Everybody seems to be missing the real issue at stake in the decision by at least four Supreme Court Justices to hear an appeal of a Fourth Circuit Court of Appeals decision affirming the applicability of Federal insurance subsidies for qualified individuals who purchase "ObamaCare" insurance policies on Federal Exchanges set up for States whose governments chose not to establish one for their State.

This case, King v. Burwell, involves not a Constitutional question per se but rather a challenge to an IRS interpretation that allows subsidies for insurance purchased on Federal Exchanges despite statutory language that could be read to limit their availability only to those who purchase insurance only on an Exchange which a State has chosen under the law to "establish" itself directly rather than leaving it to the Federal government to set one up for it. The plaintiffs in the case (King et al) are Virginia residents who argued that the IRS decision allowing subsidies provided via the Federal Exchange set up when Virginia's government refused to establish an ObamaCare Exchange on its own deprived them of an exemption from the Affordable Care Act's "individual mandate" to purchase health insurance. They claim that absent such subsidies all policies available to them on the Federal Exchange would cost more than the 8% of their income that serves as a trigger for such exemptions.

While the legitimacy of the IRS determination to allow such subsidies would seem to simply involve a Federal statutory question concerning the scope of administrative flexibility in interpreting the ACA's grant of subsidies, the plaintiff's argument in King v. Burwell opens the door to a much broader impact on ObamaCare than just the matter of subsidies. It would be huge if the Supreme Court determines the Court was wrong in affirming the IRS interpretation. Estimates indicate that, for the poor and lower middle class, upwards of seven million would lose over $36 billion in subsidies. These losses would affect residents of Texas and Florida (the biggest losers) and 32 other states subject to the King v. Burwell Supreme Court decision. These states are mostly in the hands of Republican governors and legislatures that oppose ObamaCare in principle and the potential "work-around" would depend on those governors and legislators agreeing to "establish" State Exchanges possibly "outsourcing" their operations to the existing Federal Exchange, using their states' own money instead of the Federal funds provided under the ACA because eligibility for those funds just happens to have run out on November 14, 2015! No word as yet on whether the Centers for Medicare and Medicaid would consider extending that deadline in view of the pending Supreme Court decision.

With no "work around," moreover, the dominoes at the heart of the ACA would, as noted above, begin to fall. If no subsidies are available in a particular state (or in the 34 states subject to a King v. Burwell reversal), then the premiums on the policies now on offer in the Federal Exchanges serving those states would exceed 8 percent of their income and therefore they would automatically become exempt from the individual mandate to purchase any health insurance at all. This result would not just affect the poorest families. Young, healthy college graduates -- many burdened by tens of thousands of dollars in student loan debt -- would be free to opt out of buying any insurance on a Federal Exchange or otherwise, and the economics of the Federal Exchange would be severely adversely affected without a balance of relatively healthy individuals to weigh against the insurance claims of more mature families and sub-Medicare elderly. Premiums would go up, enrollments would go down with a ruptured individual mandate.

But that's not the end of the effects of a Supreme Court decision to invalidate Federal subsidies obtained through the Federal Exchange in two-thirds of our states. The employer mandate under the ACA requires employers of more than 50 full-time workers (currently defined as all those working at least 30 hours per week) to either provide a Federally-approved health insurance package or pay an increasingly onerous per-worker tax penalty. For a variety of reasons, some clearly operational, some probably political, the Obama administration gave employers extra time to comply, but the mandate will now begin in 2015 for employers with over 100 full-time workers, and for those with between 50 and 100 in 2016. But if the Supreme Court reverses King v. Burwell by overturning the IRS rule with respect to Federal subsidies, which are in fact delivered by means of tax credits which is why an IRS rule is at issue, the employer mandate is just as fatally wounded as the individual mandate, and the biggest ObamaCare domino of all falls.

The ruling by a Federal Court panel majority in another case brought against the IRS rule on ObamaCare tax credit subsidies, Halbig v. Burwell, points directly to this conclusion. The majority ruled against the IRS subsidy interpretation (the decision has since been appealed to the entire D.C. circuit Court of Appeals), and along the way to this conclusion, laid out its objections to the IRS interpretation precisely focusing on the effect on both the individual and the employer mandate:
"[B]y making tax credits available in the...states with Federal Exchanges, the IRS Rule significantly increases the number of people who must purchase health insurance or face a penalty."

The IRS Rule affects the employer mandate in a similar way. Like the individual mandate, the employer mandate uses the threat of penalties to induce large employers - defined as those with at least 50 employees, (see 26 USC section 4980H9c) (2) (A) - to provide their full-time employees with health insurance. Specifically, the ACA penalizes any large employer who fails to offer its full-time employees suitable coverage if one or more of those employees "enroll...in a qualified health plan with respect to which an applicable tax credit... is allowed or paid with respect to the employee.' Id. Section 4980(a)(2); see also id. Section 4980h (b) (linking another penalty on employers to employees' receipt of tax credits)."

Lest there be any mistaking the view of this judicial panel majority as to the impact of their ultimate decision precluding tax credit subsidies to purchasers on the Federal Exchange, the judges went on to rub it in quite precisely:

"Thus, even more than with the individual mandate, the employer mandate penalties hinge on the availability of tax credits. If credits were unavailable in states with Federal Exchanges, employers there would face no penalties for failing to offer coverage."

If a majority of the Unites States Supreme Court were to agree with the Halbig v. Burwell majority, the last ObamaCare domino would seem to fall, more or less automatically.

And yet the media and even the most ardent supporters of ObamaCare seem to ignore this potential effect. Assuredly, the "large employers" and their lobbyists who are funding the Halbig and King cases have not. Not to mix too many metaphors, but it is most important to understand that both the King and the Halbig cases are twin Trojan Horses: ostensibly about killing ObamaCare subsidies, but really all about indirectly but effectively destroying the individual and employer mandate. In the concluding words of the majority in the Halbig case, its ruling against Federal Exchange subsidies "will likely have significant consequences both for the millions of individuals receiving tax credits through federal r exchanges and for health insurance markets more broadly." (Halbig v. Burwell at p 41.)

All the more so if the Supreme Court agrees.
###By Terry Connelly, Dean Emeritus, Ageno School of Business, Golden Gate University

Terry Connelly is an economic expert and dean emeritus of the Ageno School of Business at Golden Gate University in San Francisco. Terry holds a law degree from NYU School of Law and his professional history includes positions with Ernst & Young Australia, the Queensland University of Technology Graduate School of Business, New York law firm Cravath, Swaine & Moore, global chief of staff at Salomon Brothers investment banking firm and global head of investment banking at Cowen & Company. In conjunction with Golden Gate University President Dan Angel, Terry co-authored Riptide: The New Normal In Higher Education Reported by Huffington Post 37 minutes ago.

Obamacare Back in Supreme Court, As Controversial Law Faces Another Challenge
Has Been Optimized

The United States Supreme Court began hearing arguments on Mar. 4 in the case of King v. Burwell, or in other words, the latest challenge against the Affordable Care Act, or Obamacare.

