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The U.S. Supreme Court stepped back into the ring in the ongoing challenge to the viability of the Affordable Care Act today, agreeing to review the availability of tax credits under its provisions.

The justices will review a decision out of the Fourth Circuit, King v. Burwell,  holding that such subsidies are available to health insurance purchasers on both state exchanges and the federal exchange.

In North Carolina, which did not set up a state exchange, more than 350,000 residents purchased health insurance on the federal exchange — and more than 90 percent did so with the assistance of subsidies. Millions more across the country did the same.

Plaintiffs who brought the case contended that the language of the statute only authorized those credits for purchasers on state-run exchanges, but the Fourth Circuit unanimously rejected that position.

That ruling came just hours after a three-judge panel of the federal appeals court in Washington issued a contrary decision in a separate case pending there. Several weeks later, though, the full D.C. Circuit Court of Appeals reversed that panel and agreed to have the entire court consider the issue.

Rather than wait for a decision there, the justices today agreed to take the Fourth Circuit case up this term.

The Supreme Court’s order is here.

 

Commentary

The conservatives in Congress are already queuing up to offer proposals that would gut amend Obamacare. For instance, leaders McConnell and Boehner are already proposing to raise the threshold number of hours that employees must work per week from 30 to 40 in order to trigger the mandate that their employer provide coverage.

As Paul Van de Water of the Center on Budget and Policy Priorities explains on the blog Off the Charts, this will be a destructive idea that will actually lead to less full-time employment:

ACA work thresholdCritics of health reform claim that employers are shifting some employees to part-time work to avoid offering them health insurance.  But the data provide scant evidence of such a shift.

Moreover, raising the threshold for mandating coverage from 30 to 40 hours would make a shift toward part-time employment much more likely — not less so.

Only about 7 percent of employees work 30 to 34 hours (that is, at or modestly above health reform’s 30-hour threshold), but 44 percent of employees work 40 hours a week and thus would be vulnerable to cuts in their hours if the threshold rose to 40 hours.  Under the Boehner-McConnell proposal, employers could easily cut back large numbers of employees from 40 to 39 hours so they wouldn’t have to offer them health coverage.

The bottom line according to Van de Water:

There’s little evidence to date that health reform has caused a shift to part-time work.  There’s every reason to expect the impact to be small as a share of total employment, as we have explained.  And raising the cutoff for the employer mandate from 30 to 40 hours a week would be a step in the wrong direction.

Commentary

Medicaid expansionIn case you missed it over the weekend Ned Barnett of Raleigh’s News & Observer had an on-the-money column about the latest  bizarre claim from the McCrory administration that we can now expand Medicaid under the Affordable Care Act because they have “fixed” what was a “broken” system. As Barnett notes:

“It’s good news that the governor is now open to doing the right thing about Medicaid expansion. Even Tillis now says he might favor it. Refusing to do it could cost the state $51 billion in lost federal money over the next decade, according to a report from the Robert Wood Johnson Foundation.

But this change of position shouldn’t pass without a look at the rationale for not doing it in the first place. Wos’ reign at DHHS has been marked by massive provider payment problems, an exodus of staff, plummeting morale and expensive consultants hired to fill in the gaps. Now she’s saying that the administration of Medicaid has been fixed and it’s ready to take on a half-million new recipients.

If that turnaround is true, Wos has accomplished an amazing feat of introducing efficiency and accountability. Yet there’s nothing to suggest that is the case. DHHS under Wos remains an agency riddled by vacancies and burdened by a reputation for administrative dysfunction that has discouraged top applicants. But the Medicaid program itself was never “broken”. It has operated in North Carolina for decades and in recent years has successfully held down administrative costs compared with the national average. Medicaid’s “out-of-control costs,” which Republican legislators say busted the state budget, reflect wishful budgeting. Simply putting a number in the budget won’t hold down costs. People need treatment, and when there’s a recession Medicaid rolls grow. With the economy now improving, Medicaid costs are coming in under budget.”

In other words: It’s great that McCrory and Wos want to expand Medicaid and even fine if they want to delude themselves about the reasoning, but anyone who’s been paying attention knows their claims and rationales are bogus.
Commentary

Art Pope 3Phil BergerThe talk about Medicaid expansion for North Carolina in 2015 from political leaders without much power to do anything about it continues. Gov. McCrory and his HHS Secretary keep talking about expansion as does, rather amusingly, lame duck Speaker/U.S. Senate candidate Thom Tillis. Obviously, expansion would be a terrific thing and is horrifically overdue as the current absurd obstructionism is literally costing thousands of lives per year — all in the name of nothing but conservative ideology.

Sadly, however, neither of these stances by McCrory or Tillis will amount to a hill of beans come next legislative session unless the real conservative bosses in North Carolina politics give their assent. Those two bosses, of course, would be Senate President Pro Tem Phil Berger and the most important conservative power broker in state politics, Art Pope. After all, the General Assembly has already passed a law to prevent McCrory from doing the deed without their approval and, for all we know, Tillis could well be reduced to trolling the halls of the General Assembly next year as a lobbyist or McCrory lackey.

Meanwhile, there are few if any positive signals from Berger and Pope to be found. Berger says he’s still opposed and Pope…well, his hirelings continue to spout mean-spirited nonsense and gibberish on the subject.

Of course, all of this could change. The powers-that-be in the health care industry want expansion and understand the tremendous good it would do — both for people and in need and, perhaps even more importantly from the corporate perspective, their profits. Add to this the fact that conservative majorities in the General Assembly could be slightly smaller next year and there’s certainly reason to hope that the politics on the issue will continue to improve.

That said, when you’re dealing with true right-wing believers who don’t even bat an eye as their policies literally result in thousands of unnecessary deaths per year, it’s hard to see what’s going to bring about the change of heart. Moreover, at this point in his governorship, Pat McCrory gives literally no indication that he has the ability lead or shape the debate.

Commentary
Funeral

Photo: NC NAACP

As the North Carolina NAACP holds a “Denial of Medicaid Funeral Procession” today, it’s worth considering some of the facts and data surrounding the impact of North Carolina’s ongoing refusal to expand Medicaid under the Affordable Care Act:

The North Carolina Institute of Medicine’s 2009 Access to Care study begins with this statement: “The lack of health insurance coverage is the foremost barrier to accessing health care services.”

In the report’s introduction it continues:

In a statewide survey of adults, nearly half of the uninsured in North Carolina reported forgoing necessary care due to cost, compared to 10% of individuals with insurance coverage. Lack of coverage also adversely affects health as the uninsured are less likely to get preventive screenings or ongoing care for chronic conditions. Consequently, the uninsured have a greater likelihood than people with coverage of being diagnosed with severe health conditions (such as late stage cancer), being hospitalized for preventable health problems, or dying prematurely. In fact, adults who lack insurance coverage are 25% more likely to die prematurely than adults with insurance coverage.

A Families USA report in 2010 estimated that before the Affordable Care Act passed nearly 1,000 North Carolinians died each year between 2005 and 2010 due to lack of health insurance.

What has changed is that the states now have an unprecedented tool for saving lives. North Carolina now has the opportunity to extend health insurance coverage to nearly all low-income adults, the majority of whom are working. The federal government will finance nearly the entire cost of this coverage expansion. Not expanding coverage is not only morally misguided but it is also fiscally irresponsible. Read More