling will make headlines whenever it arrives. It will also be genuine news to much of the country. The Kaiser Family Foundation’s Health Policy News Index, which tracks how closely the public follows health stories in the news, found that 59% of Americans have not been paying much or any attention to news stories about the case, and only 16% have been following very closely. That means that when the verdict comes the media’s first job will be to explain what the case was about.”

“The degree to which the news media have established the facts will help to umpire the blame game if Republicans in Congress condition an extension of subsidies in affected states on major changes to the law and the president vetoes such legislation and millions of Americans lose coverage. Much of the response to the ruling–like so much else about the Affordable Care Act–will follow partisan perspectives, with Republicans blaming the president and Democrats pointing fingers at congressional Republicans. News coverage could shape opinion in this instance because so many Americans have not been paying attention to the case.”

Which State Would Be Most Affected if SCOTUS Rules Against Obamacare?

Kaiser Family Foundation newsletter: “Using 2015 enrollment data released today, a new Kaiser Family Foundation analysis and interactive map breaks out how residents in each of the 34 states without a state-based exchange would fare” if the Supreme Court rules in favor of the challengers in King v. Burwell.

“The analysis looks at the total number of residents in each state that would lose premium assistance, and the total dollars in subsidies that would be lost in each state, as well as the size of the lost subsidy for the average resident, and the resulting percentage increase in their premiums.”

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“The analysis finds that Florida would be most affected in terms of the number of people losing subsidies (1.3 million), and the total monthly value of those subsidies ($389 million), with Texas ranked second in both categories (832,000 residents losing a total of $206 million per month).”

“When looking at the impact per person, subsidized enrollees in Mississippi fare the worst, with the average enrollee facing an average premium increases of 650 percent if the Court rules for the challengers.”

There’s ‘No Easy Fix’ to an Adverse Obamacare Ruling

The Hill: “The Obama administration is casting doubt on Congress’s ability to pass an ObamaCare ‘fix’ if the Supreme Court decides later this month to gut the healthcare law’s subsidies.”

“With less than a month before the ruling, White House spokesman Josh Earnest is warning that Republicans will not be able to prevent the ‘significant turmoil’ that he said would result from a court ruling against the administration.”

Earnest: “There’s no easy fix to doing that, particularly when you consider how difficult it has been for common-sense pieces of legislation to move through the Congress.”

Meanwhile, “officials from states across the nation flew to Chicago in early May for a secret 24-hour meeting to discuss their options if the Supreme Court rules they have to operate their own exchanges in order for residents to get health-insurance subsidies,” according to the Wall Street Journal.

“Participants said it was extremely unlikely their state governors, legislatures and insurance commissioners would all agree to set up an exchange if the Supreme Court struck down their state subsidies, and that they could do so before the subsidies could vanish.”

“As a result, a few supporters of the law are eyeing fresh workaround options, that even they aren’t sure will work. One possibility is that an agreement, rather than a contract, could be drafted between a governor and the Obama administration to establish a state’s exchange. Others are looking into whether the Department of Health and Human Services could say states have established their own exchanges already by helping the federal government operate an exchange on a state’s behalf.”

Many Insurers Propose Hefty Rate Increases

New York Times: “In a sign of the tumult in the health insurance industry under the Affordable Care Act, companies are seeking wildly differing rate increases in premiums for 2016, with some as high as 85 percent, according to information released on Monday by the federal government for the 37 states using as their exchange.”

“The data from the Centers for Medicare and Medicaid Services included only proposed rate increases of 10 percent or more, and federal officials emphasized that it would be months before final rates were set. Regulators in some states have the authority to overrule rate increases they deem to be too high.”

Politico: “Insurers cite increased medical costs, particularly drug expenses, as a primary driver of the proposed increases. In addition, Obamacare programs designed to entice insurers into joining the marketplaces by protecting them from financial risk are starting to be phased out, meaning companies are directly bearing more of the costs of covering exchange customers.”

“The Obama administration doesn’t have much power to hold down rates. It can’t negotiate with insurers or kick them out of the marketplace if their rates are deemed unreasonable. What federal officials can do is essentially shame health plans proposing unreasonable hikes through public transparency. The ability of states to challenge rates varies, too. A dozen states have no authority to reject premium hikes.”