The justices began by questioning Michael Carvin, the attorney representing the plaintiff in the suit.  The four left-leaning justices – Elena Kagan, Sonia Sotomayor, Stephen Breyer and Ruth Bader Ginsburg – were unsurprising in their tough questioning for Carvin, who is challenging the Obama administration’s clarification of the legislation.

The issue this time with the ACA is whether or not the federal government had the right to provide federal subsidies to states that did not set up their own health care exchanges after the ACA was passed in 2010 and implemented in 2013.  The Obama administration is arguing that if states did not create their own exchanges, then the federal government can provide subsidies to citizens living in said states.  On the other side, Carvin is arguing that the Obama administration is not allowed to do that because the text in the Affordable Care Act allows subsidies for individuals living in exchanges that are “established by the states.” 

The outcome of this lawsuit is crucial to the future of the Affordable Care Act.  If five of the nine Justices agree that the Obama administration violated its own law, then the federal government will no longer be able to provide subsidies to citizens living in states without health care exchanges.  This could affect up to eight million Americans in 34 states, who currently rely on federal subsidies for their health insurance, even though it does not allow that in the national health care legislation. 

In today’s proceedings, it seemed to observers that the debate in the Court would be along ideological lines – the four liberal justices were critiquing Carvin, while the four conservative justices – Samuel Alito, Antonin Scalia, Clarence Thomas and Anthony Kennedy – were less combative in their questioning.  However, Justice Kennedy seemed concerned about the welfare of the states if this section of the ACA was shut down, but did not reveal his decision either way. 

Chief Justice John Roberts, who surprised many political pundits when he voted with the four liberal justices on upholding the health care law in 2012, did not say much throughout the debate, making it difficult to interpret how he may vote.

If the Court rules in favor of the plaintiff, there may be serious ramifications for the Obama administration.  According to U.S. Health and Human Services Secretary Sylvia Mathews Burwell, the federal government does not have a plan B in store to repair the law, saying, “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.”

President Barack Obama also weighed in on the potentially bad outcome for his law, stating, “If they rule against us, we’ll have to take a look at what our options are.  But I’m not going to anticipate that.  I’m not going to anticipate bad law.”

Sources: CNN, the New York Times, Reuters via Yahoo! Finance, Associated Press via Yahoo! News / Photo Credit: Wally Gobetz/Flickr

Comments: 
Likes: 
Shares: 
Combined FB: 
Video Piece: 
Regular Piece
OV in Depth:  Reported by Opposing Views 44 minutes ago.

Family life insurance rates for 2015 are now included in the policy search database for consumers through the Quotes Pros website at http://quotespros.com/life-insurance.html.

Cleveland, OH (PRWEB) March 04, 2015

The coverage provided by insurance companies to individuals does not always offer extended coverage to family members in the U.S. The Quotes Pros company is now making sure that adults who have families can locate family insurance rates for 2015 when using its rates location tool at http://quotespros.com/life-insurance.html.

The emergence of new agencies across the country has made it possible for the QuotesPros.com company to implement the new provider rates now searchable. Adults who seek protection for a spouse and minor children will now have the ability to find family specific plans of coverage for affordable prices.

"Some insurers raise premium rates each year although some companies keep prices the same to offer more value to consumers," said one Quotes Pros source.

The search and compare features that are now provided when making use of the Quotes Pros company portal are powered by the new zip code sort feature. Since some agencies only offer coverage in a targeted region of the country, the new sort process offered to system users is expected to return more available providers that are quoting Internet plans.

"The family insurance providers that appear inside of our revised database represent some of the most known companies on a national level," said the source.

The Quotes Pros search tool also features a new option for adults who need supplemental insurance coverage for a medical or medicare plan. The portal at http://quotespros.com/health-insurance.html now supplies access to supplemental coverage providers to offer a way to seek out affordable rates.

About QuotesPros.com

The QuotesPros.com company supplies adults with a trusted research method for finding insurance policy pricing on the web. The company has launched its open platform for agency research that is now activated and revised for this year. The QuotesPros.com company uses different sources of information to provide insurer data to consumers who are ready to buy or compare a policy type on the Internet. Reported by PRWeb 36 minutes ago.

Job-related stress can be even more deadly than secondhand smoke exposure.

That's according to a study being published next week in the scholarly journal Management Science. Work-related stress, the study finds, is partly to blame for up to $190 billion in health care costs. Specific workplace stressors contribute to 120,000 deaths in the U.S. each year -- more than the number of deaths from diabetes, Alzheimer’s or influenza.

Stanford Graduate School of Business professors Stefanos A. Zenios and Jeffrey Pfeffer and Harvard Business School assistant professor Joel Goh analyzed 228 previous studies to put together a report on the workplace stressors that are most likely to contribute to poor health and even death.

The researchers measured how work-related stressors can impact mortality using an "odds ratio." The ratio indicates how much more likely someone is to experience negative health consequences that could lead to death after being exposed to the stressors versus not being exposed to them.

Here's a chart that shows how five work-related stressors can impact mortality in comparison to secondhand smoke exposure:

(Image credit: Tricia Seibold | Stanford Business)The researchers hope this study will cause employers to put a greater focus on workers' health.

"We have lost focus on human well-being," Pfeffer, one of the study's authors, was quoted as saying on the Insights by Stanford Business website. "It’s all about costs now. Can we afford this, can we afford that? Does it lead to better or worse financial performance for the company? We’re talking about human beings and the quality of their lives. To me, that ought to get some attention."

The study also looked at the impact these stressors have on how employees self-reported mental and physical health, as well as how they're connected with physician diagnoses. Here's a more detailed breakdown on five workplace stressors that are literally killing us, according to the report:
-1. Low job control-
Having a low rank in the hierarchical structure can cause workers to feel like they have no control over their work life. This stress can also increase the risk of cardiovascular disease, a study cited in the paper found.
-2. Unemployment-
Losing your job can have serious negative impacts on your health, per studies cited in the paper. It can double the likelihood of being depressed, and those without jobs are 80 percent more likely to report poor well-being. The negative result is caused by "financial stress resulting from the loss of income and also separation from the social identity of being productively employed and social isolation from coworkers."
-3. No health insurance-
Not having health insurance negatively affects workers in two ways, according to the study. For one, not having insurance increases financial stress, which can be detrimental to health. It also delays getting necessary health care, which can make health issues worse.
-4. Long hours and overtime-
Working long hours is associated with self-reported hypertension, among other health problems.
-5. Work-family conflict-
The study defined this as “when one’s efforts to fulfill work role demands interfere with one’s ability to fulfill family demands and vice versa.” Stress related to this can cause mental and physical health problems and lead to an increased use of alcohol. Reported by Huffington Post 11 minutes ago.

It became clear Wednesday that two men with good health insurance will decide whether 7.5 million Americans lose their coverage. Reported by NY Daily News 17 hours ago.

WASHINGTON -- Phil Kerpen confessed he was getting cold. The president of the conservative group American Commitment and prolific social media presence behind the lawsuit over Obamacare’s subsidy regime had been wandering outside the Supreme Court on Wednesday morning without long sleeves.

The forecast predicted temperatures in the mid-40s. But Kerpen had shunned heavier clothing, wanting to show off a T-shirt he’d received as a gift. On it was the face of Jonathan Gruber, the now-infamous health care economist and adviser to Mitt Romney and President Barack Obama who had provided Kerpen and other Obamacare critics with a huge gift last fall.

