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)

Maryland judge to weigh Obamacare case

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

By Sarah N. Lynch

(Reuters) – Days after a judge in Texas declared that the Obamacare healthcare law is unconstitutional, Maryland’s Democratic attorney general on Wednesday will pursue his request that another judge rule the opposite way.

The lawsuit brought by Maryland Attorney General Brian Frosh also seeks to challenge President Donald Trump’s appointment of Matthew Whitaker as acting attorney general, another bone of partisan contention.

Frosh is asking U.S. District Judge Ellen Hollander in Baltimore to declare that the 2010 health law, known as the Affordable Care Act, is lawful in a bid to counter attempts by the Trump administration to undermine it.

Hollander will weigh the Whitaker claim along with the government’s motion to dismiss the case on the grounds that Maryland does not have legal standing to bring the case.

On Friday, a judge in Texas ruled that the entire healthcare law was unconstitutional following revisions to the tax code by the Republican-controlled Congress last year, which removed the tax penalty for failing to buy health insurance. Trump, who has worked for years to undermine Obamacare, on Twitter called the Texas judge’s decision “a great ruling for our country.”

The Texas judge ruled in favor of 20 states, including Texas.

The original lawsuit by the 20 states prompted Maryland to sue the federal government over then-U.S. Attorney General Jeff Sessions’ refusal to defend the portions of the Obamacare law being challenged in Texas.

Trump forced Sessions out of office in early November and named Whitaker to replace him as acting attorney general.

In response to that, Maryland asked Judge Hollander to issue an injunction barring Whitaker from serving, saying his appointment violated both the Constitution and a federal law that governs the line of succession at the Justice Department.

Then on Dec. 7, Trump nominated William Barr to become attorney general on a permanent basis. He would replace Whitaker, pending Senate review, likely in early 2019.

Maryland has asked Hollander to issue a declaratory judgment upholding Obamacare’s constitutionality.

If Hollander rules on whether Obamacare is constitutional, her decision could potentially be at odds with the decision in Texas. That could create a conflict among lower courts of the sort the U.S. Supreme Court often likes to tackle.

(Reporting by Sarah N. Lynch; Editing by Kevin Drawbaugh and James Dalgleish)

Obamacare 2018 enrollment clouded by uncertainty

A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2, 2013 photo illustration.

By Yasmeen Abutaleb

WASHINGTON (Reuters) – As Americans begin signing up for Obamacare health insurance plans on Wednesday, experts expect reduced participation as a bitter political debate clouds the program’s future.

Republicans in Congress have repeatedly failed to repeal and replace former President Barack Obama’s healthcare law, which they have said drives up costs for consumers and interferes with personal medical decisions. Democrats have warned that repeal would leave millions of Americans without health coverage.

President Donald Trump promised to kill the law in his 2016 election campaign, and he has taken executive and administrative actions to undermine it.

“The market’s going to be extremely confusing. There’s going to be entire complexity of choice,” said David Anderson, a health policy researcher at Duke University.

The Center for American Progress, a liberal think tank, estimated this week that 2018 enrollment would have held steady from 2017, with 12.2 million people either signing up for or being automatically re-enrolled in individual health coverage under the Affordable Care Act had there not been administration efforts to undercut it.

The Trump administration has cut the 2018 enrollment period in half to six weeks from Nov. 1 to Dec. 15 for states using the federal Healthcare.gov website. Enrollment previously ran until Jan. 31, and many consumers often signed up in the last two weeks, according to state officials and organizations that help people choose insurance.

Senate Republicans and Democrats are working on legislation to stabilize Obamacare markets in the short term. The nonpartisan Congressional Budget Office estimates that four million fewer people will sign up for Obamacare private insurance than previously forecast due to Trump administration policies.

Still, CBO expects total enrollment to reach 11 million in 2018, up from the around 10 million who obtained and paid for coverage in 2017.

The administration has cut off billions of dollars in subsidies that insurers use to discount out-of-pocket medical costs for low-income Americans, slashed Obamacare advertising and cut funding to groups that help people enroll in health insurance. Several insurers have exited Obamacare markets due to concerns over subsidies and other Trump actions.

The Department of Health and Human Services said on Monday that premiums for the most popular Obamacare plans would rise 37 percent in 2018. Americans eligible for Obamacare tax credits to buy insurance may pay less for coverage, but costs would increase for middle-class consumers who do not get subsidies.

“It’s been such a flood of information. A lot of the population thinks the Affordable Care Act has already been put under,” said Daniel Polsky, a professor at the University of Pennsylvania and executive director of the Leonard Davis Institute of Health Economics. “The strange premium increases are going to be very confusing for consumers.”

