Obamacare

health

Supreme court to hear Obamacare case that may lead to 20m losing insurance

For more than a decade, Republicans have sought to destroy the signature achievement of the Obama administration – the Affordable Care Act, better known as Obamacare.



a group of people standing in front of a crowd: Photograph: Lynne Sladky/AP


© Provided by The Guardian
Photograph: Lynne Sladky/AP

Exactly one week after election day, they might succeed.

After an election season like no other, in the middle of a pandemic, the supreme court will hear a case that could result in 20 million Americans losing their insurance, along with a raft of other insurance benefits disappearing from American life. Or not.



a group of people holding a sign: Adelys Ferro holds a sign in support of Obamacare on 24 October 2020 in North Miami, Florida.


© Photograph: Lynne Sladky/AP
Adelys Ferro holds a sign in support of Obamacare on 24 October 2020 in North Miami, Florida.

All of us have benefited from the act, even if we cannot see it

Abbe Gluck, Yale Law School professor

“This is the one issue now that is causing me tremendous panic,” said Daniel Dawes, author of 150 Years of Obamacare, an attorney and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

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“I have been a cup-runneth-over type of guy, very optimistic in this country, I’m not sure I can even see the cup as half full right now when it comes to the life of the ACA,” Dawes said.

Better known as Obamacare, the ACA expanded government-sponsored health insurance for the poor, required insurance companies to cover a list of benefits such as pregnancy and preventive care, and even required chain restaurants to display calorie counts on their menus. It is intimately intertwined with what Americans think of as health insurance.

“All of us have benefited from the act, even if we cannot see it,” said Abbe Gluck, Yale Law School professor and faculty director of the Solomon Center for Health Law and Policy. Overturning the law would cause “chaos” and “on-the-ground impacts on Americans” that Gluck said “cannot be overstated”.

The ACA was passed on a party-line vote in 2010, and has been loathed by Republicans ever since, viewed by many conservatives as a government intrusion into healthcare. For eight years, Republicans have sought to “repeal and replace” the law.

They failed to repeal the law legislatively after Trump’s election, despite controlling all legislative levers of government. They did, however, take the teeth out of one hated provision, called the “individual mandate”.

The individual mandate clause required all Americans to obtain health insurance or pay a tax penalty. The penalty was repealed in Trump’s 2017 tax law that primarily benefited the rich. Soon after, officials in Texas sued, arguing the entire law was unconstitutional because the individual mandate was such a central tenet.

Texas’s argument has been supported by the Trump administration, which argued because the tax penalty was eliminated, the, “rest of the ACA must also fall”.

Whether the court will overturn the law or eliminate only one provision stands on a question of “severability”, a legal doctrine that allows judges to, in the words of Chief Justice John Roberts, take “a scalpel rather than a bulldozer” to statutes.

“What is highly unorthodox

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health

The Health 202: Obamacare marketplaces survived Trump’s term better than expected

“The overall impact of the Trump administration’s policies towards the marketplaces have probably been more muted than most expected — at least so far,” said Adam Gaffney, a professor at Harvard Medical School and president of Physicians for a National Health Program.

Enrollment in Healthcare.gov and the state-based marketplaces is open through Dec. 15.

People can shop for private plans, and qualify for federal subsidies if their income is between 133 percent and 400 percent of the federal poverty level.

To the concern of health-care advocates, enrollment has ticked down over the past four years, contributing to the nation’s worsening uninsured rate amid the coronavirus pandemic and fueling a growing sense among Democrats that further health restructuring is needed.

Yet by some measures, the marketplaces look healthier than ever.

Individual insurance premiums and choices have steadily improved over the past four years, despite Democrats’ insistence that the administration’s policies would destroy the marketplaces. That trend will continue in the 2021 enrollment season.

“One thing the marketplaces proved is how resilient they actually are,” said Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services under President Barack Obama.

Still, there’s a clear difference in how a Joe Biden administration would approach the ACA.

It certainly would invest more in boosting marketplace enrollment, advisers say. The Democratic nominee, if he wins tomorrow’s election, is expected to restore funds Trump scrapped to advertise the law and may push Congress to pass legislation increasing the income-based subsidies available to people. 