Wall Street Journal: “Some observers said the requests reflected other ominous signs. The companies with the biggest market shares are raising rates, signaling they don’t care if that causes them to lose enrollment … ‘This is not a good sign,’ … ‘These people are saying they don’t care if they keep the business. They don’t want it if it’s not profitable.’”

How an Obamacare Loss Means a Loss for Republicans

Patrick Egan in the Washington Post argues that the GOP stands to lose if the Supreme Court rules in favor of the plaintiffs in the Obamacare subsidies case, King v. Burwell.

“Dealing with King v. Burwell wouldn’t just be a national problem for the GOP; it would even more profoundly be a local problem for the party. As political scientists Theda Skocpol and Lawrence Jacobs have observed, most of the states that refused to start their own exchanges are either Republican strongholds or those that happened to be under Republican control at the time the exchanges were established. Making things worse for the GOP is that many of these Republican-controlled states have also opted to reject the ACA’s expansion of Medicaid eligibility to those just above the poverty line. As RAND has noted, this has forced more of these states’ residents to rely on tax credits — and thus the federal exchange — to pay for health insurance.”

“The upshot is that a ruling for the King plaintiffs would require millions of red-state Americans to pay more for their health insurance, while leaving many blue-state residents completely untouched. This is shown in the chart [above], which plots the share of each state’s residents estimated to lose tax credits if the lawsuit succeeds against the share of the two-party vote received by Republican Mitt Romney in the 2012 presidential election.”

GOP: Total Obamacare Repeal is Impossible

Politico: “The GOP’s months-long debate over when and how to send a repeal of Obamacare to the president’s desk now appears to have an answer. They can’t do it all at once.”

“Repealing the law ‘root and branch’ is probably out of the question, the chamber’s parliamentarian is hinting, because some parts of Obamacare don’t affect the federal budget. That’s a must in order to use the obscure procedure known in Senate parlance as reconciliation, which allows lawmakers to avoid the 60-vote filibuster hurdle and pass bills on a simple majority vote.”

“That’s not the GOP’s only problem. Under those rules any Obamacare repeal has to reduce — not increase — the deficit. So Republicans will have to pick and choose which parts of the Affordable Care Act they most want to ditch.”

“The entire process has the makings of a difficult political exercise that will reveal something about the GOP’s priorities when it comes to the reviled law, forcing the party to go beyond the pile-on repeal rhetoric and say specifically what it would do and how it would pay for it.”

“The King case is the big X factor in all of this. Should SCOTUS knock down subsidies, most Republicans agree they’ll need to either extend them legislatively or replace the federal help with a health care tax credit. Both options cost money, which would again scramble the reconciliation puzzle.”

Obamacare: Who Signed Up and Where in 2015?

Kaiser Family Foundation: The analysis below and zip code tool estimate the share of the potential Marketplace shoppers in geographic areas across the U.S. who enrolled in coverage in 2015.

Map of the U.S. Shaded to Indicate Coverage Expansion

“Source: Kaiser Family Foundation analysis of federal marketplace signup data by zip code and modeling based on the Current Population Survey (CPS) applied to the American Community Survey (ACS).”

“The results show tremendous variation across the country. signups totaled 90% or more as a share of the potential market in parts of Miami-Dade and Broward counties in Florida; Philadelphia, Pennsylvania; Jackson, Mississippi; and Atlanta, Georgia. Enrollment was less than 15% of the potential market in parts of Texas, Iowa, and Ohio.”

“Even within states, the enrollment results vary substantially. For example, in Florida – a state that in general had strong enrollment with 64% of the potential market signing up statewide in 2015 – the signup percentage ranged from 21% in the Tallahassee area to approximately 100% in parts of Miami. In Texas – a state that had more modest enrollment at 39% of the potential market – the share signing up ranged from 12% in the College Station area to 81% in some Houston suburbs.”

Report: GOP Obamacare Plans Won’t Stave Massive Disruption of Insurance Market

The Hill: “Republicans have spent months pitching ideas on how to limit the potential fallout from next month’s Supreme Court decision that could wipe out ObamaCare insurance subsidies in at least 34 states.”

“But so far, none of their proposals are likely to stave off the massive disruption of the healthcare marketplace that would result from a ruling against the Obama administration, according to a new report by the American Academy of Actuaries.”

