Trump doubles down on Obamacare fight, asks court to overturn law

FILE PHOTO - A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake

(Reuters) – U.S. President Donald Trump’s administration has stepped up its attack on the Obamacare health care law, telling a federal appeals court it agrees with a Texas judge’s ruling that the law is unconstitutional and should be struck down.

The Justice Department in a two-sentence letter to the Court of Appeals for the Fifth Circuit filed on Monday said it backed the December ruling by U.S. District Judge Reed O’Connor in Fort Worth that found the Affordable Care Act violated the U.S. Constitution because it required people to buy health insurance.

O’Connor ruled on a lawsuit brought by a coalition of 20 Republican-led states including Texas, Alabama and Florida, that said a Trump-backed change to the U.S. tax code made the law unconstitutional.

The 2010 law, seen as the signature domestic achievement of Trump’s Democratic predecessor, Barack Obama, has been a flash point of American politics since it passed, with Republicans including Trump repeatedly attempting to overturn it.

Democrats made defending the law a powerful messaging tool in the run-up to the November elections when polls showed that eight in 10 Americans wanted to defend the law’s most popular benefits including protections for insurance coverage for people with preexisting conditions. The strategy paid off and Democrats won a broad 38-seat majority in the U.S. House of Representatives.

“The Department of Justice has determined that the district court’s judgment should be affirmed,” Assistant U.S. Attorney General Joseph Hunt and other federal officials wrote in the Monday letter. They said they would file a more extensive legal briefing later.

Obamacare survived a 2012 legal challenge at the Supreme Court when a majority of justices ruled the individual mandate aspect of the program was a tax that Congress had the authority to impose.

In December, O’Connor ruled that after Trump signed a $1.5 trillion tax bill passed by Congress last year that eliminated the penalties, the individual mandate could no longer be considered constitutional.

A group of 17 mostly Democratic-led states including California and New York on Monday argued that the law was constitutional.

“The individual plaintiffs do not have standing to challenge the resulting law because they suffer no legal harm from the existence of a provision that offers them a lawful choice between buying insurance or doing nothing,” they wrote in court papers.

About 11.8 million consumers nationwide enrolled in 2018 Obamacare exchange plans, according to the U.S. government’s Centers for Medicare and Medicaid Services.

About 11.8 million consumers nationwide enrolled in 2018 Obamacare exchange plans, according to the U.S. government’s Centers for Medicare and Medicaid Services.

(Reporting by Scott Malone in Boston; Editing by Bill Trott)

Health insurers, hospital operators fall as Obamacare ruled unconstitutional

FILE PHOTO: A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake

(Reuters) – Shares of health insurers, hospitals, and healthcare companies fell in early trading on Monday, after a federal judge ruled the Affordable Care Act (ACA), also known as Obamacare, unconstitutional late last week.

The ACA, introduced by former U.S. President Barack Obama in 2010 to provide affordable healthcare to all Americans, mandates that all individuals have health insurance or pay a tax.

But on Friday, Texas District Judge Reed O’Connor agreed with a coalition of 20 states that a change in tax law last year eliminating a penalty for not having health insurance invalidated the entire Obamacare law.

Centene Corp fell 7.8 percent to $117.5, while Molina Healthcare slumped 10.1 percent to $118.4. The companies are among health insurers with exposure to ACA.

WellCare Health Plans and Anthem Inc declined 4.7 percent and 2.1 percent, respectively.

“While we are disappointed in the recent Northern District of Texas court’s ACA ruling, we recognize that this is a first step in what will be a lengthy appeals process,” Molina Healthcare said.

“Regardless, the ACA will remain in effect for 2019, and we are optimistic that it will remain in effect thereafter.”

Brokerage Evercore ISI said it expected no immediate impact from the ruling, calling it only a declaratory judgment and not an injunction.

Even in case of an eventual injunction, the defendants would certainly seek and most likely get a stay pending appeal, Evercore said.

Hospitals and healthcare services providers Community Health Systems, Tenet Healthcare Corp and HCA Healthcare Inc fell between 4 percent and 8 percent.

(Reporting by Manogna Maddipatla in Bengaluru)

Twenty states sue federal government, seeking end to Obamacare

FILE PHOTO: A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake/File Photo

(Reuters) – A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine.

Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that without the individual mandate, which was eliminated as part of the Republican tax law signed by President Donald Trump in December, Obamacare was unlawful.

“The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional,” Paxton said in a statement. “With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all,” he said.

The U.S. Justice Department did not immediately respond to a request for comment on whether the Trump administration would defend the law in court.

The individual mandate in Obamacare was meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage.

Republicans have opposed the 2010 law formally known as the Affordable Care Act, the signature domestic policy achievement of Trump’s Democratic predecessor Barack Obama, since its inception.

Paxton and Schimel, both Republicans, were joined in the lawsuit by 18 states including Arizona, Florida, Georgia, Utah and West Virginia. It was filed in U.S. District Court in the Northern District of Texas.

(Reporting by Eric Beech in Washington)

Trump administration will allow states to test Medicaid work requirements

U.S. President Donald Trump attends the Women in Healthcare panel hosted by Seema Verma (R), Administrator of the Centers for Medicare and Medicaid Services, at the White House in Washington, U.S., March 22, 2017.

By Yasmeen Abutaleb

WASHINGTON (Reuters) – The Trump administration said on Thursday it would allow states to test requiring some Medicaid recipients to work or participate in community activities such as volunteering or jobs training as a condition of eligibility for the government health insurance program for the poor.

The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements. States must propose such changes through waivers and receive federal approval.

Seema Verma, the agency’s administrator, said the policy guidance came in response to requests from at least 10 states that have proposed requiring some Medicaid recipients to work or participate in activities that may include skills training, education, job search, volunteering or caregiving. Those states include Kentucky, Maine, New Hampshire, Arizona, Indiana and Utah.

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children and pregnant women. Verma also said states would have to make “reasonable modifications” for those battling opioid addiction and other substance use disorders.

“This gives us a pathway to start approving waivers,” Verma said on a call with reporters on Wednesday. “This is about helping those individuals rise out of poverty.”

Under the 2010 Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement commonly known as Obamacare, 31 states expanded Medicaid to those making up to 138 percent of the federal poverty level, adding millions of people to the rolls.

Republicans have repeatedly failed to repeal and replace Obamacare, a top campaign promise of President Donald Trump. Instead, the Trump administration has sought to weaken the program through executive orders and administrative rules.

The Obama administration opposed state efforts to implement work requirements in Medicaid because it could result in fewer people having access to health insurance.

For instance, Kentucky last year proposed work requirements for able-bodied adults to get insurance and establishing new fees for all members based on income. A study found the proposal would reduce the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million.

Republicans argue that Medicaid was created to serve the most vulnerable and has become bloated under Obamacare. Verma and other Republicans said implementing work and community engagement requirements could help improve health outcomes by connecting people with jobs and training.

(Reporting by Yasmeen Abutaleb; Editing by Peter Cooney)

Nearly 1.5 million people signed up for Obamacare plans so far: officials

Nearly 1.5 million people signed up for Obamacare plans so far: officials

WASHINGTON (Reuters) – More than 800,000 people signed up for Obamacare individual health insurance plans in the second week of open enrollment, U.S. government health officials said on Wednesday, bringing the total number of sign-ups to nearly 1.5 million so far.

There is particular scrutiny of how Affordable Care Act programs are faring after a year in which President Donald Trump has sought to undermine Obamacare, especially after his fellow Republicans in Congress failed to pass legislation to repeal and replace the law.

More people have signed up for Obamacare plans in the first two weeks of 2018 open enrollment than in the same time period last year, and the sign-ups include about 345,000 new consumers, according to the latest figures from the U.S. Centers for Medicare and Medicaid Services.

But the Trump administration halved the 2018 open enrollment period to six weeks, slashed the Obamacare advertising budget by 90 percent and cut funding for groups that help people enroll in Obamacare insurance, so it is still unclear whether there will be the same level of participation as in years past.

The Congressional Budget Office has forecast that 11 million people will buy plans in 2018, 1 million more than were enrolled in 2017.

Republicans, who control the White House, Senate and U.S. House of Representatives, failed this summer to push through legislation to overturn the 2010 law, former Democratic President Barack Obama’s top domestic policy achievement.

Repealing Obamacare has long been a goal of Republicans and it was one of Trump’s main election campaign promises. Frustrated by inaction in Congress, the president has taken steps through executive and regulatory actions to undercut the law, and has promised to let the healthcare program “implode.”

