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Retirees Have Some Options to Pay for High Medical Costs

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Retirees Have Some Options to Pay for High Medical Costs Filed under: Retirement, Long Term Care Insurance, Health Insurance, Retirement Living

*AVAVA*

By Brian O'Connell

Carl Stoces, a 70-year-old Monterey, Indiana, resident, recently fell off an extension ladder and suffered a traumatic leg injury. He was airlifted to Memorial Hospital in South Bend and had a two-month rehab stay in a nursing home. "The bills that resulted were overwhelming, and the payments would have never been manageable for my fixed retirement income," he says.

Fortunately, a hospital program called CarePayment allowed Stoces to finance his payments, starting at $54 a month. "I was immediately relieved," he says. "I had no options. For me, it was one of the greatest things that has happened. Now I can pay my bills off, and that's good for me and the hospital."

Of course, financing is a temporary measure -- you still have to pay the bills off, sooner or later, and health care bills can really mount later in life. According to Bankrate.com (RATE), high medical expenses are the biggest financial worry in for retirees like Stoces. That's true even for people earning more than $75,000 a year, who are "more concerned about high medical expenses than the overall population."

"Health care costs can be one of the most difficult, yet also most critical, expenses to project in retirement," says Joe Jennings, vice president of PNC Wealth Management (PNC) in Baltimore. "Not only do they have the potential to consume a disproportionate amount of a retiree's income, but they have also been rising at a rate much higher than inflation. Another concern is that while life expectancy for retirees continues to rise, many retirees fear they may live longer, but with a lower quality of life due to health-related issues."

*Getting the Right Coverage*

Jennings says the key is to understand what insurance coverage retirees currently have, how they may need to supplement that coverage and whether long-term care insurance is appropriate.

"Cash-flow projections and a retirement income analysis employing various scenarios with different health care needs and expenses should be performed to determine best, median and worst-case scenarios," he says, with the idea being to figure out whether "your income and assets will be sufficient to cover the worst-case scenario.""Always be conservative in estimates and plan for the worst-case scenario to determine where any shortfalls may exist."

Yet Americans are failing, and in somewhat spectacular fashion, in planning for future medical expenses. According to a study from the Washington, D.C.-based National Foundation for Credit Counseling, most Americans don't even have $1,000 put aside for medical emergencies. Some health care consumers are working with financial professionals to create a "patchwork" strategy to cover health care costs in retirement, and they're making some progress.

*Health Savings Accounts*

"A few years ago I was meeting with a client who casually mentioned that he was worried about being laid off, as his company was starting to downsize parts of his division," says Mathew Dahlberg, a financial adviser at 111th Street Investments in Kansas City, Missouri. "While the client, aged 62, had been looking forward to retiring, he was worried that he would not be able to afford health coverage on the individual market for himself and for his non-working spouse." The client and his wife were in relatively good health, but he wanted to protect his retirement savings until he could apply for Medicare at age 65.

"After some research, the client, his wife and I came up with a solution: the client would opt for the high-deductible health plan offered through work so that he could sign up for a health savings account at the same time," Dahlberg says. That's a creative approach, as the HSA provides for tax benefits and, more importantly, are available regardless of income.

Supplemental insurance and long-term care insurance are options for worried seniors. "There really is something for everyone, including plans that cost very little and let you sort of pay as you go," says Danielle Kunkle, vice president of Boomer Benefits in Fort Worth, Texas.

But Kunkle sees the fear in the eyes of retirees when she discusses future health care costs, and it's not a pretty sight. "I'll never forget one of my Medicare 101 presentations at a local hospital a couple of years ago," she says. "During my Q&A session at the end, one of the attendees stood up and said: 'There should be a mandatory class that all Americans must go through at age 50 to explain how much these things cost, when we still have time to prepare for it. To find this out now is just devastating.' I couldn't have put it any better myself."

 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 10 hours ago.

Insperity Forms Broker Alliance with UnitedHealthcare

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Insperity Forms Broker Alliance with UnitedHealthcare HOUSTON--(BUSINESS WIRE)--Insperity, Inc. (NYSE: NSP), a leading provider of human resources and business performance solutions for America’s best businesses, today announced a strategic alliance with UnitedHealthcare and its broker distribution partners. The rising costs associated with health care reform created an ideal opportunity to align forces and provide a greater value to companies facing substantial increases in health insurance cost. “The complexity and costs associated with health c Reported by Business Wire 7 hours ago.

Let's Talk King v. Burwell and the Potential Impact of Higher Health Care Costs on Patients

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When you've read about the King v. Burwell case, particularly on important days for Supreme Court decisions like today, you've probably read conflicting reports. Do the tax credit rules for state-facilitated marketplaces apply to the federal marketplace? Ultimately, we're wondering: How could the Supreme Court decision really affect the average patient? According to an ASPE report released in 2012, 8 in 10 (1.6 million) eligible, previously uninsured Asian Americans & Native Hawaiians and Other Pacific Islanders (AA&NHOPIs) qualify to receive tax credits in the Health Insurance Marketplaces, or are eligible for Medicaid or the Children's Health Insurance Program (CHIP).