“The changes to the risk pool would be particularly costly for insurance companies because they cannot make mid-year adjustments to their rates if the court rules against the subsidies.”

“’That’s the big worry. That’s really the biggest worry for most us working in the field, the fact there’s no ability to reset things,’ said the report’s author, Cathy Murphy-Barron, who has spent 25 years as a health policy actuary.”

“Another popular Republican plan — a temporary extension of premium subsidies — also drew criticism from the American Academy of Actuaries, which warned that it would only ‘delay the market disruption.’”

GOP Split Over Obamacare Alternatives

Wall Street Journal: “A month before the Supreme Court is expected to rule on a key component of the Affordable Care Act, congressional Republicans are split over their strategy for handling the possible fallout.”

“Republicans, who control both houses of Congress, are divided over whether to extend temporarily the health law’s tax credits if the court voids them in most of the country. An extension, some lawmakers say, would buy them time to enact a broader overhaul of the 2010 health law they have long opposed.”

“But some conservatives want the Republican Party to hold firm and refuse any reauthorization of the credits for the law they call ‘Obamacare.’”

“That group of more than 30 lawmakers hasn’t taken a formal position on the issue, but conservative opposition could make it hard to pass legislation in the House.”

“’That view suggests Obamacare was the right answer and that’s not what Republicans promised last fall,’ said Rep. Tim Huelskamp (R., Kan.). ‘This is a golden opportunity. If Republicans squander this opportunity to repeal and replace Obamacare, they squander an opportunity to actually win the White House. It’s not the time to support and extend Obamacare.’”

Party That Wins Obamacare Lawsuit Could Be the Loser

Associated Press: “The party that wins the impending Supreme Court decision on President Barack Obama’s health care law could be the political loser.”

“If the Republican-backed challenge to the law’s subsidies for lower-earning Americans prevails, the GOP would have achieved a paramount goal of severely damaging “Obamacare.” But Republican lawmakers would be pressured to help the millions of Americans who could suddenly find government-mandated medical coverage unaffordable — and they’d face blame from many voters if they failed to provide assistance.”

“Should the Obama administration win, relieved Democrats would crow that Obama’s foremost domestic achievement had stood unscathed. But some say they’d have lost a potentially powerful cudgel for the 2016 campaigns: Being able to accuse Republicans of ending the assistance and disrupting health coverage for many.”

“Not everyone thinks their party will lose politically should they win in court. Many Republicans say if the Supreme Court rules that subsidies were provided illegally, it would be the Democratic administration’s fault for doing so, not the GOP’s.”

States Team Up To Keep Obamacare Sustainable

Fiscal Times: “A handful of states struggling to finance their Obamacare health exchanges are considering teaming up with other states to keep their insurance portals sustainable as federal funds run out this year.”

“A number of states including California and Oregon are having trouble financing their exchanges now that federal funding is drying up. Covered California, for example, is running a deficit of $80 million.”

“To save on costs, California is reportedly in talks with Oregon, another state struggling to afford its exchange, to merge their exchanges.”

“They’re not alone. Other states are contemplating building similar multi-state exchanges. New York and Connecticut are also discussing the plan, though both are in the very preliminary stages … The option is seen as an alternative to joining the federal exchange as other struggling state exchanges, like Nevada, have done.”

Obamacare Lawsuit: An Empty Suit?

Jonathan Chait comments on the latest news related to the Obamacare subsidies case “reassuring those of us who followed the health-care debate when it happened that we are not completely insane.”

“It is difficult to convey to people who don’t follow health care for a living just how preposterous the lawsuit against Obamacare has become. The original theory behind the lawsuit seized upon a tiny drafting error.”

“At the beginning of the legislative process, the law’s authors assumed that states would be happy to build their own exchanges. As it proceeded and the backlash reached a fever pitch, Congress realized that Republican states might boycott the exchanges, and created the federal exchanges as a fallback. But they failed to correct every line in the text, leaving one stray passage that assumes exchanges will be created by a state.”

“And so we are left with a lawsuit that is likely to gain at least three, and possibly as many as five, votes on the Supreme Court despite the fact that it rests on a history that is almost literally insane. Even those of us who have a low estimation of the intellectual standards of the conservative movement have been astounded by its ability to persuade itself of a historical theory so clearly at odds with reality.”