A Democrat-led administration may also reverse some of the changes President Trump made to the marketplaces — although Trump’s record on them is more nuanced than either party claims.

“The truth is somewhere in middle between what Republicans say and what Democrats say,” said Larry Levitt, a vice president for the Kaiser Family Foundation.

The average Obamacare customer can choose from plans offered by four to five issuers.

That’s up from an average of three to four issuers in 2020, according to data from the Centers for Medicare and Medicaid Services. Four percent of enrollees will have access to plans from just one issuer, up from 12 percent of enrollees this year.

And premiums are declining for the third straight year. The average premiums for the second-lowest-cost “silver”-level plan will be 2 percent lower next year. Average premiums for these “benchmark” plans have declined 8 percent since 2018.

“Despite the uncertainty of the pandemic and concerns about the future of the ACA, the marketplaces are strong and healthy, and premiums for high-quality, comprehensive coverage remain very affordable,” said Joshua Peck, co-founder of Get America Covered — a nonpartisan group that has worked to spread the word about the marketplaces even as the administration has cut advertising for it.

It’s a distinct shift from how things looked during the Obama administration. The first few years of the marketplaces were marked by double-digit premium increases and a steady stream of exits by insurers, as they struggled with how to price and sell insurance

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‘Obamacare’ sign-ups begin as millions more are uninsured

WASHINGTON — Millions of Americans who have lost health insurance in an economy shaken by the coronavirus can sign up for taxpayer-subsidized coverage starting Sunday.

It’s not a new COVID relief program from the government but the return of annual sign-up season under the Affordable Care Act, better known as “Obamacare.” Open enrollment lasts through Dec. 15.

The Centers for Medicare and Medicaid Services, which runs HealthCare.gov, says premiums are down slightly on average for 2021 and most people will have at least three insurers from which to pick plans. Lower-income people and even middle-class families may qualify for tax credits that can greatly reduce what they pay monthly for premiums.

But President Donald Trump, unrelenting in his opposition to President Barack Obama’s signature domestic program, is asking the Supreme Court to overturn the entire law.

Trump has been promising a much better replacement since before taking office, but never came out with his plan. The justices are scheduled to hear the case Nov. 10, and the administration is doing little to promote sign-ups, having previously slashed the program’s ad budget.

“Affordable health coverage is more essential than ever during the pandemic,” said House Speaker Nancy Pelosi, D-Calif., who’s urging people to enroll even if Trump keeps trying to do away with the law.

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Those who are healthy most likely have other priorities, such as finding another job. Workers who were furloughed, but not laid off, may have been able to keep their coverage. Some appear to have switched to a spouse’s plan, and those age 65 and older can get on Medicare.

The nonpartisan Kaiser Family Foundation estimates that 80% of those

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health

‘Obamacare’ sign-ups begin as millions more are uninsured | St. Louis business news

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Source Article

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health

‘Obamacare’ sign-ups begin as millions more are uninsured

WASHINGTON (AP) — Millions of Americans who have lost health insurance in an economy shaken by the coronavirus can sign up for taxpayer-subsidized coverage starting Sunday.

It’s not a new COVID relief program from the government but the return of annual sign-up season under the Affordable Care Act, better known as “Obamacare.” Open enrollment lasts through Dec. 15.

The Centers for Medicare and Medicaid Services, which runs HealthCare.gov, says premiums are down slightly on average for 2021 and most people will have at least three insurers from which to pick plans. Lower-income people and even middle-class families may qualify for tax credits that can greatly reduce what they pay monthly for premiums.


But President Donald Trump, unrelenting in his opposition to President Barack Obama’s signature domestic program, is asking the Supreme Court to overturn the entire law.

Trump has been promising a much better replacement since before taking office, but never came out with his plan. The justices are scheduled to hear the case Nov. 10, and the administration is doing little to promote sign-ups, having previously slashed the program’s ad budget.

“Affordable health coverage is more essential than ever during the pandemic,” said House Speaker Nancy Pelosi, D-Calif., who’s urging people to enroll even if Trump keeps trying to do away with the law.