Republicans including House Speaker Paul Ryan have said they will try again next year to repeal the law, which has extended health insurance coverage to 20 million more Americans but which has long been seen by Republicans as costly government overreach.

The Senate this week added a repeal of Obamacare’s individual mandate, the requirement that most Americans purchase health insurance or else pay a penalty, to its version of an overhaul of the U.S. tax code that is working its way through Congress.

(Reporting by Yasmeen Abutaleb; Editing by Frances Kerry)

Maine governor will not expand Medicaid, ignoring voters

Maine governor will not expand Medicaid, ignoring voters

By Gina Cherelus

(Reuters) – Maine Republican Governor Paul LePage said on Wednesday he will not expand the state’s Medicaid program under Obamacare, ignoring a ballot initiative widely backed by voters, calling it “ruinous” for the state’s budget.

Maine looked set to become the first state in the nation to expand Medicaid by popular vote.

About 60 percent of voters in Maine approved the ballot proposal in Tuesday’s election, according to the Bangor Daily News newspaper.

Republicans in Washington have failed several times to pass legislation that would dismantle former President Barack Obama’s signature healthcare law.

LePage said he will not implement the expansion until it is fully funded by the Maine legislature.

“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said in a statement. “I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

LePage said a previous Medicaid expansion in Maine in 2002 had created $750 million in debt to hospitals and took resources away from vulnerable people.

Maine has been prominent in the nation’s healthcare debate. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare. Collins did not immediately respond to a request for comment on LePage’s decision.

Maine voters were asked to approve or reject a plan to provide healthcare coverage under Medicaid for adults under age 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

If implemented, about 70,000 additional state residents would be eligible for the Medicaid program, local media reported, in addition to the roughly 268,000 people who are currently eligible.

(Reporting by Gina Cherelus in New York; Editing by Daniel Wallis and Jeffrey Benkoe)

Voters in Maine approve expansion of Medicaid under Obamacare

Voters in Maine approve expansion of Medicaid under Obamacare

By Brendan O’Brien

(Reuters) – Voters in Maine on Tuesday approved a ballot initiative to expand the state’s Medicaid program under Obamacare, sending a clear signal of support for the federal healthcare law to lawmakers in the state and Washington D.C.

The approval of the ballot question in Maine comes after Republicans in Washington failed several times over the last few months to pass legislation that would dismantle the Affordable Care Act, former President Barack Obama’s signature healthcare law.

Maine has recently figured prominently in the nation’s debate on how to reform healthcare. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare this year, which angered President Donald Trump.

Maine, which becomes the first U.S. state to approve Medicaid expansion by ballot initiative, is one of 19 states that has not expanded Medicaid under the Affordable Care Act.

About 60 percent of voters in Maine approved the ballot initiative, according to the Bangor Daily News newspaper.

Tuesday’s ballot asked Maine voters to approve or reject a plan to provide healthcare coverage under Medicaid for adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

The state’s Republican governor, Paul LePage, staunchly opposes expansion of federal health care insurance, vetoing legislation to do so on several occasions.

“I’ve said it before, “free” is very expensive to somebody,” LePage said in a radio address last week.

About 70,000 residents in Maine would be eligible for the state’s Medicaid program when and if state officials certify the results of the election. Lawmakers could vote to repeal or alter the referendum, much like they have recently for several citizen-initiated referendums, the Bangor Daily News reported.

“It is now the responsibility and the duty of the governor and the legislature to fully and faithfully implement this law,” the state’s Speaker of the House, Sara Gideon, said in a statement.

The Legislature’s Office of Fiscal and Program Review in Maine estimated that expansion of Medicaid would cost the state about $55 million and bring in about $525 million of federal money to the state each year, according to the Bangor Daily News.

(Reporting by Brendan O’Brien in Milwaukee; Editing by Nick Macfie)

Iowa pulls request to opt out of Obamacare requirements

Iowa pulls request to opt out of Obamacare requirements

By Susan Cornwell

(Reuters) – Iowa on Monday withdrew a request to waive some Obamacare rules to help shore up its struggling healthcare insurance market, marking a setback in efforts by Republican-governed states to sidestep requirements of the Obama-era law.