The Trump administration is now planning changes for 2019. Last week, it proposed a rule giving states more flexibility over the benefits that must be covered by insurance. Under Obamacare, all insurers have to cover a set of 10 benefits, such as maternity and newborn care and prescription drugs.

(This version of the story corrects reference to CBO estimate on enrollment in paragraphs 7-8, clarifies estimate from think tank in paragraph 5)

 

(Reporting By Yasmeen Abutaleb; Editing by Michele Gershberg)

 

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 repeal must move quickly, says Senate’s McConnell

Activists participate in a rally to protect the Affordable Care Act outside the U.S. Capitol in Washington, U.S., September 19, 2017. REUTERS/Aaron P. Bernstein

By Susan Cornwell

WASHINGTON (Reuters) – The U.S. Senate’s top Republican on Tuesday urged quick action on a bill to repeal Obamacare but stopped short of promising to bring it to the Senate floor for a vote, as the clock ticks down on the latest attempt to kill the 2010 healthcare law.

Mitch McConnell, the Senate’s Republican leader, called the legislation drafted by senators Lindsey Graham and Bill Cassidy “an intriguing idea and one that has a great deal of support.”

Lawmakers should act because “our opportunity to do so may well pass us by if we don’t act soon,” McConnell said on the Senate floor.

The bill has revived a fight that many in Washington thought was over when an Obamacare repeal-and-replace bill flopped in the Senate in July, humiliating McConnell and President Donald Trump.

The latest measure has less than two weeks before procedural rules in the Senate make it much more difficult for the Republicans to do away with Obamacare.

The bill proposes replacing Obamacare with a system that would give states money in block grants to run their own healthcare programs and let them opt out of some Obamacare rules. Critics say it would bring deep cuts to the Medicaid program for the poor and higher insurance premiums for older people.

“Graham-Cassidy would be devastating for individuals with pre-existing conditions,” the Center for American Progress, a liberal think tank in Washington, said in a statement.

McConnell stopped short of promising to bring the legislation to the Senate floor. But he said Republican lawmakers would continue to discuss it. He has been meeting with lawmakers to assess whether the bill has the votes to pass.

The proposal is the latest salvo in a long-running Republican war on Obamacare, and Graham and Cassidy say they are close to securing the votes needed for passage.

If approved, it would replace the 2010 Affordable Care Act, known informally as Obamacare, which Republicans have long seen as government overreach into the healthcare business.

Several Republicans – the same ones whose votes blocked repeal of Obamacare in July – are still undecided on the latest bill and time is running out.

A special parliamentary procedure that would allow the bill to move forward with only 51 votes will expire at the end of the month. After that, it would need 60 votes, like most Senate legislation. Republicans have a 52-vote Senate majority.

The Senate Finance Committee said it will hold a hearing on the bill next week.

If the Senate can pass the bill, “the hope would be that the House would take it up and pass it and the president sign it,” said John Cornyn, the No. 2 Senate Republican.

Senate Democratic Leader Chuck Schumer said Republicans were “grossly irresponsible” to consider legislation before even getting a full assessment of its impacts from the non-partisan Congressional Budget Office.

(Additional reporting by Richard Cowan and Amanda Becker; Editing by Chizu Nomiyama and Alistair Bell)

Anthem to leave Ohio’s Obamacare insurance market in 2018

FILE PHOTO: A sign at the office building of health insurer Anthem is seen in Los Angeles, California February 5, 2015. REUTERS/Gus Ruelas/File Photo

By Caroline Humer

(Reuters) – Anthem Inc, which has urged Republican lawmakers to commit to paying government subsidies for the Obamacare individual health insurance system, on Tuesday announced it would exit most of the Ohio market next year.

The high-profile health insurer, which sells Blue Cross Blue Shield plans in 14 states including New York and California, for months has said that uncertainty over the payments used to make insurance more affordable could cause it to exit markets next year.

Anthem CEO Joseph Swedish two weeks ago reiterated that the company was reviewing its participation in the individual markets that are a key piece of the Affordable Care Act, commonly called Obamacare.

Republican lawmakers and President Donald Trump have promised to repeal and replace the law, but have disagreed over the details, creating uncertainty at a time when insurers must submit plans and premium rates for 2018.

In addition, Republicans are trying to cut off these Obamacare subsidy payments in court proceedings and President Donald Trump has made conflicting statements about continuing paying them.

Insurance departments across the country have reported that insurers have submitted premium rate increases of up to 50 percent and 60 percent or even higher for 2018.

