CKAHU 91316 Douglas L McSwain WYATT TARRANT amp COMBS LLP 250 W Main Street Ste 1600 Lexington KY 40507 859 2887415 dmcswainwyattfirmcom US House of Representatives v Burwell ID: 599033
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AFFORDABLE CARE ACT: LEGAL & POLICY UPDATE
(CKAHU - 9/13/16)
Douglas L. McSwain
WYATT, TARRANT & COMBS, LLP
250 W. Main Street, Ste. 1600
Lexington, KY 40507
(859) 288-7415
dmcswain@wyattfirm.com
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U.S. House of Representatives v. Burwell
Just another “Obamacare” lawsuit?
Track record of suits so far
But, who’s counting?
What’s the dispute?“Standing” – separation of powersExchange policies – legality of cost sharing subsidiesDifferent from King v. BurwellSlide4
U.S. House of Representatives v. Burwell
Where’s the case now?
District Court rulings
DC Circuit Court appeal
SCOTUS?What’s the implications?Americans affected – 5-6MExchange market impact (premiums, carriers, federal budgetary)Ct. of claims lawsuits?Slide5
WHAT’S HAPPENING WITH THE
…………..
23
Risk
Corridor ProgramExchange customer risk pool – multiple factors impacting Employer mandate success
- “and then there were none”
(but not quite 0 yet)
X∆
MARKETS?
CO-OPs
?
See CBO Charts – next slideSlide6
Note: Figures are for non-Medicare pop. & incl. unauthorized persons;
Due to rounding and estimations, figures may not sum to 100%Slide7Slide8
WHAT’S
HAPPENING WITH THE
X∆
MARKETS?
…………..Exchange customer risk pool – multiple factors impacting
Employer mandate success
Irony of premium subsidies
Enrollment abuses
Special
enrollment periods
(
SEPs
)
Certain
3
rd party purchases
Individual penalty – severity & exemptions
“Value” of exchange plans
Deductibles/co-pays
Networks – “is my doctor in it” – cost if not
Plan choice (insurer exits)
Premiums – will the feds regulate?Slide9
THOSE “PESKY” LAWSUITS
The
CO-OPs
“strike back”!
Guess who’s joining them?Breaking News Flash!See Next SlideSlide10
“. . . HHS
will explore other sources of funding for risk corridors payments, subject to the availability of [congressional] appropriations. . . . HHS recognizes that the [ACA] requires the Secretary to make full payments to issuers. HHS will record risk corridors payments due as an obligation of the United States Government for which full payment is required. We know that a number of issuers have sued in federal court seeking to obtain the risk corridors
amounts. .
. .
As in any lawsuit, the [DOJ] is vigorously defending those claims. . . . However, as in all cases where there is litigation risk, we are open to discussing resolution of those claims. We are willing to begin such discussions at any time.” CMS News Bulletin issued 9/9/16.CMS’ 9/9/16 ANNOUNCEMENTRe: RISK CORRIDOR PROGRAMSlide11
THOSE “PESKY” LAWSUITS
The
CO-OPs
“strike back”!
Central United Life v. Burwell (7/16)“What’s it all about, Alfie”?Standalone fixed indemnity plan prohibition But, is it really “Out”?
Out!Slide12
“Obamacare”
SUCCESS? FAILURE?
D E M
G O P
Dem Proposals
President’s
Hillary’s
Fix it!
GOP Proposals
Speaker Ryan’s
“
The Donald’s”
Repeal & Replace it!
Slide13
Attempts will (
must
) be tried to “Fix it”
Repeal unlikely - Alternatives 2 disruptiveSlide14
PREDICTIONS
Medicaid
Medicare
Public Option
Insurance MarketsCare DeliveryM & As
for what they’re worth - Slide15
QUESTIONS?