Megalextoria

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.

The Oregon insurance commissioner, Laura N. Cali, has just approved 2016 rate increases for companies that cover more than 220,000 people. Moda Health Plan, which has the largest enrollment in the state, received a 25 percent increase, and the second-largest plan, LifeWise, received a 33 percent increase.

Jesse Ellis O’Brien, a health advocate at the Oregon State Public Interest Research Group, said: “Rate increases will be bigger in 2016 than they have been for years and years and will have a profound effect on consumers here. Some may start wondering if insurance is affordable or if it’s worth the money.”

President Obama, on a trip to Tennessee this week, said that consumers should put pressure on state insurance regulators to scrutinize the proposed rate increases. If commissioners do their job and actively review rates, he said, “my expectation is that they’ll come in significantly lower than what’s being requested.”

The rate requests, from some of the more popular health plans, suggest that insurance markets are still adjusting to shock waves set off by the Affordable Care Act.

Source: Health Insurance Companies Seek Big Rate Increases for 2016 – The New York Times

In his dissent from the Supreme Court’s decision upholding Obamacare subsidies in 34 states, Justice Antonin Scalia accused the six-vote majority of engaging in “interpretive jiggery-pokery.”

The court “rewrites the law to make tax credits available everywhere,” he wrote. “We should start calling this law SCOTUScare.”

The case, King v. Burwell focused on a phrase that the challengers said invalidated subsidies in the states where the federal government was operating the insurance exchange.

“You would think the answer would be obvious—so obvious there would hardly be a need for the Supreme Court to hear a case about it,” Scalia wrote. However by a 6-3 vote, the court, in a opinion written by Chief Justice John Roberts, sought to uphold them.

“Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved,” Scalia wrote in his scathing dissent.

The phrase the case focused on referred to Obamacare tax credits being offered to consumers in exchanges “established by the State.” The government successfully argued that in context of the law, that included exchanges in 34 states that were operated by the federal government.

“Words no longer have meaning,” if the phrase meant what the government sent it meant, Scalia said.

“Today’s interpretation is not merely unnatural; it is unheard of. Who would ever have dreamt that ‘Exchange established by the State’ means ‘Exchange established by the State or the Federal Government’?” Scalia wrote. “Little short of an express statutory definition could justify adopting this singular reading.”

Scalia accused the Supreme Court of performing “somersaults of statutory interpretation” in its “defense of the indefensible.”

The Court interprets §36B to award tax credits on both federal and state Exchanges. It accepts that the “most natural sense” of the phrase “Exchange established by the State” is an Exchange established by a State. Ante, at 11. (Understatement, thy name is an opinion on the Affordable Care Act!) Yet the opinion continues, with no semblance of shame, that “it is also possible that the phrase refers to all Exchanges—both State and Federal.” Ante, at 13. (Impossible possibility, thy name is an opinion on the Affordable Care Act!) The Court claims that “the context and structure of the Act compel [it] to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

Scalia pointed to other times the phrase “by the State” was used in the law.

“It is bad enough for a court to cross out “by the State” once. But seven times?” he wrote.

Source: Scalia Lashes Out: ‘We Should Start Calling This Law SCOTUScare’

This month, the Supreme Court may well deliver a fatal blow to ObamaCare in King vs. Burwell, by ruling that the health insurance subsidies handed out through federal exchanges in 36 states are illegal. Many liberals seem to think that the only thing preventing the president’s crowning domestic achievement from becoming a rip-roaring success is this largely specious and semantic lawsuit. But here’s the thing: ObamaCare is teetering due to its own internal contradictions that have nothing to do with the lawsuit.

ObamaCare’s supporters would like everyone to believe that with Healthcare.gov now functioning, everything is just fine and dandy. Contrary to what the conservative press (which I guess would include me) has been saying about the many problems of ObamaCare, Vox’s Ezra Klein declared last September that “in the real world, it’s working.” In February, his fellow Voxland inhabitant Sarah Kliff rattled off eight ways in which the law had proved its critics wrong.

But has it? Not really.

For starters, the exchanges have enrolled about 3 million fewer people than the Congressional Budget Office projected in 2010. And far fewer of the enrollees are from the ranks of the uninsured than hoped. Medicaid enrollment is lower too, for the simple reason that states refused to expand the program.

The core of President Obama’s sales pitch to America was that the program, which he called the Affordable Care Act, would “bend the health care cost curve” and save an average family $2,500 on their premiums each year. How would it accomplish this feat? Essentially, he said, by forcing uninsured “free loaders” who show up in the emergency room to obtain free care to either buy (subsidized) coverage on the insurance exchange or sign up for the expanded Medicaid program. The point was that if they had coverage, they’d get cheaper care sooner in a doctor’s office rather than more expensive care later in a hospital emergency room.
Things don’t seem to be working out that way. ObamaCare is indeed bending the cost curve — but up, not down. There is no better evidence of this than the recent rate filings by insurance companies.

Every year, companies selling coverage through ObamaCare’s exchanges have to ask state regulators to approve their premiums for the following year — a practice more appropriate for the Soviet Union than an allegedly free-market economy. And this year, according to several news reports, some are requesting increases of over 50 percent.

In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6 percent in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3 percent increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4 percent across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25 percent.

Some states are even higher.

No doubt, these are just opening bids that regulators will bargain down. And in some states (such as Michigan, where I live) the hikes are in the high single-digit territory (that this seems like good news is pretty sad in itself). Still, it seems clear, many families are going to end up paying a lot more for their plans than their pockets can stand.

Why is this happening?

There are many reasons: One is that insurers are anticipating the cost of having to absorb pricey drug therapies such as Sovaldi, a new generation cure for Hepatitis C. There is also pent-up demand from the years of economic downturn when people were foregoing care because they couldn’t afford the co-pays and deductibles.

But the biggest culprit by far that companies cite is that the exchange population is weighted too heavily toward riskier and older patients with multiple chronic conditions than what is needed to hold rates steady. Washington Examiner’s Philip Klein reports that carriers needed 40 percent of their enrollees from the crucial 18-to-34 demographic, but they have only 28 percent.

What’s more, these hikes are likely just a prelude to far bigger ones in future years. Why? Because two programs — risk corridor and reinsurance — that were meant to “stabilize” rates in ObamaCare’s first few years so that insurers could obtain the right mix of enrollees are set to expire next year. (The risk corridor program slaps a fee on insurance companies that have lower-than-expected medical losses, and compensates those that have more. The reinsurance program imposes a fee on insurance policies and funnels it to insurers with high-risk individuals.) With these programs gone, the challenge of maintaining a balanced risk pool will become even harder.

The expanded Medicaid program is no picture of robust health, either. It has produced no cost-saving decline in emergency room visits, nor has it contributed to hospital profitability, as was hoped.

Source: Don’t believe the liberal spin. ObamaCare is sputtering.