It was then that old video footage surfaced of Gruber saying that tax credits to help purchase health care insurance were designed to encourage states to set up their own exchanges. Gruber subsequently disavowed those remarks, noting that in other contemporaneous works he had described subsidies as universal –- available on state and federal insurance exchanges. But that did little to alleviate his status as king goat. On Kerpen's T-shirt were the words, “I’m With Stupid” -– the "I" turned to arrows pointing to Gruber’s picture.

As the fate of Obamacare was being argued inside the Supreme Court, a far more boisterous, unruly demonstration was happening among Obamacare foes and supporters outside. This wasn’t quite the zoo that accompanied the first Supreme Court challenge to the president’s health care law. It was far smaller than that. But it still underscored how, years later, the divide over the Affordable Care Act hasn’t narrowed. Perhaps it’s widened.

*(WATCH THE VIDEO ABOVE)*

Signs declaring the law a success were countered with accusations of gross, illegal manipulation. Kerpen, now in a coat, accused the administration of using the prospect of state-based health insurance market calamities to “intimidate the court to decide not on legal grounds, but on policy ground and political grounds.” Down the block, pro-Obamacare groups produced in-the-flesh examples of what that calamity would look like.

“There is a joke that us parents of kids with pre-existing conditions say,” said Barbara Kornblau, an Arlington, Virginia, woman whose daughter was only able to get coverage on Obamacare and who would be unable to afford it without the subsidies. “And that’s that my daughter -– the lawyer –- can also work part time at Starbucks. Because Starbucks gives health insurance to part-time employees.”

If the emotional gulf between supporters and opponents was wide, the political one seemed unbridgeable. Asked what he thought about the millions of people who might lose their health care if the subsidies are struck down, Rep. Steve King (R-Iowa) argued that they’d welcome a return to the pre-Obamacare days. This struck several advocates as, well, insane.

“I would ask, who is he talking to?” said Dr. Debra Hatmaker, executive director of the American Nurses Association.

Pressed what could be done to fix the law if the court ruled that such a thing were needed, Rep. Marsha Blackburn (R-Tenn.) suggested that congressional Republicans and the Obama administration would work cooperatively together. Democrats said they assumed this was comedy.

“You mean this Congress?” Rep. Joseph Crowley (D-N.Y.) said, echoing a point made in arguments to the court by Solicitor General Donald Verrilli.

There were, indeed, two opposite universes occupying the same sidewalk on Wednesday, with nothing to keep them apart. And as the court session concluded around 11:30 a.m., one person chiefly responsible for the gathering walked out of the building.

Before she could get to her awaiting car, Kathleen Sebelius, former secretary of Health and Human Services, was hounded by reporters wanting her take on the proceedings. She said she felt good about the case, of course. It would have been odd for her to say otherwise. But how did it compare to the first Obamacare go-around, when the crowds outside were bigger and the constitutionality of the law’s individual mandate was on the line?

“I actually felt pretty confident about that too,” she said.

With reporting By Christine Conetta. Reported by Huffington Post 17 hours ago.

SALT LAKE CITY (ABC 4 UTAH) - Wednesday night the Governor's Healthy Utah 2.0 plan failed in a 9-4 House Committee vote.

Governor Gary Herbert says the plan provides health insurance for nearly 126,000 Utahns.

The price tag for the state would have been $25 million dollars over two years.

The House Committee didn't leave without an option to the insurance crisis.

"When this many people show up and the polls are so consistent in favor of this, this bill merits at least going to the House floor and frankly having each member of the House of Representatives have the opportunity to say if this is right or it is not," Senator Brian Shiozawa (R) Salt Lake City.Healthy Utah 2.0 was dissected by House members for and hour and a half.

The House of Representatives now will see HB 446 known as Utah Cares. That bill passed committee 9-4.

The bill will help 0-100% of those at the poverty level. Which could add up to 60,000 people in two years.

"I think the most important thing is that we still have a path forward," says Representative Jim Dunnigan, (R) Taylorsville.

Thats what Kenna Arcury wants.
Her daughter is 26 and no longer covered by her parents insurance.

"She is the epitome of the gap," says Arcury.

Her daughter may qualify to be one of those Medicaid recipients.
She takes 11 prescriptions.
But if she gets a job over the poverty level, she'll be taken off Medicaid and put on the Primary Care Network. The problem being not all of her prescriptions will be covered.

"It will provide us with a temporary bit of health and get us a little further than we are now. But in the long run, I think they did a disservice to the state of Utah," she adds.

If Utah Cares Passes the House of Representatives, It maybe stalled in the Senate.

"I studied the bill and there are some very positive aspects of that. But we need to work together. We need to come to a viable compromise. There is still work to be done," says Sen. Shiozawa. Reported by abc4 16 hours ago.

Doctors Medical Center in San Pablo remains in a near-death state, with a plan to infuse short-term cash in limbo and residents yet again appearing reluctant to tax themselves to keep the hospital open. The board of West Contra Costa Healthcare District, which governs the struggling hospital, had hoped on Wednesday to approve the sale of several real estate properties to the city of San Pablo for $7.5 million in a stop-gap measure to extend the hospital’s survival by a few weeks, possibly longer. The situation became dire last spring when voters in the district failed to approve a $200 parcel tax, which would have raised $20 million to keep the hospital open. Some say the combination of being a stand-alone public hospital in a low-income area makes it unsustainable. About 80 percent of its patients are covered by Medi-Cal and Medicare — which doesn’t come near covering the cost of services — and less than 10 percent have private health insurance. At Wednesday’s meeting, board members said they need to know within days whether San Pablo could give the medical center at least $1.7 million of the $7.5 million sale of a parking lot, two medical office buildings and a condominium owned by the hospital. “People don’t realize how seriously this is going to affect everyone, not just the people who use this hospital as their safety net,” said Gail Eierweiss, of Richmond, a retired UCSF Medical Center financial manager. In a telephone survey of 600 residents conducted Feb. 23 to March 1 about half the respondents supported the tax, but support at every level failed to reach the two-thirds required to pass. “If you can’t win a one-sided conversation, that gives you a sense of what a difficult situation you’re in,” said Alex Evans, president of EMC Research, a national market and opinion research firm in Oakland, which conducted the poll. Officials from Venturata, a venture capital firm, spoke publicly about plans to keep the hospital open but have yet to submit a formal proposal. Reported by SFGate 16 hours ago.

Successive attempts by Labour and the Tories to update the service have done more bad than good. It's time to put the NHS in intensive care.

Illustration by Ikon.

It is an awkward fact for many on the left that the partial privatisation of the English National Health Service – started by the New Labour government in 2003 and enthusiastically accelerated by the current Tory-led coalition – has been such an apparent success. When Tony Blair came to power in 1997 the service was struggling, particularly in terms of elective (non-urgent) care. Like all GPs, I often saw my patients having to wait up to 18 months for routine operations.

