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Friday, Jun 26 2015

Full Issue

Next For Obamacare: Legal Challenges, State Debate, Insurance Market Issues

Despite a Supreme Court ruling upholding a key part of the health law, the road forward for it is littered with obstacles. Chief among them are what insurance markets will look like, court challenges that remain and fights in the states over implementation.

Obamacare has cleared a second major hurdle at the Supreme Court 鈥 but its troubles are far from over. The law is still highly unpopular, and significant structural issues remain: Health insurance rates are rising, many people don鈥檛 have as much choice of doctors and hospitals as they鈥檇 like, some states continue to struggle with their exchanges, and 21 states still haven鈥檛 backed Medicaid expansion. (Haberkorn and Pradhan, 6/25)

At least in Congress and the courts, probably not much. Despite expressing renewed resolve to repeal the health law, congressional Republicans know any such effort would face a certain veto from President Obama. And they are far from united on any particular plan. Meanwhile, legal challenges to the law remain, but none poses as serious a threat as King v. 颅Burwell, which aimed at a pillar of the law 鈥 the insurance subsidies being provided to millions of people through the federal exchange. Most of the near-term action on the law, in fact, will occur in insurance companies, hospitals and government offices where people are working furiously to implement a complicated statute in a fast-changing environment. (DeBonis, Snell and Sun, 6/25)

In its first five years, the Affordable Care Act has survived technical meltdowns, a presidential election, two Supreme Court challenges 鈥 including one resolved Thursday 鈥 and dozens of repeal efforts in Congress. But its long-term future still isn鈥檛 ensured. Here are five of the biggest hurdles left for the law. (Appleby, Carey, Galewitz and Rau 6/26)

But Jonathan Adler, a professor at Case Western Reserve University School of Law, said there are still viable challenges, including a lawsuit filed by House Republicans that accuses the Obama administration of exceeding its powers in funding and enforcing the health-care law. 鈥淭he House suit looks more plausible now than it did originally,鈥 Mr. Adler said. 鈥淭he appropriations issue seemed to bother the judge.鈥 The Obama administration is also facing a lawsuit in Ohio alleging that it is levying an unconstitutional tax through the Affordable Care Act. While the lawsuit isn鈥檛 an existential threat to the health law, it could chip away at its foundation if successful. (Palazzolo, 6/25)

If you thought the legal fight over the health care overhaul was finally over, think again. At least four issues related to the Affordable Care Act still are being sorted out in the courts, although none seems to pose the same threat to the law as the challenge to nationwide subsidies that the court rejected on Thursday, or the constitutional case that the justices decided in favor of the law in 2012. (6/25)

The Supreme Court handed down a victory for the Affordable Care Act, ruling that people living in states with federal health exchanges are eligible for tax subsidies despite language in the law. Gwen Ifill looks at the ruling with Marcia Coyle of The National Law Journal, then gets reactions from Neera Tanden of the Center for American Progress and Michael Cannon of the Cato Institute. (6/25)

Bills to advance or cripple the law in statehouses didn't come to a halt in the months that lawmakers awaited the Supreme Court decision. They may well smolder for months or years. (Schulte, 6/25)

The health care act鈥檚 big win at the U.S. Supreme Court could mean the eventual end of MNsure. Republicans at the Legislature this year called for switching to healthcare.gov, the exchange operated by the federal government for 34 states, because of technical problems at MNsure and questions about its finances. (Snowbeck, 6/25)

When the U.S. Supreme Court ruled Thursday that nationwide subsidies under the federal Affordable Care Act are legal, supporters of the law in Minnesota celebrated the decision. (Zdechlik, 6/25)

Despite having survived a challenge in the U.S. Supreme Court, the federal government鈥檚 health insurance markets face weighty struggles as they try to keep prices under control, entice more consumers and encourage quality medical care. The government鈥檚 insurance markets 鈥 as well as more than a dozen run by states 鈥 have been operating for less than two years and are about to lose their training wheels. Start-up funds that have helped stabilize prices and partially pay for administration of the marketplaces are ending, feeding fears that premiums may rise after next year at a steeper rate. (Rau, 6/25)

The Supreme Court rebuffed the latest (and likely last) judicial challenge to Obamacare on Thursday, ruling in a 6-3 decision that the law entitles Americans in all 50 states to health insurance subsidies. Opponents of Obamacare were hoping that the Court would undermine one of the law's central components by ruling that insurance tax credits were available only to consumers in the 14 states that set up their own insurance marketplaces - not those in the 36 states that used the federal marketplace. (Miller, 6/26)

And Democrats consider their next moves on Medicaid expansion and health care cost concerns --

The Supreme Court鈥檚 decision to uphold Obamacare subsidies nationwide sidesteps a crisis at the state level and puts the focus back on the stalled push to get more states to expand Medicaid. (Pradhan, 6/25)

U.S. Health and Human Services Secretary Sylvia Burwell said on Thursday the Obama administration will focus on improving quality over quantity in the nation's healthcare system in the implementation of the Affordable Care Act. The Supreme Court ruled earlier on Thursday to uphold the nationwide availability of tax subsidies that are crucial to President Barack Obama's signature healthcare law, also known as Obamacare. In a conference call with reporters, Burwell said the administration planned to push further on a patient-centered approach. (Dunsmuir, 6/25)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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