#ppaca

Tierney Sneed and Tami Luhby at CNN:

The Supreme Court said Friday it will review the constitutionality of the Affordable Care Act’s no-cost coverage mandates for certain preventive care services, putting the landmark health care law in front of the justices again just as President-elect Donald Trump – who tried to repeal the law during his first presidency – returns to the White House.

While not an existential threat to Obamacare, the case could imperil access Americans have to cost-free preventive treatments and services, including HIV prevention medications, heart statins and various screenings for cancers and other diseases. The cost of some of these preventive services can be substantial, which would deter some people – particularly those with lower incomes – from accessing the care and slow the early detection of potentially deadly illnesses. The 5th US Circuit Court of Appeals ruled that the mandates in question, based on the recommendations of the US Preventive Services Task Force, violated the Appointments Clause of the Constitution because its members are not appointed by the president with Senate confirmation. The 5th Circuit’s ruling was directed at no-cost coverage requirements implemented after Obamacare’s enactment in March 2010.

The appellate ruling only blocked the mandates as applied to the challengers of the specific case, a Texas business and several individuals. But both the Biden administration and the challengers agreed that the 5th Circuit’s precedent set the stage for another party to sue to block the mandates nationwide, and both sides had asked the Supreme Court to take up the case.

Among the other no-cost coverage mandates that are put at risk by the 5th Circuit ruling are prenatal nutritional supplements, physical therapy for older Americans to prevent falls and lung cancer screenings that, according to the Biden administration, could save the lives of 10,000 to 20,000 Americans a year. A variety of other no-cost preventive services – such as well-baby visits and autism screenings for children, cervical cancer screenings and breastfeeding support programs for women, and flu, measles and chickenpox vaccines – are not at issue in the case.

[...]

‘Protections for millions’

In her petition that the Supreme Court take up the case, US Solicitor General Elizabeth Prelogar wrote that the 5th Circuit ruling “jeopardizes healthcare protections that have been in place for 14 years and that millions of Americans currently enjoy.” “This Court’s review is warranted because the court of appeals has held an Act of Congress unconstitutional and its legal rationale would inflict immense practical harms,” she wrote, later adding that the justices should also take up the case because the appellate “decision threatens to disrupt a key part of the ACA that provides healthcare protections for millions of Americans.” The challengers also urged the Supreme Court to take up the case, even as they argued that the 5th Circuit’s ruling was “well-reasoned and correct.” They pointed to the Supreme Court’s typical practice of granting cases where an act of Congress was deemed unconstitutional by a lower court. The Texas business, Braidwood, sued over the mandates because the company had moral objections to covering the HIV prevention medications – known as PrEP. The company also objected to paying for insurance that covered screenings for sexually transmitted diseases and other treatments related to conduct the employer morally opposed.

CALL (202) 224-3121 to tell your rep NO on Graham -Cassidy

Have you read it? Allows insurers not to cover: Pregnancy, Newborn Care, Mental Health, Rx drugs, Rehab, Birth Control Adds surcharges for Pregnany $17k, Autism $5k, Asthma $4K, Metastatic Cancer $172K Defunds Planned Parenthood of course. Allows rates to be raised at any time. CBO won't have time to score, there's no debate, no committees, no Democrats involved. Use 5calls.org to find your reps. local number and a script, if needed.

Also call: MCCAIN 202-224-2235 MURKOWSKI 202-224-6665 COLLINS 202-224-2523 PORTMAN 202-224-3353 CAPITO 202-224-6472

Prior to Obamacare, most plans paid out in benefits somewhere around 50% of total premiums. (This is not as scummy as it sounds; insurance fundamentally has to work this way, although I am somewhat surprised at how low the numbers are). Obamacare has a regulation requiring all plans to pay out at least 70% of premia in benefits; BCRA has a rule lowering this threshhold to 58%.

Originally it looked like the Obamacare actuarial value mandate was going to be interpreted in such a way to kill off high-deductible plans with health savings accounts, but that didn't actually happen.

A lot of wonks are big fans of high-deductible plans: as the deductible gets higher, the cost of the plan should go down roughly with the likelihood of you actually hitting the deductible. (The insurance company will want \$2000 more in premiums if it's going to have to pay everything past \$4000, instead of everything past \$6000).

But naively you'd think that since the outlays are going down and the premiums are also going down, this wouldn't change the actuarial value calculations that much. So I'm trying to figure out how changing the threshhold would make high-deductible plans more available.

My best guess is that a high-deductible plan has less spending going through the insurance company, but doesn't reduce the amount of overhead from the company. So all else being equal, the actuarial value goes down if more of the money is spent by the consumer, rather than handed by the consumer to the insurance agency who then spends it.

Is this enough to have a major effect? Now that I write it out and think about it I guess it probably would. The key factor is that the insurance company has to pay overhead, but doesn't have to pay much more overhead just because the deductible is lower. So to a first order approximation, 100% of the money spent on the lower deductible contributes to "spending on care".

My friends, do not ignore the most significant bit of this article (emphasis mine):

Republicans have to use a special legislative maneuver, called a budget resolution, to undo the ACA because they don't have enough votes to overcome a Democratic filibuster in the Senate. Budget bills aren't subject to filibuster, so lawmakers will be able to repeal the parts of the law that have budget and tax implications.

That means they can essentially gut the law, removing all the subsidies that help low- and middle-income people buy health insurance and getting rid of the smorgasbord of taxes — on medical devices, insurance companies and wealthy individuals — that pay for those subsidies.

