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“An Unhealthy Dose Of Politics”: Gov Matt Bevin Is Letting His Dislike For The President Blind Him To The Success Of Kynect

The New York Times reports that Kentucky Gov. Matt Bevin has informed the Obama administration that he intends to shut down his state’s health insurance exchange. The move will mean that Kentuckians will have to seek health insurance from the federal exchange. The newly-elected Republican governor may also make changes to the state’s Medicaid expansion program. Both moves would fulfill promises that Bevin made on the campaign trail last year.

Health insurance exchanges were established by the Affordable Care Act to serve as a marketplace for individuals who are not covered by the employer-based market. While the law envisioned that these exchanges would be run entirely by the states, in practice there are only 13 state-based exchanges, including the one in Washington, D.C. The rest of the states rely, either in part or entirely, on the federal exchange, Healthcare.gov.

Of the states that chose to run their own exchanges, Kentucky was doing well. The state’s exchange, known as Kynect, has in fact been lauded as one of Obamacare’s best success stories. The Washington Post reports that since it launched, Kynect has cut Kentucky’s uninsured rate in half. While some other states have struggled in their efforts to establish their own state-based exchange, Emily Beauregard, executive director of Kentucky Voices for Health, told the New York Times that “Kynect is working perfectly, and it’s been good for Kentucky.”

If the exchange had not been successful in reducing the state’s uninsured, Bevin’s plan would be justified. However, given Kynect’s effectiveness, Bevin’s plan to dismantle it makes little sense. His decision is driven purely by political motives and not with the welfare of his constituents in mind. Although the Obama administration has promised a “seamless” transition to Healthcare.gov for those who receive coverage through Kynect, there are still bound to be disruptions in coverage. For some, that disruption in coverage could be devastating.

Taking Kynect apart will also cost the state money. According to the Times, the previous governor’s administration estimated it will cost “at least $23 million” to shut it down. There’s also the question of unused grant money, approximately $57 million, which Kentucky might have to repay to the federal government. In contrast, leaving the exchange in place would provide consistency and predictability for its customers and allow the state to continue building on Kynect’s success, perhaps even lowering the state’s uninsured numbers further.

Unfortunately, Bevin is letting his dislike for the president blind him to the success of Kynect and its benefit to his constituents. Kynect has worked well for Kentucky, and the new governor should keep it in place.

 

By: Cary Gibson, Thomas Jefferson Street Blig, U. S. News and World Report, January 15, 2016

January 16, 2016 Posted by | Affordable Care Act, KyNect, Matt Bevin | , , , , , , | 2 Comments

“Give Me Lipitor Or Give Me Death”: Last Call; Ted Cruz Signs Up For Obamacare

A day after announcing his White House bid – which included beating on the Affordable Care Act, his favorite punching bag – Sen. Ted Cruz, R-Texas, says he’s signing up for Obamacare.

Yes, you read that correctly: The man whose signature applause line is a promise to “repeal each and every word of Obamacare,” went on Healthcare.gov and got himself some benefits. Hypocrisy? Sure, but not in the way you might think.

Cruz had been covered through his wife’s employer, Goldman Sachs. If some insurance plans are Cadillacs, hers was a chauffeured, solid-gold Fleetwood, reportedly worth some $20,000 a year — around half of Texas’ median income. Heidi Cruz is taking a year or so of unpaid leave to help him on his campaign, though, so her health care coverage evaporates along with her likely very substantial  paycheck.

Now, the senator – or maybe an aide, or an intern or campaign volunteer or someone – will schlep to the computer, log on to Healthcare.gov and hunch down over the keyboard to do the Obamacare two-step to get coverage for the upcoming year.

Cruz says he had to get health coverage Obamacare, and he’s right: Sen. Chuck Grassley, R-Iowa, inserted an ACA amendment that requires all members of Congress to sign up through the federal exchange. That means Cruz has to if he wants health insurance, although, unlike a lot of Obamacare enrollees, his $174,000 annual Senate salary covers the premiums.

“Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us,” Cruz told the Des Moines Register. “Members of Congress should not be exempt.”

Cruz has come up with his own Obamacare alternative, a plan which shifts a lot of control to the states — including ones like Texas, that opted out of Obamacare and all that federal money that went with it. If it were available, he probably would have signed up for Cruzcare instead.

Cruz: 2, Hypocrisy: Undecided. Still, let’s take a closer look.