Anthem attributed the Ohio decision to volatility and uncertainty about whether the government would continue to provide cost-sharing subsidies. It said it would continue to sell Obamacare compliant plans outside of the exchange in Pike County, Ohio as well as other individual plans that were grandfathered when the law went into effect.

Anthem is the only insurer selling health insurance exchange products in all 88 Ohio counties in 2017 and the only insurer in 20 counties, according to Ohio Department of Insurance spokesman Chris Brock.

In 2018, the move would leave about 10,500 people in at least 18 counties with no insurer.

“Congressional action is needed to restore stability,” Brock said. The insurance department is looking for options for those affected, he said.

Other large health insurers have also pulled out for 2018, including Aetna Inc and Humana Inc, leaving other areas facing the possibility of no insurer.

Anthem’s decision was made as rate filings were due to the state and after discussions with the insurance department.

“States can beg and plead, but much of this is out of their hands,” said Larry Levitt, health economist at the Kaiser Family Foundation.

Anthem shares rose $1.19, or 0.64 percent, to $187.88 in early afternoon trading.

(Reporting by Caroline Humer in New York; editing by Jeffrey Benkoe and Andrew Hay)

Trump meets insurers, promises catastrophic year for Obamacare

Health and Human Services Secretary Tom Price (C) and Aetna CEO Mark Bertolini (R) listen to U.S. President Donald Trump speak during a meeting with health insurance company CEOs at the White House in Washington, U.S.

WASHINGTON (Reuters) – President Donald Trump told several chief executives of large insurance companies on Monday that 2017 will be a “catastrophic” year for the Affordable Care Act as he seeks to make good on a campaign promise to repeal the measure.

The Republican president told the insurers they must all work together to save Americans from the law known as Obamacare and try to bring down health care prices. He said he hoped to work with Democrats on a health care plan to repeal the law, which provided coverage for millions of uninsured Americans.

(Reporting by Steve Holland; Writing by Doina Chiacu)

Health insurers quietly shape Obamacare replacement with fewer risks

fed forms for applying for health insurance through affordable care act aka obamacare

By Caroline Humer and Susan Cornwell

NEW YORK/WASHINGTON (Reuters) – U.S. health insurers are making their case to Republican lawmakers over how Americans sign up for individual insurance and pushing for other changes to shape the replacement of former President Barack Obama’s national healthcare law.

The health insurers, including Independence Blue Cross and Molina Healthcare Inc, are also recommending ways to put more control over insurance in the hands of states as the federal oversight of Obamacare is dismantled. They emphasize that it is crucial to keep government subsidies for low income people.

These changes, described by executives, high level officials in the health insurance sector and lawmakers in nearly a dozen interviews with Reuters, include pushing for more strict enforcement of eligibility for these plans.

Because Republicans are just starting to work with the new Trump administration and the debate is fluid, it is not clear ultimately what changes will take hold. But some of these ideas have started to surface in early Republican legislation, such as a co-sponsored bill from Maine Senator Susan Collins that would keep subsidies.

The moves underscore that private insurers are quietly working on how to benefit under the Trump administration, which is focusing on deregulation in healthcare, energy and manufacturing. And they show that insurers want to save aspects of Obamacare individual plans, but cut down on the risk to their own bottom lines and any hikes in premiums that threaten the viability of this insurance market.

This market for individual insurance covers about 10 million people and is small compared to the employer-based system that covers more than 160 million Americans and the government-paid programs for over 120 million people.

But it is one that insurers have described as having growth potential. While Obamacare cut the uninsured rate to 11 percent, there are still millions of uninsured Americans. The largest U.S. insurer UnitedHealth Group Inc told investors recently that it sees opportunities in new state-based markets and is talking to policymakers.

Many investors believe that the Republican deregulation push with Trump will benefit insurers.

“Clearly they support the private insurers and the role that they are going to play in any sort of new market,” said Jeff Jonas, a portfolio manager at Gamco Investors in Rye, New York, which he said owns the publicly traded insurers.

INFLUENCING WHAT “REPLACE” LOOKS LIKE

President Donald Trump campaigned on a promise to repeal Obama’s national healthcare law on his first day in office. He and Republicans have not presented an agreed upon replacement plan, but key issues they are expected to address include the law’s requirements for individuals to have insurance.

Insurers’ main “ask” takes into account replacement plans under discussion in Congress, and largely assumes that government funds will continue to subsidize health benefits, at least for the next two to three years.

Daniel Hilferty, CEO of Independence Blue Cross in Pennsylvania, told Reuters that he advocated tightening the rules around signing up for insurance outside of the open enrollment period, and tight control of which third parties are allowed to pay premiums for patients.