What does that mean for health center patients? If you work in a health center, you know better than anyone. Removal of the tax credits means increased costs incurred by patients, sometimes deterring them from getting, or even accessing, the care that they need. Forget that annual blood pressure screening. Forget getting those more expensive medications that are not available in generic form.

Removal of the tax credits from the Affordable Care Act means worse health outcomes for health center patients. Those who could have entered the health system at an early and treatable point of a health condition may end up visiting their health center/ER with a much more complicated (and costly) issue. Not only is this a moral argument, it's a basic public health argument.

So what does that mean? More complicated conditions ultimately mean higher costs to the health system. You know that. Together, we need to talk about the impact of higher costs, caused by the potential removal of the tax credits, on AA&NHOPI patients going to health centers.*See the harms to AAPCHO center patients highlighted in two amicus ("friend of the court") briefs led by Action for Health Justice and the National Association of Community Health Centers. Reported by Huffington Post 6 hours ago.

"There’s Going To Be Chaos" - What Is The Worst-Case Outcome Of Today's Supreme Court Obamacare Hearing

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There’s Going To Be Chaos - What Is The Worst-Case Outcome Of Today's Supreme Court Obamacare Hearing Today, for the second time since 2012, the fate of Obamacare lies in the hands of the Supreme Court, and like last time, it will likely be all about Justice John Roberts ' decision. Later today, the US Supreme Court will hear oral arguments in the case of King v. Burwell, the latest challenge to Obamacare, and one that could potentially leave it gutted from an unexpected direction. As a result, *nearly eight million Americans could lose their health insurance depending on how the Supreme Court interprets four words in the "Affordable" Care Act.*

But while the law, or rather "tax", was already found to be constitutional in the Scotus 2012 ruling, the current case centers on whether, as many Republicans argue, one line in the law was intended to restrict subsidies to people who bought insurance through a state exchange or whether, as Democrats contend, that line was a simple oversight in the law’s drafting.

As Bloomberg adds, the new case is narrower, centering on the statute’s language: *At issue is whether Obamacare can provide subsidies nationwide to people who buy insurance, or only to those in the states that have set up their own online marketplaces, known as exchanges.*

Here are the four words that could make or break Obamacare:



The statute says people qualify for credits when they buy insurance on an exchange *“established by the state.” *Those four words matter because only about one-third of the states have set up exchanges, with the rest relying on the federal healthcare.gov system. The challengers contend that the people who buy on the federal exchange can’t claim the subsidies.

 

The group behind the suit, the Competitive Enterprise Institute, describes itself as an advocate for limited government and individual liberty. According to the Washington Post, the group’s financial supporters include companies tied to Charles and David Koch, the billionaire brothers who fund conservative causes.

 

*The institute represents four Virginia residents who say they don’t want to buy the insurance required under Obamacare*. Should the court block the subsidies, the four say they would fall within an exception to the insurance mandate for people who can’t afford coverage. One lurking issue that may arise during argument is whether any of the four has suffered the type of legal injury that entitles them to sue.



As Bloomberg also notes, a decision against the Obama administration would wipe out the tax credits that make insurance affordable for millions of people under the law. It would also leave hospitals with billions of dollars in unpaid bills and potentially cause insurance markets to collapse.

“If the court rules for the challengers, *there’s going to be chaos*,” said Abbe Gluck, who teaches at Yale Law School and backs the administration in the case.

That may be a tad dramatic, but as the NYT breaks down, roughly 7.5 million people could lose their subsidies in 34 states (shown on the map below). . The status of people in three other states — Oregon, Nevada and New Mexico — is unclear because those states at one time intended to run their own marketplaces, but now rely on the federal government to manage them.

While it is difficult to handicap what the odds are of an adverse, if mostly for Obama's legacy, ruling, Reuters reports that "a growing number of U.S. patients and their doctors are already devising a Plan B in case they lose medical coverage, as even physicians who think the court will uphold the subsidies are gearing up for the worst. As a result, doctors are "dusting off playbooks they retired when Obamacare slashed the number of uninsured people."

From Reuters:



Interviews with doctors reached through professional groups show that they are lining up free clinics to care for patients with chronic illnesses, asking pharmaceutical companies to provide discounted drugs, and moving up preventive-care appointments and complicated procedures.

 

*"We have to be able to navigate this on behalf of our patients if it comes about," *said Dr. Jeff Huebner, a family physician in Madison, Wisconsin, one of the affected states.

 

Many providers as well as patients are unaware of the looming threat, but some physicians are already preparing for it.



