Supreme Court Victory May Signal New Chapter for ACA

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” summarized Chief Justice John Roberts at the end of his landmark June 25th opinion in King v. Burwell. The decision upholds the right of people in states with federally-facilitated exchanges to get “premium tax credits”, the subsidies provided under the 2010 Affordable Care Act to help low and moderate income people afford health coverage.

 

Narrowly at issue in the case was a clause saying that subsidies are available in exchanges “established by the State”, leading to a legal challenge arguing that people in the 34 states that use healthcare.gov, the federally-facilitated marketplace, should not receive the subsidies. Chief Justice Roberts’s opinion, speaking for a 6-3 majority (Justices Scalia, Alito and Thomas dissented) makes clear that this language was a drafting error and totally contrary to the intent of Congress. Recent media interviews of those involved with drafting the law also support the decision.

 

In the 1990s, Chief Justice Roberts explained, New York and other states banned insurers from denying coverage or charging higher premiums to anyone due to their bad health. In response, many bought health coverage only when they got sick, forcing health insurers to increase premiums to account for an ever sicker risk pool, causing even more healthy people to drop their insurance (known as the “death spiral”). The ACA addressed this problem by adding two reforms necessary to make the system work: (1) a requirement that all Americans (with limited exceptions) maintain health coverage; and (2) the premium tax credits. In light of this history, Chief Justice Roberts said in his opinion, Congress could not have meant for residents of the 34 states not to get federal subsidies.

 

As a result of the decision, six million Americans will not be threatened with losing their coverage and health insurance markets are not facing chaos. But it’s also critically important that the ACA has turned a corner. The major legal challenges are over. A majority of Americans now support the law. As ACA supporters, we now have a new opportunity to increase our focus on making the law work rather than refighting the battles of 2009 and 2010.

Pride table

High rates of un-insurance among lesbian, gay, bisexual and transgender (LGBT) people have finally started to drop because of the affordable, nondiscriminatory health coverage options made possible by the Affordable Care Act (ACA). The LGBT uninsured rate fell from 24.2 percent to under 18 percent in the first year of operation of ACA health marketplaces, according to national Gallup surveys. But that was still significantly higher than the 13.2 percent un-insurance rate for the U.S. population as a whole.

That’s why Health Care for All New York is reaching out to uninsured LGBT New Yorkers as they participate in Pride celebrations in June and July. Raising Women’s Voices-NY, a HCFANY Steering Committee member, will be at every Pride Month celebration in the New York City area, handing out LGBT-specific information, and collecting contact information for uninsured people and connecting them to navigators who specialize in working with LGBT consumers for enrollment assistance.

Big selling points this year are the recent New York State policy announcements requiring health insurers to cover all medically-necessary transgender care. HCFANY’s LGBT Task Force is delighted to see that the New York Department of Financial Services responded to our concerns by issuing a guidance letter covering private health plans. HCFANY is also educating LGBT New Yorkers about the March 2015 partial lifting of transgender exclusions in state Medicaid coverage.

We’re letting LGBT New Yorkers know that if they are getting married, having a baby or experiencing one of a list of “qualifying life events,” they are eligible for a special enrollment period to apply for coverage through the NY State of Health marketplace. Low-income LGBT people can apply for Medicaid or Children’s Health Insurance Program coverage for themselves and their families year-round. The third open enrollment period for ACA health coverage starts on November 15.Pride outreach

RWV-NY Community Organizer Liza Lederer and summer intern Christianna Silva were at the Brooklyn Pride festivities on June 13, handing out materials and talking with uninsured LGBT people about how to get covered. More than 10,000 people attended Brooklyn Pride, which occupied six blocks in Park Slope Community. Many of the vendors at the festival were self-employed people interested in getting health insurance for the first time, reported Lederer. The following day, June 14, RWV-NY participated in Rockland Pride, which was held in the village of Nyack, and was attended by more than 2,000 people from the Rockland LGBT community.

 

Coming up on Saturday, June 27, will be Harlem Pride, where RWV-NY staff will do outreach to uninsured LGBT people in the neighborhood. Then, on Sunday, June 28, is the big Pride Festival in Manhattan, which draws more than 200,000 people from around the country. RWV-NY staff and volunteers will be leafleting and collecting names of uninsured people along the parade route and in the exhibit and vendor area that stretches over five blocks in the West Village. Pride activities in the New York City area will conclude on July 17, when RWV-NY will have a table at Bronx Pride, which will be held from noon to 8 p.m. in Crotona Park.

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New Yorkers have five more days to enroll in January 1 coverage! On Friday, the NY State of Health extended the Dec 15 enrollment deadline to December 20 for coverage that begins January 1.

Remember that this deadline only applies to coverage that begins January 1. New Yorkers can still enroll in NY State of Health coverage beginning in February or March up until February 15, 2015 – by January 15 for coverage starting February 1, and by February 15 for coverage starting March 1. New Yorkers can enroll online, by phone, and get in-person help to enroll from an enrollment assistor.

It’s looking like another good year for affordable, quality health insurance thanks to the ACA. Nearly 155,000 New Yorkers have newly enrolled in coverage through the Marketplace since the start of open enrollment on November 15 . That’s in addition to the many who are renewing last year’s coverage. You can find stories from New Yorkers who enrolled last year in our recently released story booklet: The ACA is Working: New Yorkers Tell Their Stories.

ACA is working cover

“The Affordable Care Act gave me a chance and ended my six year nightmare of living without health insurance. It was way more simple and affordable than people think.”

Karen E., Ulster County

The Affordable Care Act is working in New York, according to HCFANY’s new publication, The ACA is Working: New Yorkers Tell Their Stories.

The new publication shares stories from New Yorkers like Karen, a single mother from Ulster County, who was finally able to get affordable health coverage for her family after being uninsured for six years, thanks to federal subsidies. Ben, from Broome county got covered thanks to the ACA’s Medicaid Expansion and enrolled in the same plan as his son. And Engracia got help from a local Navigator to enroll in a plan that saves her $4,500 a year.

The ACA is Working: New Yorkers Tell Their Stories features twelve consumer stories and quotes from New Yorkers in all regions of the State who enrolled in private Qualified Health Plans, Medicaid, Child Health Plus, and small business plans, all through the NY State of Health Marketplace during the first Open Enrollment period. Many got help to enroll from Navigators, who offer free, unbiased, in-person enrollment help. The stories are paired with key statistics and facts about how the ACA is working for New York – and most importantly, New Yorkers.

View HCFANY’s full press release here.