New Labour’s initial diagnosis was of inadequate resources: public spending on health as the party returned to power was roughly 5 per cent of GDP, substantially lower than in every other developed nation. Blair’s stated ambition was to bring this percentage up to the European average; more money, it was believed, would solve the problem. Labour set about the task with gusto. Gordon Brown’s first Budget in July 1997 heralded an immediate injection of £1.2bn into the NHS, with real-terms spending to rise year on year thereafter. At the same time, Labour began to dismantle some of the previous Conservative government’s experiments with “marketisation” – ending GP fundholding (under which some family doctors operated budgets on behalf of their patients) and re-emphasising collaboration over competition between different parts of the system. For me, as for most ardent supporters of a public-service NHS, they were optimistic days.

Yet by the time of the 2001 election, New Labour was facing accusations of failure to reform. Despite the extra investment in health, service improvements had been frustratingly slow to materialise and were incremental in scale. In addition, there was a worrying new trend. Just as they were doing with the education of their children, the increasingly prosperous middle classes were opting out of state health-care provision in ever greater numbers. Over a few short years it had become noticeably more common for patients in my reasonably affluent corner of southern England to declare they had enough spare cash, or had private insurance (often included in their employment package), and would like to use it to sidestep lengthy NHS waiting times. In an era when most of us swallowed Brown’s “no more boom and bust” myth, and there was a sense the good times might just keep rolling on, we appeared to be sleepwalking towards a US-style health-care system, where those with sufficient resources could get swift access to private treatment, leaving the rest to make do with what the public service could manage to provide.

The danger, as Blair realised, was in the medium to long term: the departure of the middle class would undermine the social contract on which the very idea of a national health service depends.

These were the considerations that led to the extraordinary spectacle of a Labour government adopting a policy direction not even the Tories had dared to explore. The NHS had to become so responsive and user-friendly that there would be no incentive for anyone to go elsewhere. In short, it must be able to compete with the private sector – and the way to do that, it seemed, was to make it “compete”.

To begin with, the Blair government’s approach was to “market-make”; and so, from 2003, successive waves of independent sector treatment centres (ISTCs) were opened throughout England. Run by private companies for profit, ISTCs were contracted (often on very favourable terms) to provide solely NHS elective procedures, creating extra capacity in the system to bring down waiting lists, and at the same time forcing existing providers to polish up their act if they wanted to hang on to any of their more “profitable” work. In parallel, the best NHS hospitals were able to apply for the new foundation trust status, which freed them from public-service constraints to operate more like private businesses.

Out of this market-making grew a new logic: that as well as deliberately inserting private provision inside the NHS, the health market should be opened to external competition. In 2009, in what transpired to be its dying days, New Labour introduced the “any qualified provider” (AQP) initiative, which allowed the private sector to undertake NHS work outside the ISTC programme. It is under AQP that the vast majority of my patients who require elective procedures now choose to spurn both our local district general and the ISTC in favour of referral to the nearby private hospital run by Circle.

The coalition government seized on the inroads made by New Labour. As well as cementing competition for work on a case-by-case
basis under AQP, Section 75 of their Health and Social Care Act 2012 makes it obligatory for commissioners to put every new NHS service (above a trivial size) out to tender. Analysis of data up to 2013 shows more than £12bn of NHS contracts were awarded to private companies during the first three years of the coalition.

On the face of it, the drive to compel competition has done what it was supposed to do (albeit at vastly increased administration costs, with contracts being negotiated, invoiced and monitored by armies of bean-counters on all sides). Much elective NHS care nowadays is provided within weeks, not months or even years. This is unquestionably good for patients. And fears for the future of the social contract have receded: where is the advantage in going private when you can get your operation paid for by the NHS at the same independent hospital?

The health insurance industry has adapted to the new realities, offering cheaper products that pay out only if the NHS should be unable to provide treatment within a specified time frame. With the fall in disposable income that has accompanied austerity, it is once again relatively unusual for my patients to request private referrals. One way or another, the NHS has remained the franchise to which most people look when they have an elective health-care need.

Why then is there a renewed row over NHS privatisation in the current election campaign? It has often been said (by both Labour and the Conservatives at different times) that patients don’t really care who provides their treatment, as long as it’s convenient, of good quality and funded out of general taxation. Surely Ed Miliband should be claiming credit for Labour having been bold enough to go where no political party had ever dared tread? And why is Andy Burnham, the shadow health secretary, publicly committed to repealing the Health and Social Care Act, with its compulsion to competitive procurement?

Burnham is resurrecting the language of the past, articulating a desire to see the NHS as the “preferred provider” of most services, and labelling the 100 days of this election campaign as the last chance to save this concept. Is this simply a belated restatement of an ideology that the left is now embarrassed to have renounced during its most recent years in government? An ideology, furthermore, whose time has been and gone?

The answers to those questions lie in the nature of the problems now facing the health service and how the privatisation agenda has created barriers to tackling them. This is where things begin to get complicated, which is why politicians generally shy away from trying to air them in the media, preferring to fall back on meaningless soundbites such as X billion pounds’ additional spending, or Y thousand extra doctors and nurses. Let me take you on a whistle-stop tour.

The first thing to appreciate is that commercial competition was a response to the NHS’s historically poor performance in providing timely access to mundane, high-volume procedures: cataract removals, joint replacements, gall bladder operations and so on. These elective cases are all discrete episodes: there’s a single problem and a definable clinical activity that will close the case. There are also readily quantifiable measures by which performance can be rated: most obviously, the length of the waiting list.

Markets can work well in this sort of scenario, particularly if risk can be mitigated by excluding complex, often very elderly patients in poor general health with multiple chronic diseases, who are more likely to experience unpredictable and expensive complications. The problem is, with every passing year, there are more and more of us living to become just this kind of patient – patients the private sector doesn’t want to do elective business with at NHS tariff prices, and for whom the old NHS is therefore the default source of help.

The second issue is that these elderly patients with multiple health problems are also presenting to the NHS’s other major arm – urgent-care services – in ever greater numbers. Their health is fragile and they are prone to frequent exacerbations in underlying chronic conditions such as heart failure or lung disease. Otherwise trivial illnesses can have a devastating impact – a simple urinary infection will, in a matter of hours, render a frail and elderly patient completely “off legs” and unable to look after him or herself. Social circumstances are often precarious, patients widowed or living with an equally vulnerable spouse, with far-flung and busy families unable to provide a rapid response should the home situation suddenly deteriorate.

When a patient of this kind becomes unwell, unless significant nursing and social care can be parachuted in at a moment’s notice to shore up community treatment (and at present they can’t) he or she is heading for hospital. Once the person is an inpatient, it can take an unconscionable length of time to help them rehabilitate, and for the social-care system to reinstate or augment a package of care that will allow them to be discharged. Beds get filled; beds get “blocked”.

The third factor is the changed face of NHS urgent-care services. There are all sorts of things one could say about this but here’s the fundamental point: when someone with anything more than a completely straightforward illness becomes unwell, at some stage you are going to need an experienced clinician to decide how to manage it. When I began in practice in 1990 there were only three places you could turn to if a crisis arose: your GP (day or night), the ambulance service, or A&E. The system was understood by virtually everyone and the vast majority of contacts went through their GP first. This, crucially, introduced a highly trained professional at the earliest stage of the process. GPs are thoroughly at home managing uncertainty and negotiating complexity, and we kept a vast amount of work away from hospitals.

