If You Have a Preexisting Condition, the GOP Health Care Bill Is Even Worse Than You Thought – PATRICK CALDWELL MAY 25, 2017 6:22 PM

Your continuous coverage won’t save you.

Bill Clark/ZUMA

Rep. Jason Chaffetz (R-Utah), moments before voting to undo Obamacare’s preexisting condition protections

When Republican lawmakers face criticism over their plan to allow states to dismantle protections for people with preexisting conditions, they have a pretty standard response. Their Obamacare repeal bill, they insist, would only allow insurers to jack up prices on sick people if those people haven’t maintained continuous health coverage. “For individuals with preexisting conditions, once you are in the system, every proposal that I’ve heard so far says you stay in the system,” Sen. Mike Rounds (R-S.D.) told NPR Thursday. “And if you do have a serious illness, you can’t run out of coverage.”

But we now know that isn’t really accurate. As Mother Jones‘ Kevin Drum points out, Wednesday’s Congressional Budget Office analysis of the bill suggests that anyone with a preexisting medical condition—even people who already have health insurance—could face steep premium hikes.

“The nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.”

Part of what Republicans are saying is technically true: The bill does, in fact, bar insurance companies from singling out individuals for price hikes if they have maintained continuous coverage. But the CBO notes that insurers would have—and likely would use—a workaround that would effectively jack up rates on every sick person they cover in the non-group market.

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What’s Left For The Supreme Court: Same-Sex-Marriage, Obamacare And More – Ron Elving JUNE 15, 201512:18 AM ET

A Tea Party supporter rings a bell in protest to the health care law in front of the U.S. Supreme Court, as Obamacare supporters shout slogans and raise signs behind her.

A Tea Party supporter rings a bell in protest to the health care law in front of the U.S. Supreme Court, as Obamacare supporters shout slogans and raise signs behind her. Alex Wong/Getty Images

Major decisions are expected as soon as Monday, as the U.S. Supreme Court works its way through several cases still pending before it closes out its calendar for the 2014-2015 term.

Among the biggest issues hanging fire: the status of same-sex marriages, subsidies for health insurance under Obamacare and the drugs that states may use to administer the death penalty by lethal injection. But the court is also expected to weigh in on the drawing of lines for congressional elections, the right to put the Confederate flag on license plates and the right of a municipality to regulate outdoor signage.

“Decision days” are scheduled for each Monday this month, along with Thursday, the 18th — and there could be yet another day announced as well. The court has not gone beyond June in more than 20 years.

It is typical for the court to issue its most important and controversial rulings in the final days of its annual session. Many expect the same-sex marriage and Obamacare decisions to come later in the month. But many court observers are expecting the lethal-injection decision sooner, along with more than a dozen cases that carry considerable significance of their own.

The court meets at 10 a.m. Monday and on the other decision days of the month. NPR will be covering the proceedings and report on the decisions as soon as they become available, on our regular radio programs, on NPR.org, NPR One and other platforms.

Lethal Injection (Glossip v. Gross)
As traditional methods such as hanging, firing squad and electrocution have fallen from favor, states with the death penalty have been injecting a “protocol” or series of drugs to execute death-row prisoners. But pharmaceutical companies now refuse to provide sodium thiopental, the drug used at the beginning of the series to make the prisoner lose consciousness.

States have looked for substitutes, including midazolam, which is a sedative and not an anesthetic. Inmates, who have brought this case, say they may remain conscious after receiving this drug and when they receive the subsequent drugs. Some members of the court were clearly sympathetic to this viewpoint in the oral argument earlier this year. But some of the court’s conservatives seemed to regard it as a “back door” means to undermine the death penalty itself.

If the court sides with the inmates, states will have to scramble to find alternative means of execution, which may include a return to the more traditional methods.

Obamacare (King v. Burwell)
Plaintiffs have argued that only those states that have set up their own exchanges for the purchase of health care insurance are entitled to give subsidies to lower income people. States that let the federal government set up their exchanges for them, they contend, may not accept the federal tax credits that subsidize those eligible in state-run exchanges. The administration argues that the intent of the legislators was clear whatever the exact wording of the 2010 Affordable Care Act and that all exchanges are eligible for the subsidies.