Huebner adds that he "would advise patients in this boat to schedule a visit with their primary care provider as soon as they can" to set up "transition plans." Other doctors, such as pediatrician Marsha Raulerson in Brewton, Alabama has persuaded one drug company to provide an expensive asthma medication to one of her patients if she loses her insurance. "But after a few months you have to re-apply" and show that the patient is still unable to afford medication, Raulerson said. "It's not an easy process, especially if you have to do it for a lot of patients." She is also stockpiling as many free samples as she can.

Dr. Robert Wergin, a primary care physician in Milford, Nebraska, is scrambling to locate labs and imaging centers that offer the lowest prices for blood tests, X-rays and MRIs.

"Around here, people feel responsible for their bills and I'm not sure they would come in if they lost insurance and couldn't pay," Wergin said.

In retrospect, perhaps chaos is not all that dramatic:



Yolanda Diaz, 27, is one of them. A single mother of two, she suffers from occasional blackouts that last several minutes. She cannot afford the full premium on her wages as a pantry manager at Brevard County, Florida, community center so she pays $74.95 a month and the rest is covered by a $205 Obamacare subsidy.

 

Her coverage began this month, Diaz said, and the first thing she did was make appointments for an MRI and CT scans in hopes of identifying the cause of the blackouts.

 

"I would hate to have to go to the ER, but if the subsidies get taken away I don't know what I'll do," she said. U.S. law requires hospitals to treat all emergency cases regardless of ability to pay, so many uninsured patients seek care there.

 

Of those expected to be priced out of insurance in case of unfavorable ruling, the Urban Institute estimated 81 percent are, like Diaz, employed full- or part-time.



To be sure, the Obama administration is confident the worst will not come to pass: it contends that the phrase is a “term of art,” and says that other parts of the law show that there is no distinction between federal and state run exchanges.

“If you look at the law, if you look at the testimony of those who were involved in the law, including some of the opponents of the law, the understanding was that people who joined the federal exchange were going to be able to access tax credits,” President Obama said in an interview with Reuters. “And there’s in our view not a plausible legal basis for striking it down.”

Enter Plan B, or lack thereof (just like the ECB, which as we all know lied to Zero Hedge that it didn't have a Plan B on Greece, when it in fact, only it called it a Plan Z):



The Obama Administration has stated it has no backup plan ready if the Supreme Court rules against it. “*If they rule against us, we’ll have to take a look at what our options are,” Obama said recently. “But I’m not going to anticipate that. I’m not going to anticipate bad law.” *

 

Republicans on the other hand, are eager to show they have a Plan B. In the past two days, lawmakers from the House and the Senate have said they’re in the process of working on alternatives to the law, should the Supreme Court rule in favor of the plaintiffs. Reps. Paul Ryan, John Kline and Fred Upton wrote in the Wall Street Journal, they’re proposing an “off-ramp out of Obamacare,” that would allow states to opt-out of insurance mandates and offer options for those who can’t otherwise insurance. Sens. Orrin Hatch, Lamar Alexander and John Barrasso wrote in the Washington Post, they too would help those who can’t afford coverage during a “transitional period” and let states create alternative marketplaces.



So as we head into today's oral argument, much is once again at stake. For those seeking further detail, here is some additional Q&A on the outcome courtesy of Bloomberg:

*1. What is the administration’s argument?*

The administration says the disputed phrase is a term of art that includes a federally facilitated exchange. U.S. Solicitor General Donald Verrilli urges the court to look beyond the “established by the state” wording to the rest of the act and its broad purpose of providing coverage to tens of millions of uninsured Americans.

Verrilli says Congress designed the law with the goal of offering tax credits nationwide and argues that no member of Congress suggested otherwise during the debate over the measure, which is President Barack Obama’s biggest legislative initiative.

*2. What will happen if the court rules for the plaintiffs?*

Prepare for falling dominoes. Within a matter of weeks, the healthcare.gov system would have to stop providing tax credits for an estimated 7.5 million Americans in the 34 states that never authorized their own exchanges. Many of those people would probably find premiums unaffordable without the subsidies and would drop their coverage, boosting the ranks of the uninsured.

Yet those who are sick and need insurance would probably try to hang onto their coverage, as healthy people dropped out. Insurers call this phenomenon “adverse selection,” and say it inevitably results in premiums spiraling upward. The Urban Institute estimates that premiums would increase by 35 percent, on average.

Doctors and hospitals, faced with more uninsured patients, would be forced to provide more uncompensated care. If they try to make up for the losses by charging commercial insurers higher prices, that would raise health-care costs for everyone.

Finally, the law’s requirement that employers provide insurance to their workers would be gutted in states where subsidies aren’t legal. Penalties on employers for not providing coverage are triggered when their workers receive a subsidy for an Obamacare plan; without subsidies, there’s no penalty.

*3. How would the federal government and states respond?*

It’s unclear. Representative Paul Ryan of Wisconsin, the Republican chairman of the powerful House Ways and Means Committee, has said his party will design a “bridge out of Obamacare” for people in states affected by the ruling. There’s no agreement among Republicans on how such a policy would work.

States could respond by simply setting up their own exchanges. The Obama administration could make that easier, for example by letting them use healthcare.gov to sell insurance online.