Nowadays there is a plethora of other entry points into the urgent-care system – the NHS 111 helpline, walk-in centres, out-of- hours (OOH) services (now mostly provided by private companies) and minor injuries units. NHS 111 and, to a variable extent, the others employ either non-clinical staff operating a risk-averse computer algorithm, or clinicians who are junior and inexperienced. The net result is that the first time many patients encounter an experienced clinician is long after they’ve been admitted to hospital. The opportunity for community management, if it existed, has been lost.

These are the principal forces behind the flurry of declared major incidents this January, which led to hospitals up and down the country closing their full-to-bursting doors. Our own district general remained open – just – but in a continual state of black alert (which is every bit as bad as the name suggests). All elective surgery was abandoned and extraordinary measures were employed to free up every scrap of capacity.

If we want to do anything other than lurch from crisis to crisis, the whole system will have to be reconfigured. Hospitals, GP surgeries, community nursing, OOH, NHS 111, the ambulance service, walk-in centres and minor injuries units are all nominally NHS bodies and should, in theory, be able to work together to ensure only patients genuinely in need of acute hospital care are admitted. The problem is, in our present-day competitive NHS, each entity is trying to protect its budget and ensure its own performance meets the benchmarks by which it will be judged next time its contract comes up for renewal. Perverse and protectionist behaviour ricochets round the system, the easiest solution often being to admit a complex patient and let their care become the responsibility of the hospital. And that’s before you try to bring social care into the mix, which is integral to the project of supporting unwell patients in their homes but which historically has been provided by local government out of a completely separate (and even more pressured) budget.

It is in this incredibly complex and messy situation that Circle – the first private company to be awarded a contract to run an NHS district general hospital, at Hinchingbrooke in Cambridgeshire – announced recently that it will walk away. It’s not that a commercial company can’t run a modern acute hospital; there are half a dozen such private facilities in London (though nowhere else in the country is affluent enough to sustain one). It’s that the kind of money the NHS is offering is woefully inadequate to mitigate the risk to the private sector of unpredictable and ever more intense surges of demand, exacerbated by perverse behaviour elsewhere in the system. Circle is going back to running its controllable elective AQP business, licking the wounds that it has sustained from its adventure into the NHS acute sector.

We made a concerted effort in our area a couple of years ago to solve the problem with urgent care. Most of the big players – our district general hospital, all local GP surgeries, the ambulance service, OOH and the walk-in centre – joined together in an effort to run the newly recommissioned service. This would have aligned the interests of all parties better and should have led to some creative solutions. However, under Section 75 regulations the procurement had to be competitive, with each of the nine eventual bidders being judged on quasi-objective grounds that were rooted largely in process and that weighed only things that could readily be measured. Such is the fear of litigation under competition law that there is simply no latitude for commissioners to use common sense or professional judgement to prefer a bid on the grounds that it is a good idea and exactly what the local area needs. Our bid narrowly lost out to a company based several hundred miles away.

As well as this structural bar to commissioning joined-up working, competitive procurement is eroding the goodwill and loyalty that the NHS has historically enjoyed from its workforce. The firm that won the contract in our area now runs the out-of-hours service and urgent-care centre adjacent to A&E. It has struggled to appoint a local clinical director (the post is still vacant a year in). Many staff who supported out-of-hours provision for years have walked away, so alienated do they feel; each week, the company has to fly or chauffeur clinicians and drivers from elsewhere in the country just to keep what is at times a skeleton service going. Turnover is high and those local staff who continue to work under the new regime are weary of the constant appeals to step into the breach to fill rota gaps.

Staff and doctors who once willingly responded to requests for assistance leave their phones unanswered when they recognise the number of the rota administrator. A rich but unquantifiable resource, which might be called the public-service ethos in the NHS, has been squandered in front of our eyes. Even at this stage it may be too late to recapture it.

The deleterious effects of a competitive marketplace have been loudly argued by opponents of privatisation throughout the past decade. Yet according to one commissioner with over 20 years’ experience of health-
service procurement, no one in government had any vision of how the competition agenda might degrade integrated systems of care for patients with multiple diseases. The
focus was unrelentingly on improving elective care – the NHS’s low-hanging fruit – with fingers crossed in the forlorn hope that the changes being made wouldn’t destabilise the rest of the service.

Of the major parties contesting the forthcoming general election, it is Labour that seems to understand the issue, and it is this that underpins Andy Burnham’s pledge to repeal the Health and Social Care Act and to legislate to exempt the NHS from EU competition legislation. Integrated care is the only game in town and it can only be delivered within projected levels of spending by well-configured public services that have been freed from the fragmentary consequences of enforced competition. That said, Labour finds itself in an embarrassing position: the party that began privatisation has to explain why that process – which has, after all, resulted in improvements in the elective-care arm of the service – is simultaneously incompatible with meeting the present-day challenges the NHS faces.

The Conservatives, by contrast, are silent; the NHS was conspicuously absent when they announced their six key manifesto areas. Having gone into the last election promising no more top-down reorganisations of the service, and having then presided over arguably the most damaging such reorganisation in the history of the service, they may quite reasonably believe that nothing they say on the subject will be trusted. They may also have calculated that the complexity of the problem defies exploration in our soundbite-dominated culture and that saying nothing will allow them to continue business as usual, should they be re-elected. If so, that would be a cynical continuation of the approach that has created the mess we are all dealing with.

Burnham is right: this election does represent a fundamental decision point as to how our NHS will develop or degrade in the future. We need to know, well in advance of the poll, where each party stands on this important matter. And having declared its approach, whichever party goes on to lead the next government must somehow be held to keep the promises on which it has been voted into power.

Dr Phil Whitaker is an award-winning novelist. He writes the New Statesman’s Health Matters column Reported by New Statesman 11 hours ago.

Filed under: Retirement, Early Retirement, Retirement Living, Retirement Plans, Social Security

*Monkey Business Images/Shutterstock*

By Emily Brandon

Retirement is a transition into a new stage of life. Retirees get the freedom to choose how to spend their time, but they also walk away from the comfort of a steady paycheck and need to make important financial decisions. Here are some important retirement rites of passage.

*1. Reaching Financial Freedom*

You have achieved financial freedom when you no longer need to work to pay your bills for the rest of your life. "Once you reach that inflection point, you can leave this job or negotiate part-time work, and you know things are going to be OK," says Maura Griffin, CEO and principal for Blue Spark Capital Advisors in New York. Griffin recommends doing an analysis of your finances, using conservative investment returns and factoring in inflation and taxes, to reassure yourself that you have enough money to retire.

*2. Telling Your Boss*

There's a certain satisfaction that comes from being able to tell your boss that you're simply not going to come into work anymore. "Some people just want to get away from a job that is killing them, and they want to get out of the rat race," Griffin says. But other people find they miss some aspects of the job, especially the social life they had in the office. The transition is often easier if you have hobbies or travel plans to look forward to.

*3. Shutting Down Your Work Computer*

There will come a moment after your stuff is packed when you walk out of your office for the last time. You get to escape from boring meetings and tight deadlines, but you also won't get another invite to a business lunch or holiday party.