If the court rules for the plaintiffs, subsidies could go away for more than six million current recipients, although the timetable for them losing their insurance is somewhat uncertain. Congress would be under pressure to act.

Taking this many people out of the system would also affect the private health-insurance market and the amount people pay in insurance premiums. The degree of impact would depend on how sweeping the justices’ ruling was. But it could affect individuals, small business, large business, the insurance industry, doctors and hospitals.

Same-Sex Marriage (Obergefell v. Hodges and related cases)
A series of recent rulings by the high court has led to the legalization of same-sex marriage in three dozen states that are home to more than 70 percent of the U.S. population. This has happened despite many states’ efforts to enact bans on such marriages, either by legislation or referenda.

These laws and state constitutional amendments have been consistently struck down by federal courts at the district and appellate levels — except for the Federal Court of Appeals for the Sixth Circuit. This one court, sitting in Cincinnati, Ohio, upheld the ban enacted in that state and several others and said states did not have to recognize marriages performed legally in other states. This “circuit split” between appeals judges brought the case before the U.S. Supreme Court earlier this year.

The court now has the opportunity to clarify the legal situation by legalizing same-sex marriage in all 50 states or to adopt any of several more complicated resolutions — leaving some states with legal same-sex marriage but others — perhaps most — without. The court is also deciding a related case regarding the right of a state to refuse to recognize a same-sex marriage that took place legally in another state.

Other cases to watch…

Arizona state legislature v. Arizona independent redistricting commission
Are state laws that put redistricting in the hands of independent commissions unconstitutional? Arizona voters created a commission by constitutional amendment, and some state legislators say that strips them of their redistricting power in violation of the federal constitution.

Walker v. Texas Division, Sons of the Confederacy
May states constitutionally ban the Sons of the Confederacy from displaying the confederate battle flag on vanity license plates?

Reed v. Town of Gilbert, Ariz.
What should be the constitutional rules for municipalities seeking to limit sign clutter? Here, a church had signs that the town wanted to regulate or remove.

Michigan v. EPA
Environmental case tests at what point the federal Clean Air Act requires the EPA to take into account the costs that factory owners face in complying with EPA regulation. Should it be before or after deciding to regulate hazardous pollutants?

Texas Department of Housing and Community Affairs v. The Inclusive Communities Project
The most significant race-related case of the term involves so called “disparate impact” in housing. Must plaintiffs have proof of someone’s intent to discriminate?

Republicans fear they will win ObamaCare court battle – By Alexander Bolton – 06/09/15 06:00 AM EDT

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Republicans in Congress are worried the Supreme Court will hand them a major headache this month if it rules against the federal health insurance exchanges in more than 30 states, ending subsidies for millions of people.

While the Affordable Care Act remains broadly unpopular, two new polls show a majority of Americans don’t want to do away with its subsidies, a core component of the law.

This poses a conundrum for Senate Majority Leader Mitch McConnell (R-Ky.) and Speaker John Boehner (R-Ohio). They are under pressure from colleagues up for reelection in swing states and districts to extend the subsidies, at least temporarily, if the court strikes them down. But doing so would risk a backlash from the conservative base.

The Supreme Court is expected to hand down its decision in King v. Burwell, which could strip 6.4 million people of health insurance subsidies, in late June.

States that would be hardest hit by a ruling against the law include the Senate battlegrounds of Illinois, North Carolina, Ohio and Wisconsin.

“The politics of the King vs. Burwell case are extremely treacherous and tricky for Republicans because if the subsidies are thrown out by the court, Republicans are in the position of having to create a fix that would be seen as a problem by their most conservative supporters,” said John Ullyot, a GOP strategist and former senior Senate aide.

A new Washington Post/ABC News poll found that a majority of the public, 55 percent, does not want the court to block federal subsidies for people in states that have not set up their own exchanges. Only 38 percent said they wanted the subsidies ended.