Hard numbers on how virus-related job losses have affected health coverage are not available because the most reliable government surveys will not be out until next year. Estimates range from 5 million to 10 million newly uninsured people. That’s on top of 26 million uninsured last year, before the pandemic, or about 8% of the U.S. population.

“There is a coverage crisis happening, ” said Stan Dorn, a health policy expert now with Families USA, a liberal advocacy group. “And there are fewer resources available to help, thanks to the Trump cuts.”

Dorn worries that’s “a setup for epic failure,” and many people will remain uninsured even as states across the country are seeing alarming increases in coronavirus cases.

Administration officials say HealthCare.gov is open for business and ready to handle sign-ups online or via its call center. “We’ll be working through the upcoming open enrollment period…to ensure a smooth user experience,” CMS Administrator Seema Verma said.

More than 11 million people currently have coverage through HealthCare.gov and state-run health insurance markets offering subsidized private plans. The health law also covers another 12 million people through its Medicaid expansion, adopted by all but 12 states.

Medicaid enrollment has gone up by nearly 4 million people since March, but it’s still unclear how many laid-off workers are coping after the loss of employer coverage in the coronavirus economy.

Those who are healthy most likely have other priorities, such as finding another job. Workers who were furloughed, but not laid off, may have been able to keep their coverage. Some appear to have switched to a spouse’s plan, and those age 65 and older can get on Medicare.

The nonpartisan Kaiser Family Foundation estimates that 80% of

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health

Attacks on Obamacare threaten coverage gains among minorities

Threats to Obamacare could deal a new blow to communities of color that have been disproportionately ravaged by the coronavirus pandemic as the nation is reckoning with generations of inequity.

The Affordable Care Act’s insurance subsidies, its expansions of Medicaid eligibility and its protections for preexisting conditions have especially helped Americans of color, narrowing historic disparities in access to health insurance and affordable care. The coverage gains are among the most significant since the passage of Medicare and Medicaid and the desegregation of American hospitals more than 50 years ago.

Now, President Donald Trump is again threatening to replace the law if he’s reelected. And exactly one week after the election, the Supreme Court, with its new 6-3 conservative majority, will hear oral arguments in a case brought by conservative states seeking to overturn the entire Affordable Care Act. If the law is dismantled, the communities it aided the most stand to lose the most.

“Health care could be ripped away from millions and the numbers of uninsured Americans of color could skyrocket—aggravating the health care disparities that already exist in this country,” said Sen. Tammy Duckworth (D-Ill.). “It’s especially infuriating that this is happening in the middle of a deadly pandemic that is disproportionately devastating so many seniors, Black, Brown and Native Americans and those with pre-existing conditions.”

Between 2013, the year before the Obamacare markets opened and Medicaid expansion began, and 2018, the rate of Latinx adults without health insurance plummeted from 40 percent to 25. The uninsured rate for Black adults fell from 24 percent to 14. For white adults, it dropped from 15 percent to 9, according to the Commonwealth Fund.

“There is no doubt that the Affordable Care Act, though it left millions uninsured, narrowed the racial gap in health insurance coverage and that’s a good thing,” said Mary Bassett, the former New York City health commissioner who is now a professor at Harvard’s School of Public Health. “Having millions suddenly lose their health insurance seems very likely to have an adverse impact.”

If the health law disappeared, the Urban Institute estimated that the gaps would widen once again, almost back to 2013 levels. And that assessment was in 2019 — before the devastation wrought by the coronavirus which is exacerbating inequality, in both health and the economy overall.

Especially affected would be people of color living in one of the 38 states that expanded Medicaid, the joint federal-state health program for low-income people. Without health coverage, many would lose access to much-needed care for chronic health conditions — and become more vulnerable to serious complications from Covid-19.

Trump says he wants a health system that will give people more choice, at less cost. “It’s in court, because Obamacare is no good,” he said at his second and last debate with Democratic challenger Joe Biden.

Even the Affordable Care Act’s backers admit it was not a panacea. Health inequities, some driven by generations of systemic racism, persist. Private insurance remains out of reach

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Liz Weston: How losing Obamacare could cost you

If the Supreme Court throws out the Affordable Care Act, your finances and your future could pay the price.