*4. Responding to "What Do You Do?"*

Most people answer this question with their profession, but retirees need to think of a new answer. You may want to talk about your volunteer position or an important hobby, or have a quip ready about how you finally get to do whatever you want every day.

*5. Withdrawing From Your Retirement Accounts*

After decades of saving for retirement, retirees finally get to spend some of that money. But you also need to worry about making your savings last for the rest of your life. Once you turn 59½, there's no longer a 10 percent early withdrawal penalty to take money out of your retirement accounts, but you will need to pay income tax on each withdrawal from traditional 401(k)s and individual retirement accounts. After you reach 70½, you will be required to take withdrawals from your retirement accounts each year. The penalty for missing a required minimum distribution is 50 percent of the amount that should have been withdrawn. "When you retire, you are going to be using up those savings, sometimes very rapidly," says Stan Hinden, a retiree and author of "How to Retire Happy: The 12 Most Important Decisions You Must Make Before You Retire.""My wife and I had not had the time to travel very much while we were working, and that was a lot of fun and we enjoyed it, but it made a big dent in our savings. Having fun costs money, and unless you have got a lot of money in retirement, you have to have some discipline."

*6. Collecting Social Security Payments*

Workers pay into Social Security throughout their entire career, and many retirees are eager to collect. However, the age you sign up for benefits drastically changes the monthly payment you receive. Although you can begin collecting benefits as early as age 62, monthly payments are reduced if you claim benefits before your full retirement age, which is 66 for most baby boomers and 67 for people born in 1960 or later. Monthly payments will increase for each additional year you delay claiming payments up until age 70. "The decision about when to take Social Security is a bet on longevity," Griffin says. "If you have longevity in your family, waiting until 70 gives you the most that you can have for your life, but if you have health issues, then maybe you want to go ahead and take it early."

*7. Signing Up for Medicare*

Beginning three months before you turn 65, you can sign up for Medicare. It's important to sign up for benefits in the seven-month window around your 65th birthday, because premiums are sometimes increased for beneficiaries who sign up later. Medicare is likely to have different coverage and cost-sharing requirements than your previous health insurance plan, so it's a good idea to examine how your benefits and medical bills will change. "The expenses for our medical bills after we retried were considerably higher than before we retired. Those benefits paid for things like dental work, but Medicare doesn't pay for those things," Hinden says. "And even if you have a Medicare supplement, which you certainly need, you are going to wind up somewhat surprised by the expenses for health care after you retire."

*8. Realizing You Don't Have to Be Anywhere*

Retirees don't have to get up early or report anywhere at a specific time. You're free to linger over a second cup of coffee and take your time running errands. But you may find that you want to make an effort to get out of the house and be with other people. "There are three needs that a job provides to most people: structure, purpose and sense of community," says Ernie Zelinski, a life coach and author of "How to Retire Happy, Wild, and Free: Retirement Wisdom That You Won't Get from Your Financial Advisor.""Retirees have to put those three things back in their life." 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 11 hours ago.

The Obama administration says it's doing nothing to stave off the potential disaster if the Supreme Court upends Obamacare and millions of Americans lose affordable health insurance. Reported by CNN.com 9 hours ago.

Democratic legislators in Madison are proposing a state-run health insurance exchange for people and companies with up to 100 workers. The proposed Badger Health Benefit Authority is in response to the ongoing U.S. Supreme Court case which could eliminate subsidies in the Affordable Care Act for residents in states including Wisconsin. Citizen Action of Wisconsin said the lawsuit decision could mean the premiums would more than triple for 183,000 state residents. Read more at Wisconsin State Journal. Reported by bizjournals 8 hours ago.

WellCare Health Plans, Inc. announced today that it launched a nationwide, toll-free Community Assistance Line (CAL) to help connect people to social services including financial, food, education and utility assistance, transportation, disability and homeless services, support groups and child care.

TAMPA, Fla. (PRWEB) March 05, 2015

WellCare Health Plans, Inc. (NYSE: WCG), a leading provider of managed care services for government-sponsored health care programs, announced today that it launched a nationwide, toll-free Community Assistance Line (CAL) to help connect people to social services including financial, food, education and utility assistance, transportation, disability and homeless services, support groups and child care. WellCare’s CAL is open to the public and is a referral service that matches needs with more than 1.2 million programs and services.

The CAL is staffed by 32 WellCare community liaisons who act as peer support specialists. Two members of the team are deaf or hearing impaired and use video relay and video chat to assist callers who are also deaf or hearing impaired. All liaisons are trained to evaluate a person’s needs, to match those needs with relevant community-based programs and services, and to provide the requestor with contact information for the programs and services. The community liaisons are also responsible for populating the data base to continuously increase the number of programs and services that are available.

If the data base does not contain the programs and services needed, the community liaison will conduct research and/or work with local, community-based WellCare staff to try and fill the gap. Once the appropriate programs and services are identified, the community liaison will contact the person in need to connect them.

“We know that people cannot prioritize their health when their basic need for food, shelter, clothing and safety is not being properly met,” said Pamme Taylor, WellCare’s vice president for advocacy and community-based programs. “By simply helping people to address these needs, WellCare expects three positive outcomes: people will lead better, healthier lives; there will be greater support for the social safety net, and the overall costs of health care will be reduced.”

"St. Elizabeth Physicians is participating in this program in Kentucky because it provides a service we can offer to our patients that gets at the heart of many of the issues that are negatively impacting their overall health," said Denise Page, director of quality and care management at St. Elizabeth Physicians. "More than seven offices and 100 staffers, including nurses and front desk personnel, have been trained to refer patients to the Community Assistance Line, and we expect another 21 offices with more than 300 people to be trained in the next six weeks."

“Because my teenage daughter and I didn’t have enough money to stretch our food budget for the entire month, we were going hungry for days,” said Sarah Gonzales, whose daughter is a WellCare member and lives outside of Atlanta, Ga. “It was painful for me to know that sometimes her only meal would come from school.” Gonzales added, “When I called WellCare to get transportation assistance for a doctor’s appointment, I was told about the Community Assistance Line. I was then transferred to a Spanish speaking person who helped me to get food stamps. I can now focus on other areas of our lives like taking care of her, making my doctor’s appointments and enjoying life.”

WellCare’s CAL currently operates Monday through Friday, from 9 a.m. to 6 p.m. EST. To contact the line for assistance call 866-775-2192 (main line) or 855-628-7552 (video relay).

About WellCare Health Plans, Inc.
WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4.1 million members nationwide as of Dec. 31, 2014. For more information about WellCare, please visit the company's website at http://www.wellcare.com or view the company’s videos at https://www.youtube.com/user/WellCareHealthPlan. Reported by PRWeb 8 hours ago.

The spouses of two West Coast dockworkers and a doctor have sued a union health insurance plan for longshoremen, alleging millions of dollars in legitimate unpaid claims in the last two years. Reported by L.A. Times 6 hours ago.

CHICAGO--(BUSINESS WIRE)--Fitch Ratings has published a special report providing a credit overview of Blue Cross and Blue Shield (BCBS) licensed health insurance and managed care companies. This report, which is updated and published annually by Fitch, discusses the BCBS companies' common credit strengths and weaknesses, key credit challenges, and historical formation and growth. The report also includes a comparison of company-specific size/scale characteristics and quantitative credit factors Reported by Business Wire 6 hours ago.