However, the U.S. health secretary, Sylvia Mathews Burwell, said in a Feb. 24 letter to Congress that the administration couldn’t do much on its own.
“We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse decision,” she wrote.

*4. What is corporate America’s take on the case?*

The hospital and health-insurance industries are backing the administration. That includes HCA Holdings Inc., the hospital chain that is the nation’s largest private health-care provider. Trade groups for the hospital and health-insurance industries are also urging the court to back nationwide subsidies.

*5. Who holds the pivotal vote?*

The most likely candidate is Chief Justice John Roberts. He cast the decisive vote in 2012, joining the court’s four Democratic-appointed justices to uphold the core of the law. The other four Republican appointees voted to invalidate the entire measure, saying Congress exceeded its authority.

Opponents of Obamacare accused Roberts, normally the leader of the court’s conservative wing, of betrayal. Those criticisms escalated after CBS News reported that the chief justice first voted against the administration and then switched sides.

*6. Which way is Roberts likely to go?*

Both sides can find reasons for hope. Roberts is no stickler for statutory wording. He reads laws against the backdrop of institutional principles that Gluck says might cut in the administration’s favor, including deference to the views of administrative agencies.

In a 2009 case involving the Voting Rights Act, as well as the 2012 health-care decision, Roberts deviated from what he said was the most natural reading of a law to avoid declaring it unconstitutional.

“The chief is an institutionalist,” Gluck said. “He’s not a hyper-literalist.”

Jonathan Adler, a law professor who was one of the first to make the case against nationwide subsidies, says Roberts is more inclined to adhere to a statute’s wording in non-constitutional cases.

“The chief certainly is willing to bend a statute in order to avoid declaring a statute unconstitutional, but that’s not at issue here,” said Adler, who teaches at Case Western Reserve University in Cleveland.

One other factor: As chief justice, Roberts has always kept one eye on the court’s institutional integrity. One theory is that he was driven in 2012 by concern that a ruling striking down the law would be seen as a political decision.

If true, that thinking might suggest another Roberts vote in favor of the administration and another close call for Obamacare.

* * *

Finally, here is some visual detail courtesy of the NYT:

*How would insurance coverage change?*

The effect of a court decision would not be limited to the people currently receiving subsidies in the federal marketplaces. People who buy their own health insurance in those states, even without subsidies, could be affected, because rates would increase if insurance pools become older and less healthy. Estimates from the Urban Institute prepared for The New York Times show how a post-King world would look compared with the current trajectory for the Affordable Care Act — or if the health law had never passed.

*Which groups would be most affected?*

The people who would lose their insurance are more likely to be white, high-school graduates, employed and from the South.

*What about the rest of the states?*

States that run their own insurance marketplaces would be unaffected by a court ruling, meaning a widening gap between insurance coverage in the two groups of states. The Urban Institute estimated the outcome for federal and state-run marketplaces by 2016.

*How will the states react?*

Under any court ruling, states will have the power to restore their residents’ subsidies if they establish their own exchanges. It would not be easy, but some states face more hurdles than others. Here is a look at the status of the states that could be affected. Some have already begun doing the work of building exchanges. Some have signaled weak interest and taken little action. Others have already set up legal impediments. Reported by Zero Hedge 6 hours ago.

Obamacare at the Supreme Court: Round 2

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A decision could cut off health insurance subsidies to more than 7 million. Reported by Politico 4 hours ago.

Supreme Court Hears Arguments in Test of Health Care Law

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After arguments are heard Wednesday, the court’s decision, expected by late June, will determine whether roughly seven million people in some three dozen states will continue to receive subsidies to help them buy health insurance. Reported by NYTimes.com 5 hours ago.

Twitter chatter predicts health insurance marketplace enrollment

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An increase in Twitter sentiment (the positivity or negativity of tweets) is associated with an increase in state-level enrollment in the Affordable Care Act’s (ACA) health insurance marketplaces — a phenomenon that points to use of the social media platform as a real-time gauge of public opinion and provides a way for marketplaces to quickly identify enrollment changes and emerging issues. Reported by Science Daily 3 hours ago.

In shadow of Obamacare hearing, Supreme Court hands online retailers a victory

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Though the decision will be rightly overshadowed by the court's hearing of the King v. Burwell case regarding health insurance subsidies, the Supreme Court just handed a big victory to online retailers. Tuesday, Justice Clarence Thomas issued an opinion in the Direct Marketing Association v. Brohl case, giving a solid victory to online retailers such as Amazon. Colorado law requires online retailers to send customer information to the state in order to enforce online sales taxes. The Direct Marketing… Reported by bizjournals 4 hours ago.

This comment from Justice Kennedy could signal a win for Obamacare

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This comment from Justice Kennedy could signal a win for Obamacare The Supreme Court is in the middle of hearing arguments in a case that could gut Barack Obama's signature health reform law, and legal experts are focusing on one comment from Justice Anthony Kennedy.