Independence is part of a nationwide network of Blue Cross Blue Shield licensees such as Anthem Inc and has enrolled more than 300,000 consumers in individual plans.

Hilferty’s requests, echoed by other people in the industry who did not want to be named, are similar to demands the industry made of Obama. Enrollment outside of the regular period – and third-party groups that keep poorer, sicker patients in the private market by paying their premiums – has helped lead to hundreds of millions of dollars in losses for insurers and pushed three of the nation’s largest players out of the Obamacare market.

In addition, Independence is also asking for a bigger role in signing up new customers who want to buy individual plans. Insurers sell plans both on the exchanges and off the exchanges, but subsidized plans are currently mostly sold on the government run HealthCare.gov and on state-run websites in a dozen states.

“It would be really helpful if we in the industry played a more significant role in the actual enrollment process,” Hilferty said.

Trump signed an executive order on Friday directing the federal government to scale back regulations, taxes and penalties related to the law. But the directive did not change the priorities outlined to Reuters by the insurers and industry sources, they said.

FOCUS ON THE MANDATE, COST SHARING

Insurers have built their list of top priorities assuming in part that Republicans will try to overturn the existing individual mandate, which requires Americans to pay a fee if they do not have insurance. A replacement plan would need to include some type of bonus to entice healthy people to get insurance.

That, they say, would be a step towards a good mix of sick and healthy people that will keep the plans profitable. Ideas include creating high-risk pools to keep the very sick in a separate market and offering low prices to the young and healthy.

Without a punishment for not buying insurance that is like the individual mandate, the market can’t survive, according to Dr. J. Mario Molina, Chief Executive Officer of Molina Healthcare Inc, a company that provides Medicaid for the poor and individual insurance plans on the exchanges.

“It probably needs to be a combination of both an incentive and a penalty,” Molina said.

Insurers also want to keep the cost-sharing subsidies that have made healthcare costs affordable for millions of people as well as the premium subsidies that help to reduce the monthly cost for people with low incomes. Those subsidies are part of a court case filed last year that is on hold.

“If it’s free or close to free, you are more likely to sign up in the absence of the mandate,” said Dan Mendelson, CEO of Avalere Health, a research group and consultant that advises health insurers and is part of Inovalon Holdings.

Insurers also want continued premium subsidies, skewed to keep up enrollment of younger people.

“I think if you don’t have the subsidies, then the whole thing falls apart,” said Molina.

(Reporting by Caroline Humer; additional reporting by Susan Cornwell in Washington D.C.; editing by Edward Tobin)

U.S. Republican senator introduces Obamacare repeal resolution

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as "Obamacare", outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S

WASHINGTON (Reuters) – Republican U.S. Senator Mike Enzi introduced on Tuesday a resolution allowing for the repeal of President Barack Obama’s signature health insurance program, which provides coverage to millions of Americans, Enzi’s office said in a statement.

The move by the Senate’s budget committee chairman on the first day of the new Congress set in motion the Republican majority’s promise to repeal the 2010 Affordable Care Act, known as Obamacare, as its first major legislative item.

Republicans have said the repeal process could take months and that developing replacement health insurance plans could take years.

More than 20 million previously uninsured Americans gained health coverage through Obamacare. Coverage was extended by expanding the Medicaid program for the poor and through online exchanges where consumers can receive income-based subsidies.

Republicans have launched repeated courtroom and legislative efforts to dismantle the law, criticizing it as government overreach. Democrats have scoffed at Republicans’ plans, accusing them of never having united around a replacement strategy.

The Republicans are using a budget resolution to provide for Obamacare’s repeal, allowing them to act without any Democratic votes. Budget resolutions require a simple majority to pass in the Senate, instead of the 60 votes normally required to clear procedural hurdles. There are 52 Republicans in the 100-seat chamber.

The budget resolution contains so-called reconciliation instructions, directing committees to dismantle Obamacare as part of reconciling taxes and spending with the budget blueprint – and to report back to the budget committee by Jan. 27.

A Senate vote on the resolution could come next week, with action in the House of Representatives expected to follow. But the repeal process won’t be complete until the committees finish the reconciliation procedure and votes are taken on their work.

“These instructions to committees are provided to facilitate immediate action on repeal, with the intent of sending legislation to the new president’s desk as soon as possible,” the statement from Enzi’s office said.

U.S. President-elect Donald Trump repeatedly vowed during last year’s presidential campaign to repeal Obamacare.

(Reporting by Susan Cornwell; Writing by Doina Chiacu; Editing by Bill Trott and Paul Simao)