New York bucks trend in face of Texas ruling

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As a federal judge in Texas threatens to upend the Patient Protection and Affordable Care Act, New York’s heath insurance exchange bucked the trend in federally run marketplace enrollments to report gains.

“Despite the constant threats to the Affordable Care Act, New York’s health insurance marketplace stands strong,” New York State of Health executive director Donna Frescatore declared this week. 

Enrollment volumes in qualified health plans and the Essential Plan outpaced last year’s levels with more than 68,000 additional people enrolled. What’s more, nearly 16,000 people enrolled in QHPs and EP on Dec. 15, bringing the combined enrollment in these two programs to more than 1 million consumers, the highest level to date. On the last day to enroll for coverage in 2019, nearly 19,000 individuals signed up for coverage across all New York State of Health programs. Monroe County accounted for 141,196 for all programs in 2018.

Insurance exchanges like New York’s are a key feature of the ACA, the sweeping 2010 federal health care law commonly called Obamacare. Known as insurance marketplaces, exchanges offer one-stop shopping where plan purchasers can compare various insurers’ offerings. On Dec. 14, a Texas judge declared the ACA unconstitutional. That decision will leave the law in place for now but calls its ultimate survival into question.

The idea behind the insurance exchanges is to provide affordable access to care for tens of millions of uninsured individuals and small-business employees who were previously either frozen out of a health insurance market dominated by employer-sponsored plans or stuck with high-premium plans with scant benefits. Plans sold on exchanges must provide a minimum range of benefits spelled out in the law. The law also provides for subsidies to offset premium costs for low-income purchasers.

As of Dec. 9, with a week left before the Dec. 15 deadline to sign up for plans starting Jan. 1 hit, federally-run exchange enrollments at 4.1 million were lagging 2016 enrollment by approximately 500,000 sign-ups. Factors that may have discouraged some potential enrollees include the Trump administration’s decisions to cut advertising touting the exchange program and to shorten the enrollment period.

According to the state Department of Health, New York State of Health enrollment for the coming year stands at 4.7 million, a boost of more than 1 million enrollees.

The ACA requires all U.S. states to have an insurance exchange. Eleven states, including New York, have set up and run their own exchanges, while 28 states chose not to set up their own programs and instead have exchanges fully run by the federal government. Of the remaining 22 states, six formed partnerships with the federal Centers for Medicare and Medicaid Services in which the states and CMS share responsibilities. Five states run their own program but use the federal government’s platform to manage the health exchange program.

In addition to purchasers of strictly private plans sold on New York’s health exchange are enrollees in government-sponsored Medicaid and Child Health Plus plans. The latter two categories account for 3.7 million of New York State of Health’s 4.7 million enrollees.

President Donald Trump along with nearly every Republican in Congress has made terminating the ACA a top priority. So far, the GOP has failed to do so despite controlling both houses of Congress as well as the White House.

In a tweet, Trump lauded U.S. District Judge Reed O’Connor’s decision. The president’s praise of the ruling notwithstanding, the White House issued a statement promising to leave the law in effect through 2019.

If it withstands the Federal Circuit Court of Appeals and Supreme Court appeals that legal experts see as virtually inevitable, O’Connor’s ruling would end the health exchange program. It also would end popular ACA features like requirements that insurers cover pre-existing conditions and a provision letting parents keep children aged 26 and under on their plans as well as Medicaid expansions that have added millions to U.S. insurance rolls.

The ruling came in a case brought by Texas in which the Lone Star State sought an end to the ACA’s provision requiring all U.S. residents to buy health insurance. The judge’s declaration of the entire law as unconstitutional came on a summary judgment motion. Its sweep was a surprise to some.

In a prior constitutional challenge to the ACA, the Supreme Court upheld the law. The challengers argued that an ACA feature requiring all U.S. residents to be insured was unconstitutional. In a 5-to-4 decision, the Supreme Court said that since the law defined the penalty for failing to heed the individual mandate as a tax, the mandate would stand under federal government’s taxing power.

The Texas challenge arose after the current Republican-controlled Congress voted along party lines to kill the ACA penalty but left the individual mandate in place. The mandate is the law’s linchpin but is unenforceable without the penalty, and thus the law is rendered unconstitutional, O’Connor reasoned.

Nineteen other states, which like Texas have Republican governors, have joined the Texas ACA action. Opposing the plaintiff states’ attorneys generals are Democratic attorneys general from 15 states, including New York.

The Democratic attorneys general entered the fray after the Trump administration declined to defend the federal law but in an unusual move instead partly joined the case on the plaintiffs’ side to back part of the GOP attorneys generals’ complaint.


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