Ed Kilgore at NY Intelligencer:

As you probably know, we’re beginning the final week of a dead-even presidential contest between Kamala Harris and Donald Trump, with Pennsylvania’s 19 electoral votes being the most desperately sought prize by both campaigns. Team Trump is already having a difficult week in the Keystone State thanks to a crude racist joke about Puerto Rico that one of Trump’s comedian buddies told at his wild Madison Square Garden rally, which is not going over well among the pivotal bloc of Puerto Rican voters in northeastern Pennsylvania. Now, Harris has gotten a helping hand in the same vicinity from none other than House Speaker Mike Johnson, as NBC News reports:

[House Speaker Mike Johnson took a dig at Obamacare during an event in Pennsylvania on Monday, telling a crowd there will be “massive” health care changes in America if Donald Trump wins the election. “Health care reform’s going to be a big part of the agenda. When I say we’re going to have a very aggressive first 100 days agenda, we got a lot of things still on the table,” Johnson, R-La., said in Bethlehem while campaigning for GOP House candidate Ryan Mackenzie, according to video footage obtained by NBC News. “No Obamacare?” one attendee asked Johnson, referring to the law Democrats passed in 2010, also known as the Affordable Care Act. “No Obamacare,” Johnson responded, rolling his eyes. “The ACA is so deeply ingrained, we need massive reform to make this work and we got a lot of ideas on how to do that.”]

Health care is not at all an issue Trump wants Republicans talking about. The effort to repeal Obamacare was one of the less popular initiatives of his presidency and, not coincidentally, one of his biggest failures. It’s also one of the areas where Harris has outpolled him. He added to his problems during the September debate with his rival when he could cite only “the concepts of a plan” for replacing Obamacare despite having allegedly spent many years on his own yet-to-be-revealed proposal.

Worse yet, Johnson’s remarks very strongly suggest two things that are potentially dangerous to Trump in the eyes of swing voters: (1) He plans to make repealing Obamacare an immediate priority if Trump wins and Republicans control Congress, which likely means it would be rolled into a gigantic budget-reconciliation bill and steamrolled through to passage if possible, and (2) his party’s designs on health-care policy are radical, meant to replace the regulations central to Obamacare’s coverage guarantees with “free market” provisions almost certain to return the health-care system to the days when insurers aggressively discriminated against anyone old, sick, or poor. Johnson’s rhetoric will also give Democrats an opportunity to remind voters that the last “repeal Obamacare” package aimed to decimate Medicaid, the federal-state health-care program for poor people and a key part of the country’s social safety net

Nadra Nittle and Shefali Luthra at The 19th:

President Joe Biden’s administration on Monday announced a plan that would eliminate out-of-pocket expenses for most birth control for a majority of Americans.  Officials called the proposed rule, which affects people with private health insurance, the most significant expansion of contraception coverage under the Affordable Care Act (ACA) in over a decade. They estimate it could benefit 52 million women of reproductive age. “For the first time ever, women would be able to obtain over-the-counter contraception without a prescription at no additional cost, and health plans would have to cover even more prescribed contraceptives without cost sharing,” said Jennifer Klein, assistant to the president and director of the White House Gender Policy Council, in a call with reporters.  The proposed rule would alleviate a significant financial burden for millions of Americans. The 2010 health law already required private health plans to cover at least one form of birth control for beneficiaries without any out-of-pocket costs. Research shows that the benefit has contributed to higher use of contraception, lower health care expenditures by women, and may have helped lower rates of unintended pregnancy. 

But applying the contraception mandate to over-the-counter methods has been difficult.  If enacted, the proposed rule would require health plans cover forms of birth control such as condoms and emergency contraception – both typically bought without a prescription – as well as a new over-the-counter hormonal birth control pill. That pill, known as Opill, hit retail shelves earlier this year, and a six-month supply costs about $90.  Democrats have pushed for years to strengthen enforcement of the ACA’s existing birth control mandate, citing reports of poor enforcement and of women receiving surprise bills for contraceptives that should have been covered. A 2021 survey by KFF, a nonpartisan health policy research, polling and journalism organization, found that 1 in 5 women with private insurance said they had paid something out of pocket for birth control.  Biden administration officials reiterated those concerns. 

[...] Some Republican state lawmakers have been clear about their intentions to restrict birth control as well as abortion. Conservatives in Congress have called for the defunding of Title X, a federal program offering family planning and related health care services. They have also blocked federal legislation to protect contraception access. Harris, in contrast, has maintained that “contraception is health care.” Since Roe was overturned in June 2022, Harris has discussed the repercussions of limiting women’s health care during more than 100 events, according to Kristine Lucius, deputy assistant to the president and domestic policy adviser to the vice president. 

Harris has also criticized Republican efforts to repeal the ACA, which covers nearly 50 million Americans. Among those protected by the law are more than 100 million people with preexisting medical conditions. The law has already allowed millions of women to save on contraception costs.  The proposed rule will likely have a 60-day comment period, meaning that it will be finalized in 2025, officials said during the call, making it uncertain if it would still take effect if former President Donald Trump is elected. Trump’s position on contraception hasn’t been clear. In May, he gave an interview in which he suggested he would consider certain restrictions, but he later said he would not impose any. Project 2025, which Trump has distanced himself from — even though its writers have ties to both him and his running mate, Sen. JD Vance — does support restricting some forms of contraception. 

The Biden Administration announced on Monday a plan that would eliminate out-of-pocket spending for most birth control items by not requiring a prescription for birth control. This would be a significant expansion of contraception coverage under the Patient Protection and Affordable Care Act (PPACA).

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