“It does create a political problem for the GOP because there could be millions of people who got health insurance as a result of ObamaCare who lose it,” said Darrell West, director of governance studies at the Brookings Institution.

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This Is What It’s Really Like to Survive a Gunshot


As part of our ongoing investigation into gun violence, which costs the nation at least $229 billion a year, we documented the stories of eight survivors. How does the toll add up for a victim of street violence? What does it cost to lose a loved one to suicide, or in a mass shooting? From Brooklyn and Chicago to Cheyenne and Oakland, these are some of the prices paid. (See the rest of our special investigation here.)


Antonius Wiriadjaja

On the afternoon of July 5, 2013, Antonius Wiriadjaja was walking in his Brooklyn neighborhood when a man stalking an ex-lover pulled out a gun and began shooting at her in broad daylight. A stray bullet pierced Wiriadjaja’s chest and lodged in his stomach. A stranger rushed over to help, compressing Wiriadjaja’s wound until the ambulance came. At the hospital, Wiriadjaja was put into a coma, beginning what would be a two-week stay. Then, “it took me seven months of physical therapy to regain most of my day-to-day functions, and about 18 months of psychiatric treatment to stave off PTSD,” he says. “I would never wish this amount of pain and misery on my worst enemy.”

Part of Wiriadjaja’s response was to blog about his recovery, including a series of photos displaying his scars. His medical and mental-health treatments have totaled about $169,000, most of which have been covered by his health insurance. Still, his deductibles and other out-of-pocket expenses cost more than $20,000 and ate up all his savings. For a while, he says, he had to couch-surf with friends “while my insides were still sloshing around.” He was told that he was eligible for reimbursements from the state’s office of victim services, but the process was so daunting on top of his recovery and return to work—”like adding an extra full-time job”—that he decided to move on.

Today, Wiriadjaja is an assistant arts professor at New York University in Shanghai. “I know I’m lucky, because I had savings, health insurance, and an incredible support network,” he says. “Many other gunshot survivors are not. I count my blessings every day.” The man who helped save his life on the street was shot and killed in South Carolina last year.

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Critical day for ObamaCare as high court hears new challenge – By Sarah Ferris and Peter Sullivan – 03/04/15 06:00 AM EST

The nine justices of the Supreme Court on Wednesday will again hold the future of ObamaCare in their hands, as they take up a new legal challenge that could strip insurance subsidies from millions of people.

Getty Images

The court on Wednesday will hear oral arguments in the King v. Burwell case, with the plaintiffs contending that people in 37 states are illegally receiving subsidies through President Obama’s signature law.

Should the justices rule against the administration, the consequences could be lasting and dramatic.

The Obama administration says it is impossible to carry out the healthcare law without the subsidies, which were designed to help people cover the cost of health insurance.

A victory for the plaintiffs would instantly revoke the insurances subsidies for up to 9.3 million people, according to the nonpartisan Urban Institute, sending shockwaves across the healthcare system.

“Not only would many millions of people lose health insurance and rejoin the ranks of the uninsured, but premiums for everyone else would skyrocket,” said Ron Pollack, the executive director of the pro-ObamaCare Families USA.

Republicans acknowledge the high stakes in the case and have drafted emergency plans to soften the financial blow for ObamaCare participants if the lawsuit succeeds.

The case hinges on the meaning of four words in the text of the law: “established by the state.”

The challengers argue that a plain English reading of the phrase means that subsidies are invalid in the roughly three-dozen states that opted not to set up their own healthcare marketplaces, instead relying on the federal website HealthCare.gov.

Administration lawyers argue a literal reading of the phrase is nonsensical and contradicted by the rest of the law, which they say makes clear that subsidies were intended to be available nationwide.

The outcome of the case could rest on whether a majority of the justices focus on the four-word phrase or opt to view it within the broader context of the Affordable Care Act, experts say.

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Dying for a Conservative Cause – By Mark Joseph Stern FEB. 4 2015 3:23 PM

Republicans put liberty ahead of life.

