Will the ACA Survive the Scales of Justice Yet Again?

In late December, the U.S. Court of Appeals for the 5th Circuit struck down the individual mandate of the Affordable Care Act but ducked the central question – is the rest of the ACA valid after Congress zeroed out the tax penalty for not having health insurance?

The case was sent back to the lower court to reconsider how much of it survives; the lower court judge previously ruled the entire law unconstitutional. This move reduces the likelihood of the Supreme Court considering the case before the 2020 election, but the Democratic-led states defending the law might appeal directly to SCOTUS.

The case was brought by 18 Republican-led states and the ACA has been defended mainly by a coalition of Democratic attorneys general, as the Administration refuses to defend the law.

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California Adopts Statewide Insurance Subsidies

Not only are the views of the California coast spectacular, but now they come with the bonus of a buffer to the rising cost of health insurance.

California will be the first state to offer state-funded tax credits for insurance purchased through Covered California, the state insurance Marketplace. The federal government offers credits as well, but many people fall into a coverage gap due to earning too much for Medicaid and the federal credit but too little to afford insurance on their own. The California credits will be paid for in part by a new tax penalty on Californians who do not have health insurance.

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The ACA Goes to Court Again (and again, and again…)

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I’ve been enjoying a few days at my parents house after an exam and it’s given me a chance to catch up on the nitty gritty health policy news of the past few months. And hoo boy, is there a lot going on. Congress might be in recess until after the election, but that doesn’t mean things are slowing down in the health policy arena!

Today we’re taking a look at two lawsuits that could have an immense impact on the future of the ACA. The Texas v. Azar lawsuit, which was filed in February 2018 by Texas and 19 other states, builds on the repeal of the individual mandate tax penalty by the Tax Cuts and Jobs Act of 2017. The lawsuit argues that because this tax penalty was reduced to $0 in 2019 by the 2017 tax legislation, the individual mandate will become unconstitutional. Since the ACA is dependent on the mandate, the lawsuit calls for the ACA to be invalidated by the court. After the U.S. Justice Department declined to defend the ACA in this lawsuit, Democratic state attorneys general from 16 states and D.C. were allowed to intervene on behalf of the law.

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Shop ’til you Drop

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You’ve heard of healthcare.gov, right? I’m sure you know it crashed or was incredibly sluggish during its first week of operation. Or that there was some controversy over the company contracted to build the site. But did you know that healthcare.gov is the home of the ACA’s Exchanges, also known as the health insurance Marketplace?

The Marketplaces were set up by the ACA to create organized, competitive markets for purchasing health insurance. Prior to the creation of the Marketplace, individuals needing health insurance would have to contact insurance companies directly and would receive limited transparency on cost and benefits.

In contrast, the Marketplace allows individuals, families, and small businesses to: (1) compare health insurance plans for benefits and cost; (2) determine eligibility for tax credits for private coverage or Medicaid/CHIP; and (3) enroll in a health insurance plan. Some states have chosen to operate their own Marketplace (CA, CO, CT, DC, ID, MD, MA, MN, MS, NM, NY, RI, UT, VT, WA). In all remaining states and territories, the federal government facilitates the Marketplace.With limited exceptions, enrollment in a Marketplace plan is only possible during an Open Enrollment period. Outside of the Open Enrollment period, individuals and families are only able to choose a health plan on the Marketplace if they have a special circumstance, such as moving or losing coverage due to a change in employment. After the first Open Enrollment period in 2014, 8.0 million people signed up for coverage using the Marketplace.

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The Individual Mandate: One Leg of the ACA’s “Three-Legged” Stool

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The individual mandate has been a magnet for contentious debate since the ACA became law in 2010. The ACA was not the first time a mandate to purchase insurance has been floated in the U.S.–the Clinton Administration supported the concept in the Health Security Act of 1993which did not become law. Prior to the ACA, Massachusetts became the first state to require all individuals over 18 to have health insurance and helped enacted measures to help facilitate the expansion in coverage. And, as art imitates (or predicts) life, the West Wing featured the health care debate even before Senator Obama became candidate-Obama. [You can watch it on Netflix. Season 7, Episode 7, “The Debate.” The health care portion starts at 16:43].

Before we get into the details of what the mandate requires (and an update on its current status), let’s take a quick look at the arguments on either side of the issue.Supporters of the mandate have two primary justifications: (1) it will help the U.S.’s private-public hybrid insurance system work most effectively by spreading the cost out among as large a risk pool as possible; and (2) a moral imperative that healthcare is a right, and not a privilege afforded to those with means. On the other side of the issue, opponents of the mandate argue that it is a government infringement on personal freedom.

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