THE RETURN OF PREEXISTING CONDITIONS

The Trump administration and a group of Republican attorneys general have asked that the entire law be thrown out. The Supreme Court is scheduled to hear oral arguments on Nov. 10.

Before the ACA, insurers routinely used preexisting health conditions as a reason to deny coverage or charge people more. Preexisting conditions included serious ailments such as cancer or heart disease as well as more common conditions such as high cholesterol, high blood pressure, asthma, diabetes and obesity, and temporary conditions including pregnancy. Insurers denied about 1 in 5 applications for individual policies because of preexisting conditions, and some employer-provided group policies required people to wait up to a year before their preexisting conditions were covered.

President Trump signed an executive order in September announcing “a steadfast commitment to always protecting individuals with preexisting conditions,” but the order alone can’t force insurers to offer coverage if the ACA is struck down.

And America is a land of preexisting conditions. Half of adults under age 65, or up to 133 million people, had health issues that could cause them to be denied coverage or charged exorbitant premiums, according to a 2017 government analysis.

‘USE IT AND LOSE IT’ COVERAGE

Health insurance is meant to help people pay their medical expenses and avoid potentially catastrophic bills. Before Obamacare, however, using your insurance could cause you to lose it.

If someone with an individual insurance policy got sick, the insurer could scour the person’s application looking for errors. Even minor mistakes could cause the company to revoke the policy, a practice called

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How Trump success in ending Obamacare will kill Fauci plan to conquer HIV

In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.

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Related: ‘Rick Scott had us on lockdown’: how Florida said no to $70m for HIV crisis

But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.

Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee will vote on Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.

The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US.



a person holding a sign: Amy Coney Barrett listens during a confirmation hearing. Photograph: Anna Moneymaker/AP


© Provided by The Guardian
Amy Coney Barrett listens during a confirmation hearing. Photograph: Anna Moneymaker/AP

The central aim of the Trump-backed plan is to improve access to antiretrovirals, given that successfully treating HIV with such medications eliminates transmission risk. For HIV-negative people, the plan promotes greater use of PrEP – a daily antiretroviral tablet that cuts the risk of HIV by more than 99% among gay and bisexual men, who are its predominant users and account for seven in 10 new infections.

Given antiretrovirals’ enormous cost, the ACA and its broadening of insurance access serves as backbone to the HIV plan, which seeks a 90% reduction by 2030 to the otherwise slowly declining or stagnant national HIV transmission rate of about 37,000 new cases annually.

“The plan is dead in the water if the ACA goes down,” said Amy Killelea, senior director of health systems and policy at Nastad, an HIV public policy non-profit.

“President Trump’s healthcare agenda, in particular his plan to get the supreme court to rule against families’ healthcare, does more to end access to HIV care than it does to end HIV,” said the Washington state senator Patty Murray.

‘Heartbreaking and morally indefensible’

Kaiser found that between 2012 and 2018, the proportion of the non-elderly HIV population lacking insurance declined from about 18% to 11%. This shift was mainly driven by the expansion of Medicaid in the states that opted under the ACA to open the program to all residents with incomes below 138% of the federal poverty level.

About 60% of non-elderly people receiving care for HIV fall into that lowest of income brackets. Forty per cent of people with HIV receive Medicaid, compared with 15% of the general population.

“Striking down the ACA would lead many people with HIV to lose insurance coverage,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.

Not following the science to address HIV or Covid-19 primarily

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Repeal of Obamacare Could Leave Young Cancer Patients in the Lurch | Health News

By Cara Roberts Murez, HealthDay Reporter

(HealthDay)

THURSDAY, Oct. 22, 2020 (HealthDay News) — If Obamacare, or the Affordable Care Act (ACA), is repealed, pediatric cancer patients could lose critical insurance coverage, a new study warns.

Kids with cancer often require intensive treatment and long-term follow-up to beat the disease. The ACA allows them to stay on their parents’ insurance coverage to age 26 and bans exclusion of patients with preexisting conditions.

The U.S. Supreme Court is poised to rule on the future of the ACA this fall. Researchers at the University of California, San Francisco’s Benioff Children’s Hospital and the Children’s Hospital of Philadelphia studied the potential impact of dismantling it on 18- to 25-year-old cancer patients.