With open enrollment for the Affordable Care Act – better known as Obamacare – set to start in just over a week, the state announced it would no longer wait to hear if federal officials would approve its request aimed at cutting individual healthcare insurance premiums and widening coverage.

The withdrawal prompted a leading U.S. Senate Republican to urge Congress to approve a bipartisan fix to Obamacare, which President Donald Trump has vowed to scrap.

Iowa was viewed as a test case by some for other states that submitted similar, if far less-reaching, waivers and of how the Trump administration would respond to such requests.

Iowa Governor Kim Reynolds said the law had not been flexible enough to accommodate the state’s request.

“Ultimately, Obamacare is an inflexible law that Congress must repeal and replace,” the governor said in a statement, adding that premiums under Obamacare had increased by 110 percent for Iowans since 2013.

Iowa sought the waiver after its individual healthcare marketplace shrank to only one insurer for next year, Minnesota-based Medica.

Some of the state’s requests were similar to provisions included in Republican repeal and replace bills this year. For instance, the waiver sought to replace Obamacare’s income-based tax credits with flat age-based credits and eliminate insurer payments that Trump cut off earlier this month.

Senator Lamar Alexander, Republican of Tennessee, said the move by Iowa demonstrated the need for repairs to Obamacare that he and Democratic Senator Patty Murray have proposed aimed at stabilizing insurance markets. It would also provide states more flexibility in reshaping some parts of Obamacare.

Trump has sent mixed signals over whether he would support the bipartisan fix. Senate Majority Leader Mitch McConnell said on Sunday that he was willing to bring up the proposal for a vote but needed to know where Trump stood.

Alexander said the bipartisan repair proposal would allow the federal government to approve Iowa’s waiver.

Alexander told reporters that the Congressional Budget Office, a nonpartisan scorekeeper, would soon announce its analysis of the bipartisan repair legislation, possibly on Tuesday.

(Reporting by Susan Cornwell,; additional reporting by Yasmeen Abutaleb and Amanda Becker in Washington; Editing by Andrew Hay)

Obamacare whiplash leaves states, insurers with dueling price plans

FILE PHOTO: U.S. President Donald Trump smiles after signing an Executive Order to make it easier for Americans to buy bare-bone health insurance plans and circumvent Obamacare rules at the White House in Washington, U.S., October 12, 2017. REUTERS/Kevin Lamarque/File Photo

By Caroline Humer

NEW YORK (Reuters) – President Donald Trump’s reversals in the past week on maintaining Obamacare subsidies to insurers are sowing new confusion over what kind of health insurance will be available to consumers, and at what price, when enrollment for 2018 begins in two weeks.

Trump said last week his administration would stop paying billions of dollars in subsidies that help insurers give discounts to low-income households, one of several moves to dismantle the signature healthcare law of his Democratic predecessor, Barack Obama.

Since then, Trump has alternately supported, and dismissed, an effort by Republican and Democratic senators that would reinstate the subsidies for two years, until a broader replacement to the 2010 Affordable Care Act, commonly known as Obamacare, can be negotiated.

“We are worried that consumers on (Obamacare) plans will be confused by all the back and forth and proposed policy changes and that this will cause them to not seek out assistance,” said Bryna Koch, special projects coordinator at the Arizona Center for Rural Health, which helps consumers choose and sign up for individual health plans offered under Obamacare.

Trump, who promised during his election campaign to repeal and replace Obamacare, which he has called a “disaster,” has said the subsidies amount to a bailout for insurance companies.

By law, health insurers must still offer the discounts on deductibles, co-pays and other out-of-pocket costs, even if the government stops reimbursing them. Insurers say they do not profit from the subsidies.

Anticipating Trump’s move, insurers proposed higher prices on monthly premiums in 2018 to recoup the money. In all but a handful of states, they submitted two sets of premium rates – a lower rate to use if the subsidies remained, and a higher rate to use if the funding was cut.

LAST WORD ON SUBSIDIES?

The fate of the subsidies remained in limbo on Thursday. A senior White House aide said that Trump would demand steps toward repealing Obamacare in any healthcare legislation, comments that cast doubt on the prospects for the bipartisan effort to shore up insurance markets.

A California court is expected to consider on Monday a request by Democratic attorneys general to keep the subsidies flowing until a legal challenge to Trump’s decision is resolved.

