A rumble in the courts

keep calm_know you're covered

Guest post: Jessie Kavanagh, Health Policy Intern at Community Service Society of New York

Last week, a 3-judge panel of the U.S. Court of Appeals for the District of Columbia ruled 2-1 that states using the federally-facilitated marketplace (healthcare.gov) cannot offer government subsidies to their residents. The same day, a 4th U.S. Circuit Court of Appeals in Virginia unanimously came to the opposite conclusion– that the states using the federal marketplace should be able to offer subsidies.

What to make of this conflict? Regardless of the disagreement, the bottom line for New Yorkers is simple: the decisions have no immediate impact on New Yorkers’ eligibility for the ACA tax credits and subsidies.

The main issue in these cases concerns the language in the ACA regarding the subsidies. The language states that subsidies are only available “through an exchange [aka marketplace] established by the state.” The U.S. Court of Appeals for the DC Circuit argued that this language means subsidies should be available only to people who enroll through a state-based marketplace. However, the 4th Circuit Court said that the law was ambiguous, and that the IRS was entitled to its interpretation that the federal marketplace acts as a state’s marketplace, and therefore all states can offer subsidies to their residents.

Ultimately, the ACA was written with the intent to make insurance more affordable for all Americans. And, it seems to be working. In New York, 3 out of 4 enrollees in commercial Qualified Health Plans during open enrollment- or 274,247 New Yorkers – were eligible for tax credits that made insurance more affordable.

 

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Guest post: Sarah Fishman, Intern at Raising Women’s Voices – New York

Have you recently received a letter from your health insurance company about a rate increase for next year? Don’t panic! This is only a proposed rate increase that must be reviewed by state officials, and you have the right to weigh in on whether it should be approved or not.

New York State law says that the Department of Financial Services (DFS), headed by Superintendent Benjamin Lawsky, has the authority to review all insurer rate change requests and can deny or reduce any that it deems excessive. Consumers have a 30-day period to voice their concerns to the DFS, and this year that period ends on August 1. Your comments can make a difference, saving consumers millions of dollars in premium costs. For example, in 2013, DFS only approved the rate increases after reducing them by 5% in the individual market.

Some of the plans being sold in New York State have proposed large rate increases for the next year. Many are requesting increases in the range of 15-20%, with some as high as 28%. Others are requesting decreases. Find your plan’s request here.

Take action by submitting your own comments. Remember to act quickly to meet the August 1 deadline. Below is a sample letter you can adapt and submit to the Department of Financial Services.  You can also download the sample letter by clicking here. After editing the letter with your information, you can copy and paste it to be submitted here.

SAMPLE LETTER TO DEPARTMENT OF FINANCIAL SERVICES RE: HEALTH INSURANCE RATE INCREASE

Dear Superintendent Lawsky:

I write to file an objection on the proposed premium rate increase of [insert percent or amount of increase here], recently filed by [insert insurance company name].

I have been a customer for [x number of years].  I need health insurance because [explain why you need coverage, list special health conditions for yourself, your family or employees who are covered by your insurance plan].  This proposed rate increase will be a major hardship for me.

I believe that my carrier’s profits, administration, and executive compensations costs are too great and urge you to require it to invest more premium dollars into its customer’s health expenses.

I strongly support the Department of Financial Services’ efforts to make more insurance more affordable and information about rate increases more accessible.  Thank you for your attention to this matter.

If you need more information about my situation, please feel free to contact me at: [insert your email or phone number or address here].

girls_doctor_officeThe Alliance for Health Reform and Kaiser Family Foundation held a briefing on Monday about the Children’s Health Insurance Program (CHIP). CHIP provides quality health coverage for over 8 million kids – including nearly 500,000 in New York under Child Health Plus.

The Program was extended in the ACA through 2019, but unfortunately funding for the program expires next September without congressional action. This would be bad news for kids - many could lose coverage (some due to the “family glitch“) or pay more for comprehensive coverage. Not to mention it would cut short a program that has been enormously successful in reducing the child uninsurance rate, which fell by half since the program began in 1997.

A summary of the briefing and all materials are available on the Alliance for Health Reform website, including background materials, videos, and speaker presentations. Speakers included Joan Alker, executive director at Center for Children and Families at Georgetown University, Robin Rudowitz, associate director for Kaiser Commission on Medicaid and the Uninsured, Robert Stewart, analyst at the Congressional Budget Office, and Cathy Caldwell, director of the Bureau of Children’s Health Insurance in the Alabama Department of Public Health.

Check it out!

 

 

birth_control_supreme_courtGuest post by Lois Uttley, Director, Raising Women’s Voices – NY

The Supreme Court’s decision this week in the Hobby Lobby case is a blow to the hard-fought campaign to ensure that women have affordable health insurance coverage for contraception. The court, in a 5-4 ruling, said that family-run corporations like the crafts chain store Hobby Lobby can refuse to provide contraceptive coverage to their employees if the owners say contraception violates their religious beliefs.

Women’s health advocates are concerned that the decision could begin to undermine valuable gains for women’s health and economic well-being that we’ve started to see as a result of the Affordable Care Act’s Women’s Preventive Services provisions. Last year, the share of women with no out-of-pocket costs for the types of contraception covered by the law increased to 56 percent from 14 percent only one year earlier. The contraceptive coverage mandate saved women an estimated $483 million in out-of-pocket spending last year, according to the IMS Institute for Healthcare Informatics.

Prior to the Hobby Lobby decision, the Obama administration already had exempted purely-religious organizations, such as churches and seminaries, from complying with the contraceptive mandate. In addition, the administration had fashioned an accommodation for religiously-affiliated non-profits, such as Catholic hospitals and nursing homes, that allows them to shift the burden of providing contraceptive coverage to their insurance companies or third-party health plan administrators.

The court’s ruling carves out an exception to the contraceptive coverage mandate for another type of employer (so-called “closely-held corporations” in which more than half the stock is held by five or fewer people), when the owners of the company (such as the conservative Christians who own Hobby Lobby) have religious objections to contraception. By some estimates, as many as 90 percent of all corporations are closely-held entities, and they employ about half of American workers. Hobby Lobby runs more than 600 stores across the country, with 13,000 employees.

Justice Samuel Alito, who authored the majority opinion by five male judges in the Hobby Lobby case, suggested that the employees of corporations like Hobby Lobby could still get contraceptive coverage if the government granted those companies the kind of accommodation already in place for religiously-affiliated employers, or if the government simply paid for their contraception. However, the accommodation is being challenged in separate lawsuits by religious entities. Moreover, Justice Ruth Bader Ginsburg, who authored the dissent that was joined by the other two female justices, wondered:  “Where is the stopping point to the “let the government pay” alternative?  Suppose an employer’s sincerely held religious belief is offended by health coverage of vaccines or paying the minimum wage [...] or according women equal pay for substantially similar work [...]?”

The Hobby Lobby decision was the first time that corporations were granted legal protections under the federal Religious Freedom Restoration Act for the religious beliefs of their owners, a step that was very troubling to Ginsburg and the dissenters. “The exemption for these employers from the requirement to provide contraceptive coverage would deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage that the ACA would otherwise secure,” Ginsburg wrote.

Fortunately for women in New York State, the decision and the federal RFRA does not apply to state contraceptive coverage laws, such as the Women’s Health and Wellness Act in New York. The Women’s Health and Wellness Act requires employers to cover contraception, as well as other important women’s health services. This state law was upheld by the state’s highest court, the Court of Appeals, which rejected a challenge by religious groups in our state.