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Get Covered AmericaThe good folks over at Get Covered America, who have been working tirelessly and with great success to get hundreds of thousands of North Carolinians into affordable health insurance over the last several months despite the mean-spirited obstructionism of the state’s conservative political leadership, issued the following common sense response to today’s competing U.S. Court of Appeals rulings:

Today the Federal Court of Appeals for the Fourth Circuit, which covers North Carolina, ruled in the King v Burwell case that the U.S. Internal Revenue Service does have authority to issue tax subsidies in states with a federally facilitated marketplace such as North Carolina. In a separate ruling today, the federal court in DC ruled differently. The end result, is that nothing changes for the 357,584 North Carolinians that already enrolled in insurance on the federal marketplace and nothing changes for those who can still enroll now. While the legal process takes its course, Get Covered America-North Carolina staff and volunteers will continue to reach out to uninsured North Carolinians and let them know about the financial help that continues to be available to them during the current Special Enrollment Period and the upcoming Open Enrollment Period beginning in November. The financial assistance made available by the Affordable Care Act to help consumers afford health coverage has made a huge difference for thousands of North Carolinia families. In fact, 91% of North Carolinians who enrolled in insurance on the federal marketplace are receiving financial assistance to pay for it. The clear intention of the law is to make health insurance affordable for all Americans. (Emphasis supplied.)

The U.S. Court of Appeals for the D.C. Circuit has ruled that tax credits under the Affordable Care Act can only be available to people who enrolled in new exchanges set up in states — not those who enrolled in the default federal program.

Think Progress explains the 2-1 decision in Halbig v. Burwell:

The two Republicans’ decision rests on a glorified typo in the Affordable Care Act itself. Obamacare gives states a choice. They can either run their own health insurance exchange where their residents may buy health insurance, and receive subsidies to help them pay for that insurance if they qualify, or they can allow the federal government to run that exchange for them. Yet the plaintiffs’ in this case uncovered a drafting error in the statute where it appears to limit the subsidies to individuals who obtain insurance through “an Exchange established by the State.” Randolph and Griffith’s opinion concludes that this drafting error is the only thing that matters. In their words, “a federal Exchange is not an ‘Exchange established by the State,’” and that’s it. The upshot of this opinion is that 6.5 million Americans will lose their ability to afford health insurance, according to one estimate.

But the fight over this issue is far from over.

As Policy Watch noted last week, the same question is currently pending before the Fourth Circuit in Richmond in King v. Sebelius, with a decision expected any day.

And the ruling from the D.C. Circuit is likely to go to the full panel,  according to Vox:

This decision comes from three judges on the D.C. Circuit. The federal government will probably ask the entire D.C. Circuit — eleven judges in total — to review the decision “en banc.” The court skews to the left (there are seven Democratic appointees and only four Republican appointees) which bodes in the administration’s favor. En banc review probably won’t happen until early fall.

Read the full opinion in Halbig v. Burwell  here.

Health-Reform-SBAs Adam Linker explained last week when he debunked the latest conservative mythology surrounding the Affordable Care Act, the law continues to succeed despite its imperfections and the endless, hysterical attacks of the President’s political opponents.

Today, there’s still more confirmation of this undeniable reality from Washington state. As The Olympian reported this morning, the state’s uninsured rate has been plummeting:

State insurance officials say fewer than 9 percent of Washington residents still don’t have health insurance.

That’s a significant improvement from numbers before the Affordable Care Act went into effect.

The state Office of the Insurance Commissioner counted 970,000 uninsured Washington residents last year. That number is now 600,000 or about 8.65 percent of the state population.

Agency spokeswoman Stephanie Marquis told The Olympian (http://is.gd/p2XsBG ) two factors are driving the improvement: enrollment in Medicaid and sign-ups for private insurance, but inside and outside of the new state health insurance exchange.

The insurance department reports the individual market has grown to more than 327,000 policies. That represents about 81,000 more insured people than before Oct. 1, when Washington’s Health Benefit Exchange opened.

The exchange also helped sign up nearly 350,000 people for free insurance through Medicaid.

Despite the many successes here, at last check, North Carolina’s uninsured rate remains significantly higher.

In a new post this afternoon, Jesse Cross-Call at the Center on Budget and Policy Priorities reports the latest confirmation that North Carolina is shooting itself in the foot with its stubborn and shortsighted refusal to expand Medicaid to hundreds of thousands of uninsured people under the Affordable Care Act.

As a growing number of reports increasingly make clear, a state’s decision whether to expand Medicaid as part of health reform has real-life effects on its residents and its businesses.  In the 26 states and the District of Columbia that have expanded Medicaid (see map), the positive benefits are already playing out.  Here’s some of the latest information:

  • Hospitals are providing less uncompensated care.  In Arizona, hospitals reported that the Medicaid expansion is the chief reason for a 30 percent decline in the amount of uncompensated care they have provided so far this year, compared with a year ago.  The Colorado Hospital Association found a similar decline in charity care through April when it surveyed hospitals in 15 states that have expanded Medicaid and 15 that have not.
  • Medicaid expansion is driving large gains in health coverage.  A survey conducted by the Urban Institute finds that while the uninsurance rate is dropping across the country, states that have expanded Medicaid have seen a drop in the percentage of non-elderly adults who are uninsured by more than one-third — a 37.7 decline — while the uninsured rate fell by only 9 percent among states that haven’t expanded.  A survey from the Commonwealth Fund found a similar trend. Read More

The Supreme Court Ruled One Way - Here's How You Fight BackThe US Supreme Court decided today that “closely held” corporations that object to contraceptives on religious grounds can deny this preventive coverage to female employees. There will be a great deal of constitutional banter on this opinion but, not being a constitutional scholar, I will make a few practical points.

First, when HHS wrote this popular regulation ensuring that women have access to preventive health care, the department looked to what most states require as a guide. North Carolina, along with a majority of states, mandate that health plans cover contraceptives. Our state has a reasonable exemption for religious employers, and HHS included a similar exemption in its regulations. I hasten to add that, despite this state law, few employers have argued that our state is impeding their religious freedoms.

Second, if you read the Supreme Court decision the majority opinion spends strikingly little time examining the possible impact on women. Instead, Justice Samuel Alito spends most of his space arguing that corporations are people and should enjoy the same religious rights and freedoms as individuals. In contrast, Justice Ruth Bader Ginsberg spends a great deal of time balancing the claims of the Hobby Lobby owners with the health care needs of female employees.

Third, this opinion opens the gate to whittle away many types of preventive health coverage mandates. Justice Alito says that each of these requirements will have to undergo its own analysis and that the current decision is narrowly tailored, but Hobby Lobby certainly invites a great deal of mischief. We will find out in the coming months and years just how deeply this court is willing to cut into protections for women and families.

Here are some initial links to analysis of the Hobby Lobby decision: ThinkProgress, the National Health Law Program, the American Academy of Pediatrics, and TalkingPointsMemo.