“We know that even brief disruptions in insurance have been associated with harmful health consequences,” said first author Dr. Lena Winestone, of the Helen Diller Family Comprehensive Cancer Center at UCSF. “Strict adherence to chemotherapy regimens, for example, is essential for those patients with acute lymphoblastic leukemia,” the most common pediatric cancer.

Researchers tracked patients born in 1982 or later who were diagnosed with cancer between 2000 and 2015. Most had leukemia, lymphoma or tumors of the brain or spine.

The investigators contrasted insurance status in four age groups, including a group who turned 19 within two years of the ACA’s adoption. They were matched by cancer type, diagnosis date, demographics and treatment characteristics to patients who were two years older and, therefore, unprotected by the ACA.

They did similar comparisons with patients who were 23 to 25 years of age and between 26 and 28 when the ACA went into effect.

The average time to end of coverage was 26 months, compared to 22 months for the older group — a 15% lower risk of insurance loss. The younger patients also were more likely to retain coverage for four years — 37% versus 31%.

Winestone was senior author on a 2019 study that showed private insurance coverage may boost survival in pediatric cancer patients. In that study, 71% of patients with private insurance were alive five years after being diagnosed with bone and soft-tissue sarcomas, compared to 61% of patients with public insurance.

“Cancer survivors experience ongoing loss of income and financial burden related to their medical issues,” Winestone said in a UCSF news release. “At a time when unemployment is rising to unprecedented levels, due to the economic fallout of the pandemic, the Affordable Care Act provides a mechanism for patients to maintain access to their parents’ health insurance.”

The findings were published Oct. 22 in JCO Oncology Practice.

Copyright © 2020 HealthDay. All rights reserved.

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For Latino voters, health care is a top issue as Obamacare gains reverse under Trump

SAN ANTONIO — Larisa Alvarado, 36, feared she had the coronavirus when she woke up last week feeling an itch and pain in her leg that later advanced to swelling. She began running a fever and became nauseous.

A friend and poison control expert suggested her symptoms could be from a spider bite, and advised her to see a doctor. But before she went to an urgent care clinic, Alvarado first had to research the cost of a visit and of the medicine a doctor was likely to prescribe—to see if she could afford them.

That’s because she doesn’t have health insurance. Alvarado lost her job as a patient resource specialist with the American Cancer Society after the organization’s fundraising was hit due to the pandemic.

Alvarado is just one of more than 11.2 million Latinos in the United States who don’t have health insurance—in 2019, almost 17 percent of Hispanics didn’t have health coverage, the highest of any group. That was the figure from before the pandemic, which was already up from 10.22 million in 2016.

Now experts say that number is likely even higher given the pandemic’s disproportionate toll on the community.

As people lose work and health care benefits, it’s become an even tougher task to ensure residents get health coverage access, said Joe Ibarra, co-chair of EnrollSA, a coalition of organizations trying to boost insurance enrollment in the San Antonio area.

“In Texas, there is no expanded Medicaid. The rules are really harsh. Folks are losing coverage as a result of losing their jobs and they are left without good options,” Ibarra told NBC News.

Latinos gained the most under the Affordable Care Act after it was enacted in 2010, with about 4 million adults and 600,000 children obtaining health care coverage by 2016.

As more people lose health insurance, the cost and the availability of coverage are top-tier issues for Hispanics this election cycle. Latinos rank it even ahead of jobs and the economy and place more importance on it than they did about this time in 2016.

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“Latinos are going to the polls keeping health care in mind and their experience with Covid in mind and voting for change for their health and well-being,” Alberto Gonzalez, senior policy strategist at UnidosUS, a Latino civil rights organization, said.

Early in the election cycle, the GOP was pointing to record low unemployment rates Latinos were experiencing as reason to re-elect Trump, while Democrats countered that Hispanics were not economically stable if many had to work more than one job to make ends meet.

But the pandemic’s disproportionate effect on Latinos has forced a reckoning of the gaps in health care coverage, especially in states like Texas with a huge Hispanic population.

Fears of Covid-19 — without health insurance

Before Alvarado lost her job, she was already skimping on her health, forgoing therapy for carpal tunnel to save on the steep copay and deductibles. Now

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