If Obamacare survives yesterday's Supreme Court challenge, it will really be the cat with nine lives.

The death of what became the Affordable Care Act has been predicted regularly ever since President Obama's election in 2008. Right after Obama's election, I got a wave of calls from reporters, each highly skeptical that the President-elect would really try to get health care passed. When you consider the relentless attacks and near-death experiences ever since, the reporters' skepticism was understandable.

So when I found myself with a fresh wave of anxiety before the Supreme Court heard oral arguments yesterday on the latest assault on the law, I decided to list all the times that the survival of what became the Affordable Care Act was up in the air. And when I then counted them, it turned out that they number eight. So if Obamacare survives this last, desperate challenge at the Supreme Court, it really will have nine lives. Here they are, in chronological order:

*1. The Great Recession*: After Obama's election a chorus of pundits predicted that the new President would have to give up his promise of health care reform because of the economic crisis. Instead, the President worked to get the economic stimulus passed, while paving the ground for health reform moving. Just a few weeks after the stimulus became law, the President went on a national tour to push for action on health care. 

2. *Tea Party August*: The tea party movement came to national attention, with loud, vitriolic attacks on health care at congressional town meetings held by Democrats in August 2009. Republicans gleefully predicted they had killed the bill. But by the second half of August supporters of health reform had rallied at dozens of town hall meetings, usually turning out more activists than the tea partiers. The press didn't give the same attention to meetings that were not marked by raucous demonstrations. But Democratic members of Congress were sent back to Congress knowing they had support in their home districts to move ahead.

3. *Scott Brown's Election*: The surprise election of Republican Scott Brown to the U.S. Senate in January 2010, on a platform opposing health care, looked like it might kill the bill. But having voted to pass the legislation in both houses, Democrats were not going to turn back. President Obama rallied the public by finally attacking the practices of health insurance companies and even without a filibuster proof majority in the Senate, the Patient Protection and Affordable Care Act became law.

4. *The Supreme Court Challenge*: Immediately after the ACA's passage, opponents launched a legal attack, which - shocking most legal scholars - was taken seriously by the courts. And by the time the Supreme Court heard the challenge, the odds were that the Court would gut the key provision of the law that enabled insurance to be affordable to individuals. But Chief Justice Roberts saved the day  - and much of the Court's credibility.

5. *The 2012 Election*: If the Senate had gone Republican in 2012 - as was widely predicted - and Mitt Romney been elected, Obamacare would have been repealed. Instead, the ACA emerged with a new electoral mandate.

6. *Government Shutdown and Congressional Repeals*: I hesitated to put the 50 or so Republican votes to repeal the law, culminating in the government shutdown in the fall of 2013, on the list, only because of President Obama's veto pen. But even if the ACA always had the presidential veto as armor, the barrage of repeal missiles has got to be counted. Texas Senator Ted Cruz led the government shut down before health insurance enrollment opened up because, as he said, "no major entitlement has ever been implemented and then unwound."

7. *Healthcare.gov*: And then, with the disastrous launch of the website to enroll people in health care, Ted Cruz appeared to have gotten his wish fulfilled. The ACA might not be legally dead, but much of it was functionally comatose. Then the administration resuscitated the website, and millions were enrolled and started benefitting from the coverage. It looked like, As Cruz feared, the ACA was here to stay.

8. *Supreme Court Redux*: That is until the Supreme Court agreed to hear a desperate, last minute challenge to ACA's for millions of newly enrolled people in the King v. Burwell case. Could this be like one of those movies where the soldier survives the war, only to be killed by a bullet on his way home, fired by an enemy that hadn't heard the war was over?

The news reports of the oral arguments yesterday were encouraging, particularly Justice Kennedy's raising of a constitutional issue with the plaintiff's case. And there are a host of other legal reasons to believe that the lawsuit is groundless. But then it did get this far. The opponents have been relentless. They haven't gotten the message that the war is lost.

In June, we'll find out if the ACA is the cat with nine lives. Easy to laugh at, if not for the fact that the actual lives of millions of people who rely on the law for life-saving health care are at stake. Cross-posted from Next New Deal Reported by Huffington Post 5 hours ago.

Health insurance premiums and out-of-pocket costs paid by employees increased 21% from 2007 to 2013, the Center for American  -More- 

*Lead the business of human capital*
Gain a comprehensive view of how human resources can benefit your organization. The Saint Mary's University of Minnesota master's in human resource degree equips you with the skills to provide a comprehensive breadth of knowledge. *Learn more*. Reported by SmartBrief 5 hours ago.

The Supreme Court argument over subsidies that help millions of people afford their health insurance suggests that the Obama... Reported by Deseret News 5 hours ago.

You may have read that the Supreme Court heard arguments Wednesday in yet another case challenging the Affordable Care Act.

What you probably have not heard is that regardless of how the Court eventually rules in King v. Burwell, your premiums will likely go up next year simply because the justices agreed to take the case in the first place.

As illogical as that might sound, here's what's going on behind the scenes that will make the cost of coverage more expensive in most of the country next year than it would have been if the Court had not taken the case.

*King v. Burwell puts subsidies in crosshairs
*
But first some background. Although the lead plaintiff in the case is a Virginia man named David King, the money behind the lawsuit is the Competitive Enterprise Institute, a conservative organization that would like to see the ACA abolished one way or another. (The named defendant in the case is Health and Human Services Secretary Sylvia Burwell.)

The plaintiffs argue that because of the way the ACA is worded in a few places, the subsidies the government is providing to residents of all but 16 states are illegal. If the plaintiffs prevail, those subsidies - which make coverage more affordable to millions of low- and moderate-income individuals and families - can no longer be paid unless Congress or the states act promptly to keep them in place.

The people who will be directly affected by the Court's decision live in the 34 states that defaulted to the federal government to set up and operate their health insurance exchanges.

What the plaintiffs have seized upon is the use of the word "State" in some references to the exchanges in the ACA. In those references the law says that folks who enroll in a health plan "through an Exchange established by the State" are eligible for subsidies in the form of tax credits if they earn less than 400 percent of the federal poverty level.

Members of Congress who drafted the law insist that it was never their intention to limit the subsidies to residents of states that set up their own exchanges. The Obama administration agrees with them. And so have all the federal appellate courts that have ruled on this and similar cases. In fact, when King v. Burwell reached the Fourth Circuit Court of Appeals in Richmond last year, the justices unanimously upheld the government's position that the subsidies are legal in every state, including the 34 that have what are referred to as Federally Facilitated Exchanges (FFEs).

Nevertheless, the Supreme Court decided to take the case, leading some Court watchers to speculate that at least four of the justices will likely rule in favor of the plaintiffs. Justice Anthony Kennedy and Chief Justice John Roberts are expected to cast the deciding votes.

*A shock to the industry's rate-setting system*

The decision by the high court to hear the case has added a level of uncertainty in the health insurance marketplace that the industry's executives never expected. It has been the equivalent of throwing a huge wrench into the works of their rate-settings operations.