 Sen. Rand Paul and other conservatives choose “freedom” over lives. Photo illustration by Slate. Photo by Kevin Lamarque/Reuters.

Sen. Rand Paul and other conservatives choose “freedom” over lives.
Photo illustration by Slate. Photo by Kevin Lamarque/Reuters.

A measles epidemic is creeping across America, bringing a once-vanquished disease roaring back to life and sickening hundreds of people, mostly children. These serious illnesses, like the outbreak itself, were entirely preventable; the disease has re-emerged because of the anti-vaccine movement, and its victims were largely unvaccinated. You might expect politicians to line up in support of vaccinations. Instead, Gov. Chris Christie and Sen. Rand Paul—both presumptive 2016 Republican presidential candidates—swung in the opposite direction, with Christie calling for parents’ “choice” and Paul advocating for vaccine “freedom.”

Many commentators were puzzled by the politicians’ decisions to pander to the anti-vaccine movement, especially given that turning vaccines into a partisan issue may well cause more people to put their children at risk of preventable illnesses. (There are willfully ignorant liberals who spread lies about vaccines, including one disgrace to his famous name, but no Democratic Party leaders endorse anti-vax conspiracy theories.) But no one should be surprised that Republicans are putting politics ahead of public health. Republicans are currently cheering on an anti-Obamacare lawsuit that could strip millions of health insurance. They’re willing to put Americans at risk of death just to score points against a law they hate.

To see why the GOP’s new legal campaign against Obamacare poses such a serious threat to public health, it helps to understand that it is based on what Slate contributor Eric Segall called “an outright falsehood.” The Affordable Care Act was designed to encourage states to create their own health care exchanges, allowing people to sign up on state-run websites to receive subsidies for health insurance. However, Congress understood that not every state would be eager to partake in the subsidies system. Accordingly, the ACA calls for the federal government to create exchanges in states that refuse to make their own, allowing people in anti-Obamacare states to receive federal subsidies to purchase a health insurance plan.

Improving the Affordable Care Act to help the chronically ill – By Larry Hausner December 20, 2014, 09:00 am

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This year, one in three Americans chose to forego medical care for themselves or a family member because of cost concerns, according to a new Gallup poll.

The Affordable Care Act was supposed to prevent those situations and extend reasonably priced health care to everyone. But insurance companies have been exploiting loopholes in the law to avoid this obligation.

Fortunately, the Centers for Medicare and Medicaid Services — the federal agency that regulates health insurance — recently proposed a new rule that will close such loopholes and strengthen patient protections.

As the organization finalizes its regulations, it has come under pressure from insurance industry lobbyists to water them down. The CMS should resist these efforts and install genuine reforms that will improve health coverage for vulnerable Americans.

These new regulations take aim at one of the biggest shortcomings of the Affordable Care Act — unreasonably high patient cost-sharing. The healthcare law caps out-of-pocket expenses at $6,350 for individual plans and $12,700 for family plans. After an insured person or family hits the cap, the insurance company must pay the rest of the treatment costs.

However, insurers have found a way around that cap by forcing families to pay all the way up to that $12,700 threshold even when only a single household member is sick. The new CMS regulations would prohibit insurance companies from charging more than $6,350 for treating any one patient.

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All Senate GOP staff going on ObamaCare – By Elise Viebeck – 12/10/14 02:17 PM EST

Senate Republican staffers will be required to obtain health insurance through ObamaCare’s exchanges under a rule passed Wednesday by the GOP Conference.

The proposal from Sen. David Vitter (R-La.) means that Senate Republicans will designate their staff as “official,” moving them automatically onto the marketplaces.

A loophole used in both chambers allows lawmakers to designate staff as “unofficial” or “official staff,” which permits them to keep their insurance coverage under the Federal Employee Health Benefits Program.

“Republican senators made a strong, principled statement today in passing my resolution,” Vitter said in a statement.

“Washington should have to live under ObamaCare just like everybody else until we repeal it. And we won’t be complicit in Obama’s illegal rule designed to protect Washington insiders.”