Kennedy, a key swing voter, said during the first half of oral arguments on Wednesday morning that he sees a "serious Constitutional problem" with the interpretation of the Affordable Care Act (ACA) set forth by the plaintiffs who are trying to strike it down.

"If that's Kennedy's view of the case, there's almost no chance that the challengers can win," UCLA constitutional law professor Adam Winkler told Business Insider.

The current fight over the Affordable Care Act (ACA) centers around whether the federal government can keep subsidizing insurance in the roughly three dozen states that have not set up their own insurance marketplaces. The health reform law laid out a plan where states set up their own exchanges but said the federal government could step in and set up the exchanges for the states if they couldn't do it on their own.

In reality, 34 states have not set up their own exchanges. Now opponents of Obamacare are claiming the law only allows subsidies in states where a healthcare exchange has been "established by a state."

If the opponents win, people in all of those states would effectively lose their health insurance unless they set up their own exchanges. Justice Kennedy appears to have a problem with that scenario because it would effectively coerce states into setting up their own exchanges if they wanted their citizens to have insurance. Kennedy doesn't like that because he's a big fan of federalism.

From SCOTUSBlog:

Simply put, Kennedy expressed deep concern with the federalism consequences of a reading that would coerce the states into setting up their own exchanges to avoid destroying a workable system of insurance in the state. 

The high court will issue its opinion in the next few months, and all eyes will be on Kennedy and Chief Justice John Roberts, a conservative who surprised everybody in 2012 when he voted to save Obamacare.

Join the conversation about this story »

NOW WATCH: 11 Facts That Show How Different Russia Is From The Rest Of The World Reported by Business Insider 4 hours ago.

Supreme Court Appears Sharply Split in Case on Health Law

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Oral arguments were heard Wednesday in a case that will determine whether millions of people will continue to receive health insurance subsidies. The court’s decision is expected by late June. Reported by NYTimes.com 3 hours ago.

How's That Deflation Working Out For You?

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How's That Deflation Working Out For You? Submitted by Jim Quinn of The Burning Platform blog,

The BLS put out their monthly CPI lie last week. *They issued the proclamation that inflation is dead.* Did you know your costs are 0.1% lower than they were one year ago. They then used these deflation numbers to proclaim your real wages soared last month. It’s all good. *The American consumer is so flush with cash, they decided to spend less money for the second month in a row.* The Wall Street shysters are so happy with declining consumer spending, declining corporate profits, and a global recession, they pushed the NASDAQ up to 5,000 for the first time in 15 years. Hey!!! That was the year 2000. Things really got better after that milestone.

So we know gasoline prices have plummeted in the last year (but are up 20% in the last month), but I’m trying to think of other things I use in my everyday life that have declined in price. Maybe going through the BLS detailed list will jog my memory. Here is the link to their data:

http://www.bls.gov/cpi/cpid1501.pdf

Let’s see how much deflation we’ve experienced in the last year for things we need to live our everyday lives.

· Beef and veal  +22.5%
· Ground beef  +21.0%
· Steaks  +14.9%
· Pork  +7.4%
· Ham  +11.5%
· Whole Chicken  +6.1%
· Fresh Fish  +3.5%
· Eggs  +8.2%
· Cheese  +7.8%
· Fresh Vegetables  +4.3%
· Lettuce  +12.2%
· Tomatoes  +9.6%
· Coffee  +6.7%
· Butter  +19.5%
· Restaurant food  +3.1%
· Housing  +2.9%
· Hotels  +7.6%
· Owners Equivalent Rent  +2.6%
· Homeowners Insurance  +5.6%
· Electricity  +2.5%
· Water & Sewer  +5.5%
· Home Repairs  +4.4%
· Footwear  +2.6%
· Car Insurance  +5.0%
· Parking Fees & Tolls  +2.3%
· Medicinal Drugs  +4.2%
· Prescription Drugs  +5.6%
· Hospital Services  +4.3%
· Veterinarian Services  +3.2%
· Sporting Events  +3.6%
· Newspapers & Magazines  +4.6%
· College Tuition  +3.6%
· Educational Books & Supplies  +6.5%
· Grade School & High School Tuition  +4.0%
· Childcare & Nursery School  +3.0%
· Postage  +3.6%
· Cigarettes  +2.5%
· Financial Services  +5.7%
· Tax Return Prep  +9.3%

*These figures are directly from the BLS website. *These are the annual price increases of things most Americans need to purchase on a regular basis. I know most of them affect me every day. My weekly grocery bill is much higher than it was one year ago, and we don’t buy nearly as much steak or beef as we did last year.

The price of oil and gas has certainly declined by the 30% or so in the BLS figures, but it doesn’t come close to covering the price increase in food and other living expenses. The BLS declares we are experiencing deflation and our wages are expanding in real terms. It’s a bold faced lie. The other items declining in price are mostly discretionary items which might be purchased every few years. Furniture, appliances, computers and TVs are falling in price. I didn’t buy any of those items in the last year, so the lower prices had ZERO impact on me.