If Cruz wanted to stand on no-Obamacare, no-way principle, however, perhaps he could opt out of government-sponsored health care entirely, just like the 6.3 million Texans who don’t have health insurance — in part because his state, and his party, decided to block it. That includes 1.2 million children just like Cruz’s two little girls who can’t get health care if they get sick.

That’s made Texas the state with the highest number of uninsured people, nearly twice the national average.

Further, if you squint, the changes the Cruz family are undergoing — loss of a job or a dramatic life change that reduces income — are the top reasons people lose health insurance, and among the reasons Obamacare exists in the first place. And if a parent or spouse gets sick without insurance, it can lead to some serious financial hardship.

It’s perhaps safe to say Cruz understands that intuitively, even if he probably would never say so explicitly. Which is probably why he signed up, and where the hypocrisy comes in.

Even though it exposes him to a modicum of ridicule, allegations of hypocrisy and getting the stink-eye from some of his die-hard supporters, Ted’s Excellent Obamacare Adventure speaks more loudly than his “repeal every word of Obamacare” applause line. When it came down to brass tacks and he lost his wife’s coverage, he opted-in.

He may be a fierce Obamacare critic, and he may agree with the decision to deny affordable health insurance to more than 6 million Texans who, one imagines, he assumes would rather have liberty than Lipitor. But when it becomes a personal matter involving his own family, his conservative ideals don’t necessarily apply.

 

By: Joseph P. Williams, Washington Whispers, U. S. News and World Report, march 24, 2015

March 25, 2015 Posted by | Affordable Care Act, Ted Cruz, Uninsured | , , , , , | Leave a comment

“The Limited Role Of The Courts”: Why Obamacare Probably Isn’t Doomed

The Affordable Care Act took a potentially serious hit today when the D.C. Circuit Court of Appeals struck down a rule that extended the law’s health-care subsidies to residents of the  three-dozen states where the federal government runs a health insurance exchange.

But the fact that another court of appeals upheld the same rule on the same day shows that the legal issue is very thorny and will very likely  be ultimately resolved by the Supreme Court. And the administration probably will come out ahead in the end.

The controversial part of the law says that the government can provide subsidies for health insurance bought on exchanges “established by [a] State.”

The argument against the administration’s rule is straightforward: if a state refuses to set up an exchange, forcing the federal government to operate it instead, then the subsidies aren’t available. That legal reading of the statute makes some sense, because Congress may have wanted to encourage states to create exchanges with the carrot of promising subsidies for the states’ residents.

But the courts are required to uphold the rule if the law is ambiguous and the administration’s position is reasonable. The Supreme Court will probably uphold the rule under that lax standard.

Here’s why. Other provisions of the statute reference an exchange “established by [a] State,” but really include the federal government. Another section of the law refers to a state-run exchange when everyone agrees that it means to include the federal government too. Also, the law actually requires every state to set up an exchange, and it refers to all the exchanges as having been established by states. So you can look at the statute as a whole and reasonably read it to extend the subsidies to residents of every state.

It also makes some difference that the section of the law cited by the rule’s opponents is a strange place for Congress to have limited the availability of subsidies, because that section states the formula for tax credits rather than core rules on who gets benefits under the Act. There also isn’t much evidence to suggest that Congress actually was intending to use the subsidies to encourage states to create exchanges.

We won’t have a final answer for a while. The parties can ask all the judges of both of the courts of appeals that issued today’s rulings to rehear the case. The administration has the better chance, because recent appointments to the court that struck down the rule tilt the court to the left. But it may be that both courts will see that Supreme Court review is inevitable and stand aside to let the Justices decide the issue.

The issue is so close and contentious that it is basically inevitable that the Supreme Court will have to resolve it. If the case goes straight to the Supreme Court, we will get a final decision within a year; otherwise, it will probably be two. My best guess is that a majority of the Justices will cite the limited role of the courts and rule for the administration and uphold the rule by the same5-to-4 majority that rejected the major constitutional challenge to the law two years ago.

 

By: Tom Goldstein, Appellate Advocate, best known as one of the nation’s most experienced Supreme Court practitioners, Co-founder and Publisher of SCOTUSblog; The Washington Post, July 22, 2014

 

July 23, 2014 Posted by | Affordable Care Act, Health Exchanges, Obamacare | , , , , , | 1 Comment

   

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