A big part of the problem is the timing of what the Court will ultimately decide to do. Although the nine justices are expected to vote within days of Wednesday's hearing, the Court's is not expected to announce its decision until June. That's just how the high Court does things.

The problem for insurance companies is that by June, many if not most of them will already have told state and federal regulators how much they plan to charge customers for policies they will sell on the exchanges in 2016.

That's causing a lot of consternation among insurance company actuaries - the people who analyze financial risk - because, if the Court sides with the plaintiffs, a very high percentage of their exchange customers won't get any more to reduce the cost of their premiums.

And if the government can't legally continue providing subsidies in those 34 states, the actuaries expect a very high percentage of their youngest and healthiest customers to drop their coverage. The only people who would keep their policies, they believe, would be people who are older and sicker. And those folks are far more likely to need expensive medical care.

If this happens, insurance companies would have no choice but to hike premiums substantially to stay solvent.

America's Health Insurance Plans, the industry's biggest trade group, wrote in an amicus brief supporting the Obama administration that "the lack of tax credits in the (34) FEEs (Federally Facilitated Exchanges) would alter the fundamental dynamics of those markets in a manner that would make insurance significantly less affordable even to those who would not rely on the subsidies."

*Will rates be based on worst-case scenario?
*
What that means is that everyone who buys coverage in the individual market in those 34 states - not just those getting subsidies - may see big spikes in their premiums.

The American Academy of Actuaries has asked the Department of Health and Human Services to allow insurers to submit two sets of rates for 2016: one assuming the subsidies will still be available, and the other assuming they won't.

Insurers don't know if the feds will allow them to do that. Meanwhile, they're having to begin the work of setting rates for next year. Because of all this uncertainty, insurers reportedly are thinking of pricing their policies higher for 2016 than they would if they knew today which way the Court will rule come June. Many if not most insurers - maybe even all of them - will be setting rates based on the worst-case scenario of a plaintiff's victory.

And those rates will be higher than they would have been if the Court had never agreed to take King v. Burwell.

In my next post, I'll explain why a Court decision in favor of the plaintiffs would likely lead to a collapse of the individual marketplace most if not all of those 34 states.

Read Part 2 of this post: Anatomy of a true health insurance death spiral.

This post originally appeared at healthinsurance.org, where I frequently write about Obamacare and other health policy issues. Reported by Huffington Post 4 hours ago.

You may have read that the Supreme Court heard arguments Wednesday in yet another case challenging the Affordable Care Act.

What you probably have not heard is that regardless of how the court eventually rules in King v. Burwell, your premiums will likely go up next year simply because the justices agreed to take the case in the first place.

As illogical as that might sound, here's what's going on behind the scenes that will make the cost of coverage more expensive in most of the country next year than it would have been if the Supreme Court had not taken the case.

*King v. Burwell Puts Subsidies in the Crosshairs*

But first some background. Although the lead plaintiff in the case is a Virginia man named David King, the money behind the lawsuit comes from the Competitive Enterprise Institute, a conservative organization that would like to see the ACA abolished one way or another. (The named defendant in the case is U.S. Health and Human Services Secretary Sylvia Burwell.)

The plaintiffs argue that because of the way the ACA is worded in a few places, the subsidies the government is providing to residents of all but 16 states are illegal. If the plaintiffs prevail, those subsidies -- which make coverage more affordable to millions of low- and moderate-income individuals and families -- can no longer be paid unless Congress or the states act promptly to keep them in place.

The people who will be directly affected by the Supreme Court's decision live in the 34 states that defaulted to the federal government to set up and operate their health insurance exchanges.

What the plaintiffs have seized upon is the use of the word "State" in some references to the exchanges in the ACA. In those references the law says that folks who enroll in a health plan "through an Exchange established by the State" are eligible for subsidies in the form of tax credits if they earn less than 400 percent of the federal poverty level.

Members of Congress who drafted the law insist that it was never their intention to limit the subsidies to residents of states that set up their own exchanges. The Obama administration agrees with them. And so have all the federal appellate courts that have ruled on this and similar cases. In fact, when King v. Burwell reached the Fourth Circuit Court of Appeals in Richmond last year, the justices unanimously upheld the government's position that the subsidies are legal in every state, including the 34 that have what are referred to as Federally Facilitated Exchanges (FFEs).

Nevertheless, the Supreme Court decided to take the case, leading some court watchers to speculate that at least four of the justices will likely rule in favor of the plaintiffs. Justice Anthony Kennedy and Chief Justice John Roberts are expected to cast the deciding votes.

*A Shock to the Industry's Rate-Setting System*

The decision by the high court to hear the case has added a level of uncertainty in the health insurance marketplace that the industry's executives never expected. It has been the equivalent of throwing a huge wrench into the works of their rate-settings operations.

A big part of the problem is the timing of what the court will ultimately decide to do. Although the nine justices are expected to vote within days of Wednesday's hearing, the court is not expected to announce its decision until June. That's just how the high court does things.

The problem for insurance companies is that by June, many if not most of them will already have told state and federal regulators how much they plan to charge customers for policies they will sell on the exchanges in 2016.

That's causing a lot of consternation among insurance company actuaries -- the people who analyze financial risk -- because if the Supreme Court sides with the plaintiffs, a very high percentage of their exchange customers won't get any more subsidies to reduce the cost of their premiums.

And if the government can't legally continue providing subsidies in those 34 states, the actuaries expect a very high percentage of their youngest and healthiest customers to drop their coverage. The only people who would keep their policies, they believe, would be people who are older and sicker. And those folks are far more likely to need expensive medical care.

If this happens, insurance companies would have no choice but to hike premiums substantially to stay solvent.

America's Health Insurance Plans, the industry's biggest trade group, wrote in an amicus brief supporting the Obama administration that "the lack of tax credits in the (34) FEEs (Federally Facilitated Exchanges) would alter the fundamental dynamics of those markets in a manner that would make insurance significantly less affordable even to those who would not rely on the subsidies."

*Will Rates Be Based on the Worst-Case Scenario?*

What that means is that everyone who buys coverage in the individual market in those 34 states -- not just those getting subsidies -- may see big spikes in their premiums.

The American Academy of Actuaries has asked the Department of Health and Human Services to allow insurers to submit two sets of rates for 2016: one assuming the subsidies will still be available, and the other assuming they won't.

Insurers don't know if the feds will allow them to do that. Meanwhile, they're having to begin the work of setting rates for next year. Because of all this uncertainty, insurers reportedly are thinking of pricing their policies higher for 2016 than they would if they knew today which way the Supreme Court will rule come June. Many if not most insurers -- maybe even all of them -- will be setting rates based on the worst-case scenario of a plaintiffs' victory.

And those rates will be higher than they would have been if the Supreme Court had never agreed to take King v. Burwell.

In my next post, I'll explain why a Supreme Court decision in favor of the plaintiffs would likely lead to a collapse of the individual marketplace in most if not all of those 34 states.

Read Part 2 of this post: "Anatomy of a True Health Insurance Death Spiral."

This post originally appeared at healthinsurance.org, where I frequently write about Obamacare and other health policy issues. Reported by Huffington Post 1 hour ago.