Apparel falls in price, but is made so cheaply in Chinese slave labor camps, you only get half the use out of it before you have to replace it. I’m guessing the BLS hasn’t factored that into their little calculation.

*And now for the BIGGEST LIE in the entire report.* The have the balls to tell you that *health insurance only makes up 0.753% of your entire annual budget* and it has FALLEN by 0.5% in the last year. This must be some cruel Obamacare joke perpetrated by these government apparatchiks. I haven’t met anyone who has seen their health insurance costs go down in the last year. My premiums went up by 20% and my annual family deductible went from $0 to $2,000. How the BLS can get away with issuing this drivel is beyond my comprehension. It’s pure and utter bullshit.

*I wonder if the sheep actually believe what the government peddles. Does anyone with two brain cells think their daily living expenses are declining? Do they really think their wages are going a lot farther? Evidently not, because they have stopped spending money.* Reported by Zero Hedge 4 hours ago.

Apple Security Guards Promoted to Full-Time Staff

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Security staff will soon be entitled to full health insurance, retirement contributions, and new-parent leave. Reported by PCMag.com 4 hours ago.

Supreme Court Obamacare Arguments Offer Small Hints Of Outcome

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WASHINGTON -- A lawsuit challenging the Affordable Care Act received a serious hearing at the Supreme Court Wednesday, as lawyers from both sides faced tough questioning from justices, making it difficult to predict how the court will rule and whether millions of people will have to relinquish their health insurance.

The interplay between the justices and the attorneys representing the plaintiffs and President Barack Obama's administration mainly aligned with partisan expectations, covering familiar ground -- the meaning and context of a few key words in the statute and what Congress was trying to do when it wrote the law.

But the justices spent a great deal of time discussing federalism -- specifically, whether the plaintiffs' reading of the Affordable Care Act would cause inappropriate federal coercion of state governments. Critically, Anthony Kennedy, a conservative justice and possible swing vote, seemed particularly animated about the issue -- and asked repeated, tough questions of Michael Carvin, the plaintiffs' attorney.

"There's some serious constitutional problems if we adopt your argument," Kennedy said.

Over the course of more than an hour in front of a packed courtroom, the nine justices heard oral arguments in King v. Burwell, one of the most highly anticipated and potentially consequential cases of this term.

The lawsuit does not seek a ruling on major constitutional matters, as previous lawsuits against Obamacare did. Instead, it asks the justices to determine what the text of the Affordable Care Act means and, in particular, whether a few key words, “established by the state,” condition the availability of Obamacare’s generous tax credits on the actions of state officials.

The controversy in King v. Burwell focuses on the exchanges run by the federal government through HealthCare.gov: Can people buying coverage there receive Obamacare's tax credit subsidies for low- and moderate-income households? The plaintiffs in King say no. The government says yes.

One issue in this case is whether the plaintiff's reading is unconstitutionally coercive to states, in part because the language in question is buried in the statute and because the federal government never communicated to states their residents would lack access to subsidies if officials decided not to create a state-run exchange.

The Affordable Care Act calls for the creation of exchanges through which people can buy health insurance. States have the option to operate them.When states chose not to, the U.S. Department of Health and Human Services took on that task. Just 13 states and the District of Columbia currently fully run their own health insurance exchanges.

Chief Justice John Roberts said little during the arguments. Fellow conservative justices Antonin Scalia and Samuel Alito were generally more skeptical of U.S. Solicitor General Anthony U.S. Solicitor General Anthony Verrilli arguments, while justices Elana Kagan, Sonia Sotomayor and Stephen Breyer pressed Carvin harder. Justice Clarence Thomas did not speak, as is his custom.

The stakes in this case are enormous -- and, in some ways, unprecedented. If a majority of the justices are persuaded to support the King lawsuit, millions of Americans, across more than 30 states, would lose the financial assistance that allows them to buy insurance -- and, in the process, most would likely lose health insurance altogether. The exodus of paying customers would rattle insurers, throwing state insurance markets into disarray.

According to the Rand Corp., as many as 9.6 million people could lose their health insurance if the disputed subsidies were invalidated. An Urban Institute analysis concluded that these individuals are predominately working, white and Southern. The states that defaulted to federally run health insurance exchanges tend to be governed by Republicans.

Never before in American history has the federal government taken public benefits away from such a large number of people. And while polls indicate the public would want Congress or the states to restore these subsidies, that seems a long shot at best.

Any effort to address the consequences of a high court ruling against the subsidies would run into staunch opposition from Republicans who still want to repeal the entire law, disagreements within the GOP about how to respond, and Obama's reluctance to cast aside more elements of his health care program in order to strike a deal. And state leaders have been unwilling or unprepared to take steps to create new exchanges in the face of the lawsuit, even though that would shield their residents. Reported by Huffington Post 3 hours ago.

