What's on your mind this weekend, Bleeding Heartland readers? This is an open thread.
The enrollment period for 2015 health insurance coverage began today and runs through February 15. Approximately "23,000 people nationwide successfully submitted applications to enroll or re-enroll in health insurance plans" today at Healthcare.gov. The Obama administration has set a target of 9.1 million enrollees for 2015. As of this past April, approximately 29,000 Iowans had selected a health insurance plan through the federal marketplace. But roughly double that number are eligible to enroll in a marketplace plan.
Democrats in the Iowa Senate advocated for creating a state portal where Iowans could buy health insurance under the 2010 Affordable Care Act. However, Governor Terry Branstad and Iowa House Republicans refused to go along, perhaps hoping that the health care reform law would be overturned in court or soon after the 2012 presidential election. So, Iowa formed a "partnership" exchange, whereby the state regulates insurance plans, but citizens purchase those plans on the website created and maintained by the federal government. That political decision may prove costly for tens of thousands of Iowans and millions of people in more than 30 other states.
On November 7, the U.S. Supreme Court agreed to hear an appeal that could end tax credit subsidies for all Americans who purchase health insurance plans through the federal website. The SCOTUS blog has compiled links on the King v Burwell case here. Jonathan Cohn provides a concise explanation of how the lawsuit could "wreck Obamacare" if a Supreme Court majority finds in favor of plaintiffs, who argue that subsidies should be available only to people who purchase insurance on state exchanges.
Brianne Gorod argues here that the Supreme Court should "recognize what the statutory text makes clear, and the structure, purpose, and history of the statute all confirm: tax credits and subsidies should be available on all exchanges, state-run and federally facilitated."
Michael Cannon argues the opposite side here: namely, that the Affordable Care Act "makes no provision for subsidies in federally established exchanges."
Chief Justice John Roberts is a highly political, results-oriented judge rather than a consistent legal theorist. Will he seize this chance to destroy Obamacare, or will he allow the current system to survive, as he did in the Supreme Court ruling that left most of the Affordable Care Act intact?
The outcome of King v. Burwell should not affect roughly 105,000 Iowans who have received health insurance coverage under the Iowa Health and Wellness Plan, the compromise alternative to simple Medicaid expansion in this state. According to a report by the Iowa Policy Project, those people "previously were not eligible for Medicaid or who were enrolled only in the IowaCare program." (IowaCare benefits were inferior to Medicaid in various ways.) Iowa hospitals have benefited from these policy changes, as they provided much less uncompensated care to uninsured Iowans during the first half of this year compared to the previous year.
UPDATE: Added after the jump excerpts from the Des Moines Register's unsigned editorial published on November 17. The editors note the irony of conservatives who oppose the Affordable Care Act hoping that "activist judges" will help unravel it.
From the Des Moines Register's November 17 editorial: Obamacare foes are hoping for activist judges:
People have long understood how the law would work: Americans would buy coverage in exchanges and many would receive federal help paying for it, based on their income, regardless of who operated the website where they were shopping.
Congress clearly intended this. Federal rules clarified it. Even Republican governors who opposed the law understood it. When Gov. Terry Branstad declined to expand Medicaid to cover more lower income Iowans, he successfully pushed an option that relies on federally-subsidized plans.
Meanwhile, opponents scoured thousands of pages of law, searching for the tiniest inconsistency or typo. They found one. The Affordable Care Act's tax credit provision says subsidies will be available to those who buy insurance on an exchange "established by the state." Those four words became the basis for another legal challenge.
The irony of this challenge is difficult to overlook. That's because it seeks to abolish a practice conservatives have long embraced: Funneling public money to private insurers to cover Americans.
Known for opposing any kind of government insurance, Republicans have repeatedly said the private sector is best suited to provide insurance. They like the idea so much they encourage seniors to leave government-run Medicare and sign up for private Medicare Advantage plans, which are paid for with tax money and cost the federal government more than traditional Medicare costs. [...]
Opponents of Obamacare are hoping the Supreme Court has an activist majority ready to strike down the subsidies. If the court does that, millions of Americans could lose the private insurance that conservatives are so fond of.