Vitter is an outspoken critic of some lawmakers’ decision to keep their staff off the marketplaces.

He also opposes the employer subsidy for insurance given to lawmakers and staff by the government, arguing it gives Congress an unfair advantage. The question of whether staffers will still receive financial help to pay for their coverage was not addressed in Wednesday’s resolution.

The GOP Conference challenged Senate Democrats to adopt a similar policy and not allow their aides to remain on the Federal Employee Health Benefits Program.

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Obamacare Premiums To Increase By Less Than 4 Percent On Average by Meghan O’Toole Posted on November 14, 2014 at 7:42 pm

For the second year in a row, Obamacare premiums are lower than anticipated and millions of Americans can expect to find affordable health insurance options during the second open enrollment period.

shutterstock_obamacare moneyCREDIT: Shutterstock

For the second year in a row, Obamacare premiums are lower than anticipated and millions of Americans can expect to find affordable health insurance options during the second open enrollment period.

A Center for American Progress analysis of 2015 premium rates for the individual market in states with Federally-Facilitated Marketplaces shows that premiums will increase by an average of only 3.9 percent from 2014 to 2015. This average is for individual coverage for a 27 or 40 year old across all plans in each metal level in each state and weighted by each state’s enrollment by metal level in 2014.

Silver plans, the most popular type of plan in 2014, will increase even less –- by only 3.45 percent on average. While there is wide variation around the average growth in different geographic areas, the low national average is a testament to the popularity and affordability of the health insurance plans on the exchanges, where more than 7 million Americans purchased health insurance in 2014.

Increased competition in the exchanges, with about 25 percent more issuers offering plans on the exchanges in 2015 than 2014, helped to keep premiums low. Some of the nation’s biggest insurers will now be participating in the exchanges for the first time.

To put this premium increase into perspective, an average increase of 3.9 percent is much less than historical premium growth. From 2008 to 2010, the national average rate of premium increase was 10.9 percent, which is 179 percent greater than the increase between 2014 and 2015.

Meghan O’Toole is the Policy Analyst for Health Policy at the Center for American Progress.


Opportunities For Entrepreneurs In Health Care – Todd Hixon 7/25/2014 @ 7:58AM

As we head to the beach to recharge the batteries, it’s a good time to reflect on what has changed in U.S. healthcare since last summer, and what opportunities lie ahead for entrepreneurs and investors. [Disclosure: New Atlantic Ventures, in which I am a partner, has an investment in Qliance, one of many companies mentioned in this post.]

Our $3 trillion health care economy is morphing as we watch, driven by intolerable cost levels, consumer activism, digital technology, and health care reform. The past year brought some of the biggest milestones:

• The public exchanges launched. It was a classic government FUBAR, but the federal exchange eventually worked, and some state exchanges actually worked well. Eight million people signed up, exceeding the goal (1).

• More quietly, private exchanges have become significant: online benefits purchasing sites sponsored by employers or health insurers.

• Medicaid expansion happened, in about half the country anyway. The number of people without health insurance in the U.S. declined by 20%-25% (2), due largely to Medicaid expansion plus the exchanges. I doubt this expansion will be rolled back, and I expect that over time the “red” states will come to the table in one way or another. Managed Medicaid is expanding rapidly, and while the impact of this is not yet clear from national studies, insiders tell me that the opportunity to both save cost and improve health status is large.

• Providers have come to realize they are risk-bearers. At conferences this year I repeatedly heard leaders from the provider side say that bearing risk is the future and it is here now. This takes many forms: ACOs, penalties for readmission of Medicare patients, risk-sharing agreements with insurers, bundled payments direct from self-insured employers, etc. This has profound consequences for health insurance markets: why channel everything through insurers, when the providers bear much of the risk, and many employers bear risk too?

• Quantified self is now a major meme: FitBit and Pebble are doing well. AppleAAPL -0.16% and Google GOOGL -0.38% announced enhancements to their mobile OS products that support gathering and processing of health information.

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