Watch: Obamacare Subsidies Challenged in Supreme Court

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Affordable health insurance for millions of Americans is on the line as the Affordable Care Act is tested in front of the Supreme Court for a second time. Reported by ABCNews.com 3 hours ago.

Investors Don't See Supreme Court Stripping Obamacare Subsidies

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As reactions from U.S. Supreme Court Justices to the latest Affordable Care Act challenge trickled from inside the high court to Wall Street, investors in hospital and health insurance company stocks didn’t seem to think a key financial lifeline to the health industry would be taken away. Reported by Forbes.com 2 hours ago.

Justices Sharply Divided Over Obamacare Tax Subsidies

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Justices Sharply Divided Over Obamacare Tax Subsidies Filed under: Health Care, Taxes, Scandals and Lawsuits, Barack Obama, Health Insurance

*Alex Wong/Getty Images*Supporters of the Affordable Care Act gather in front of the U.S Supreme Court during a rally Wednesday.

By MARK SHERMAN

WASHINGTON -- The Supreme Court was sharply divided Wednesday in the latest challenge to President Barack Obama's health overhaul, this time over the tax subsidies that make insurance affordable for millions of Americans.

The justices aggressively questioned lawyers on both sides of what Justice Elena Kagan called "this never-ending saga," the latest politically charged fight over the Affordable Care Act.

Chief Justice John Roberts said almost nothing in nearly 90 minutes of back-and-forth, and Justice Anthony Kennedy's questions didn't make clear how he will come out. Roberts was the decisive vote to uphold the law in 2012.

Otherwise, the same liberal-conservative divide that characterized the earlier case was evident.

Opponents of the law say that only residents of states that set up their own insurance markets can get federal subsidies to help pay their premiums. The administration says the law provides for subsidies in all 50 states.

The liberal justices peppered lawyer Michael Carvin almost from the outset of his argument to limit the subsidies.

Justice Ruth Bader Ginsburg said the law set up flexibility for states to either set up their own markets or rely on the federal healthcare.gov. Giving subsidies only to people in some states would be "disastrous," Ginsburg said.
It may not be the statute Congress intended, but it may be the statute Congress wrote.

When Solicitor General Donald Verrilli Jr. stepped to the lectern, the liberal justices fell silent, and Justices Samuel Alito and Antonin Scalia took over.

"It may not be the statute Congress intended, but it may be the statute Congress wrote," Scalia said of the provision in question. The case focuses on four words in the law, "established by the state." The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies to those consumers who get their insurance through a marketplace, or exchange, that was established by a state.

Verrilli argued that the law can only be read more broadly and noted that millions of people would lose health insurance if the court rules against the administration.

Alito wondered if the justices could delay the effect of such a ruling to allow states and perhaps the federal government to act. Scalia said he believes Congress would act.

"This Congress, Your Honor?" Verrilli said to widespread laughter in a packed courtroom that included leading congressional Democrats and Republicans.

Kennedy voted to strike down the health law in 2012, but on Wednesday he asked questions of both sides that made it hard to tell where he might come out this time.

He suggested that challenger Carvin's argument raised a "serious" constitutional problem affecting the relationship between states and the federal government.

On the other hand, he seemed less than convinced by Verrilli's reading of the law to allow the subsidies nationwide.

*Who's Eligible?*

Millions of people could be affected by the court's decision. The justices are trying to determine whether the law makes people in all 50 states eligible for federal tax subsidies to cut the cost of insurance premiums. Or, does it limit tax credits to people who live in states that created their own health insurance marketplaces?

A ruling that limits where subsidies are available would have dramatic consequences because roughly three dozen states opted against their own marketplace, or exchange, and instead rely on the U.S. Health and Human Services Department's healthcare.gov. Independent studies estimate that 8 million people could lose insurance coverage.

Activists on both sides were in place outside the marble courthouse by 5:30 a.m. Wednesday. Some held placards showing how many people in each state would lose insurance if the court ruled that the law does not allow subsidies everywhere.

Opponents of the Affordable Care Act failed to kill the law in an epic, election-year Supreme Court case in 2012. Chief Justice Roberts joined with the court's liberal justices and provided the crucial vote to uphold the law in the midst of Obama's re-election campaign.

The new case, part of a long-running political and legal fight to get rid of the law also known as Obamacare, focuses on the four words "established by the state" in a law that runs more than 900 pages.

*'Term of Art'*

The administration counters that the law was written to dramatically reduce the ranks of uninsured, and that it would make no sense to condition subsidies on where people live. The phrase "established by the state," is what the administration calls a "term of art" that takes in both state- and federally run exchanges. The administration also says the term cannot be read in isolation, and that other parts of the law show that subsidies should be widely available.

Each side in the case argues that the law unambiguously supports only its position. One other option for the court is to declare the law is ambiguous when it comes to subsidies and defer to the Internal Revenue Service's regulations making tax credits available nationwide.