If the funding is not restored when 2018 enrollment opens on Nov. 1, many consumers will see premium rates that are on average 20 percent higher than they would have been otherwise.

Even before Trump’s decision on the subsidies, the Congressional Budget Office said the Republican president’s policies to roll back Obamacare enrollment efforts would lead to 4 million fewer people signing up for insurance in 2018 than previously forecast. The CBO still expects 11 million people to sign up for next year – an increase from this year’s enrollment of 10 million.

The federal government has already halted a subsidy payment to the insurance industry for October. But leading insurers are not yet sure whether that is the last word.

Anthem Inc Chief Executive Officer Joseph Swedish told Reuters he could not yet predict how ending the subsidies or restating them through “potential congressional action” would affect pricing next year. Anthem has submitted premium rates that account for the subsidies being cut.

Should the subsidies be restored at any time after Nov. 1, insurers may be able to revert to the lower monthly premium rates, or provide rebates for consumers.

“A midyear change in premiums would be highly unusual, but this would be the right thing to do,” said Marc Harrison, CEO of Intermountain Healthcare, a Utah-based health plan and hospital chain. “Intermountain Healthcare would pursue this.”

Washington state’s insurance regulator said it would allow insurers to change rates as soon as practical – even the next month – if lawmakers reinstate the funding, an approach backed by the National Association of Insurance Commissioners. But that could run up against federal government objections.

The Affordable Care Act does not allow for changes to premium rates after they have been finalized, an official for the U.S. Department of Health and Human Services said. At the same time, the administration is working to approve higher rates in several states that did not take into account Trump’s cut in subsidies for 2018.

(Additional reporting by Yasmeen Abutaleb in Washington; Editing by Michele Gershberg and Peter Cooney)

U.S. Senate backers of Obamacare deal seek support but prospects unclear

U.S. Senate backers of Obamacare deal seek support but prospects unclear

By Yasmeen Abutaleb and Richard Cowan

WASHINGTON (Reuters) – Proponents of a bipartisan deal struck by two U.S. senators to stabilize Obamacare sought on Wednesday to win Republican support for the measure, which would restore subsidies to health insurers that President Donald Trump has scrapped.

With 2018 health insurance markets facing potential chaos, Republican Senator Lamar Alexander and Democratic Senator Patty Murray were hoping to build broad support for a short-term fix for former President Barack Obama’s signature healthcare law.

Their proposal would meet some Democratic objectives, such as reviving subsidies for Obamacare and restoring $106 million in funding for a federal program that helps people enroll in insurance plans.

In exchange, Republicans would get more flexibility for states to offer a wider variety of health insurance plans while maintaining the requirement that sick and healthy people be charged the same rates for coverage.

The Trump administration said last week it would stop paying billions of dollars to insurers to help cover out-of-pocket medical expenses for low-income Americans, part of the Republican president’s effort to dismantle the 2010 Affordable Care Act, known as Obamacare.

Trump and other Republicans have disparaged the payments to insurers as a “bailout” but the president on Tuesday indicated support for the efforts by Alexander and Murray as a one- or two-year fix while work continues to unwind the law.

While the two senators’ proposal has broad Democratic support, it is unclear how many Republicans will endorse it and whether Senate Majority Leader Mitch McConnell and House of Representatives Speaker Paul Ryan will allow a vote on the plan.

It also remained unclear how fully Trump supported the plan and whether he would sign it into law.

Republican Senator Susan Collins, a moderate who helped kill earlier efforts to repeal and replace the healthcare law, said she backed efforts to shore up Obamacare, but that it remained unclear if there would ultimately be enough support.

“Now, the White House is sending conflicting messages,” she told CNN in an interview on Wednesday, adding that the insurer payments had been “mischaracterized” as a boon for the industry.

Collins said she did not know if McConnell would schedule a vote but that “if it comes to the floor, I think the votes are there.” She said it also could win House approval if Trump “reiterates his support.”

Republicans, describing Obamacare as ineffective and a massive government intrusion in a key sector of the economy, have sought for seven years to repeal and replace it. Scrapping the law was also a top Trump campaign pledge. But the party, which has controlled the White House and Congress since January, has so far failed to make good on its promise.

Democrats have fought to defend Obamacare, which extended health insurance to 20 million Americans.

(Reporting by Yasmeen Abutaleb; Editing by Peter Cooney and Bill Trott)