Unin­sured drop as ACA faces threats

Modern Healthcare - - NEWS - By Beth Kutscher, Bob Her­man and Har­ris Meyer

The num­ber of Amer­i­cans who were unin­sured for at least part of last year dropped to a low not seen in decades.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion found that only 11.9% of re­spon­dents sur­veyed dur­ing the first nine months of 2014 said they were unin­sured. The unin­sured rate had hov­ered in the high teens and low 20s since at least the mid-1990s.

The pre­lim­i­nary data re­lease from the Na­tional Health In­ter­view Sur­vey comes just weeks be­fore the U.S. Supreme Court is ex­pected rule on the le­gal­ity of pre­mium sub­si­dies in up to 37 states. A rul­ing strik­ing down the sub­si­dies likely would cause mil­lions of Amer­i­cans to lose their cov­er­age.

Mean­while, a top ex­ec­u­tive at Unit­edHealth Group, the na­tion’s largest health in­surer, told in­vestors last week that his com­pany be­lieves some re­me­dial ac­tion would be taken if the jus­tices strike down the sub­si­dies. “There will be a re­sponse, and we’ll be po­si­tioned to aid in that re­sponse” so in­di­vid­u­als can keep their cov­er­age, said David Wich­mann, Unit­edHealth’s pres­i­dent and chief fi­nan­cial of­fi­cer.

But a re­port from the Amer­i­can Academy of Ac­tu­ar­ies last week found that many of the fixes pro­posed by con­gres­sional Repub­li­cans if the sub­si­dies are struck down would not help the in­di­vid­ual in­sur­ance mar­ket. Tem­po­rar­ily ex­tend­ing pre­mium sub­si­dies, elim­i­nat­ing the in­di­vid­ual man­date, and al­low­ing in­sur­ers to sell plans across state lines all have draw­backs that could threaten the in­sur­ance mar­ket, the group said.

And, last week, a new legal threat to the ACA emerged. A judge’s com­ments in a pre­lim­i­nary hear­ing Thurs­day sug­gested that it’s very pos­si­ble the Obama ad­min­is­tra­tion will have to fight a new court battle to save the cost-shar­ing sub­si­dies that make health­care af­ford­able to low-in­come ex­change-plan en­rollees.

House Repub­li­cans are chal­leng­ing the ad­min­is­tra­tion’s de­ci­sion to use Trea­sury funds that were not ap­pro­pri­ated by Congress to pay for $175 bil­lion in sub­si­dies for low­in­come ex­change plan mem­bers to help them with out-of-pocket costs. Dur­ing the hear­ing, Rose­mary Col­lyer, a judge for the U.S. Dis­trict Court for the Dis­trict of Columbia who was nom­i­nated by Pres­i­dent Ge­orge W. Bush, fired skep­ti­cal ques­tions at the ad­min­is­tra­tion’s lawyer who was urg­ing her to dis­miss the case.

Ac­cord­ing to news ac­counts, Col­lyer ham­mered him on the sub­stan­tive is­sues of the case even though the hear­ing was held only to de­ter­mine the legal stand­ing of the plain­tiffs to bring the case. “So it is your po­si­tion that if the House of Rep­re­sen­ta­tives af­fir­ma­tively voted not to fund some­thing … then that vote can be ig­nored by the ad­min­is­tra­tion, be­cause, af­ter all, no one can sue them?” she asked.

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