Partisan and ideological divisions remain stark for a law that passed Congress in 2010 with no Republican votes. Of the judges who have ruled on lawsuits over the subsidies, Democratic appointees have sided with the administration and Republican appointees have been with the challengers.

Roberts was the only justice to essentially cross party lines with his vote in 2012. His fellow conservatives on the court voted to strike down Obamacare in its entirety.

A decision in King v. Burwell, 14-114, is expected by late June.

-Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 3 hours ago.

Tufts Health Plan and Granite Healthcare Network to Launch New Hampshire-based Health Insurance Company, Tufts Health Freedom Plan

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Tufts Health Plan and Granite Healthcare Network to Launch New Hampshire-based Health Insurance Company, Tufts Health Freedom Plan CONCORD, N.H. & WATERTOWN, Mass.--(BUSINESS WIRE)--Combining clinical expertise and a focus on population health management with market leading insurance products and provider network designs, Tufts Health Plan, ranked the No. 1 health insurance plan in the country*, and Granite Healthcare Network, comprising five of New Hampshire’s largest high-value health systems, have signed an agreement to create a new and innovative insurance company. To be known as Tufts Health Freedom Plan, the company Reported by Business Wire 2 hours ago.

Wonkblog: Five key takeaways from the Supreme Court’s Obamacare hearing today

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Based on oral arguments this morning, the latest Supreme Court showdown over Obamacare could lead to another narrow ruling determining the fate of the health-care program. Here are five important takeaways from the hearing in King v. Burwell, a challenge to the financial assistance provided to millions purchasing health insurance through the federal-run exchange offered in states that did not create their own online marketplaces. (Read our guide for everything you need to know about what us to this point.) Reported by Washington Post 2 hours ago.

In King v. Burwell, Supreme Court Must Rule for Our Health

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Today, the Supreme Court heard a landmark case that directly impacts the lives of millions of Americans. At issue in King v. Burwell are the tax credits that millions of Americans in approximately three dozen states receive in order to enable them to purchase quality, affordable health coverage. A ruling invalidating these tax credits would be catastrophic to the American public and the American health care system alike. Those of us in the public health community understand the enormous stakes in this case, and we understand that the clear text, purpose, and history of the Affordable Care Act require a ruling for the administration. A ruling for the administration is also a ruling for our health.

Five years ago, Congress passed the Affordable Care Act, with the intention of expanding access to affordable insurance to Americans. Five years ago, we applauded the move by Congress and President Obama. We applauded the move to expand access to quality care because we believe that access to health care is a fundamental right. Not only is it a fundamental right, but it is integral to the health and well-being of the individuals who gain coverage as well as the health of our communities. This law allows those with pre-existing medical conditions to get coverage, it enables those who could not previously afford care to seek treatment for illnesses that have long afflicted them. The stories of people's first doctor's appointments and diseases caught just in the nick of time and life-saving treatments that were previously out of reach abounded. In short, the law is working just as intended.

Those who have health insurance are more likely to treat illnesses, they are more likely to maintain good health, and they are able to avoid death from preventable diseases. Preventive measures, like mammograms, are more available to those who have insurance. Indeed, the ACA guarantees that a wide range of preventive care is now provided at no additional cost to beneficiaries. Those who have health insurance are more likely to have a usual source of health care than those without it and have better health outcomes. The ACA, and its tax credits that make insurance affordable to millions of people, have fundamentally changed the public health outlook of the country. And removing them would be disastrous.

There is no need to speak in the abstract about the calamitous effects that would come to pass if the Supreme Court takes away these vital tax credits from so many across the country. According to a recent study, 9.3 million people who live in states in which the federal government has set up insurance markets will lose tax credits by 2016 if the Supreme Court decides in favor of those challenging the law. Of those 9.3 million, an estimated 8.2 million people will lose their health insurance.

Care will be delayed, denied, and will once again simply be out of reach for too many. The human cost of care delayed or denied is staggering. As told to the Supreme Court in a brief we filed last month, the loss of health insurance by 8.2 million people can be expected to translate into over 9,800 additional deaths each year.

As people who have spent our lives working to protect and improve the health of people across this country, that number is devastating to the public health community. That almost 10,000 people would needlessly lose their lives if the Supreme Court takes health care away from those who need it is unacceptable. We can't live with that, just like Americans can't, and shouldn't have to, live without access to quality, affordable health care.

The good news is that thanks to the Affordable Care Act, the percent of Americans without health insurance is at or near the lowest level on record and is more affordable for millions. The Supreme Court should rule to uphold the exchange subsidies as legal as implemented by the administration and in line with Congressional intent. Such a ruling will ensure that all exchange participants have access to affordable health insurance coverage and better health. Reported by Huffington Post 37 minutes ago.

Supreme Court: Could Obamacare ruling destroy health insurance for millions?

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If the Supreme Court strikes down subsidies offered through Obamacare's federal exchange, the business model on which the program is founded could fall apart. Reported by Christian Science Monitor 1 hour ago.
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