Breaking News: Conflicting Court Rulings Create Confusion Around ACA Premium Subsidies

gavelYou may have heard today that the U.S. Court of Appeals for the District of Columbia Circuit issued a 2-1 decision that could threaten the future of health insurance premium subsidies under the Affordable Care Act (ACA). This is relevant in the 34 states where the federal government runs the exchange under Healthcare.gov. Then just a few hours later, the U.S. Court of Appeals for the Fourth Circuit ruled on a similar case that premium subsidies continue to be permissible. So what does this mean for the future of premium assistance in the Marketplace plans? In short, today’s rulings do not change anything in the near-term.

At question in the cases was the language in the law that authorizes subsidies in “an exchange established by the State.” The plaintiffs in the D.C. Circuit Court case successfully argued that the federal government incorrectly applied subsidies in the states with federally-run programs; however, premium subsidies will continue while the Obama Administration appeals today’s ruling.  If the ruling is upheld and Congress does not amend the law, enrollees in the federal exchange likely will have to pay the full premium in future years, which will make health coverage unaffordable for many.

The ruling, if it stands, will impact people in the states where the Federal Government runs the Exchanges: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Iowa, Michigan, New Hampshire, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming.

If you do not wish to buy health insurance and reside in one of these states, you may be pleased with the DC Circuit Court decision.  If the decision is upheld, you won’t have to pay a tax penalty for being uninsured.  Employers won’t have to pay that penalty either if they don’t offer their full-time employees health insurance.

The ACA’s tax credits and subsidies have benefitted many of those with kidney disease or at risk for it.  People with kidney disease who do not qualify for other health insurance through the government or their employers have been able to purchase plans at a relatively low cost and access healthcare services where they previously had little or no options.  For example, transplant recipients who are under age 65 have benefited from this law by finding coverage in the Marketplace once their Medicare expired 36 months post-transplant.  This has allowed those transplant recipients to continue getting the healthcare and medications they need.  For people in the earlier stages of  kidney disease whose kidneys have not failed, subsidized  coverage has improved their ability to access the healthcare they need in order to prevent or delay progression to kidney failure and to avoid complications of their kidney disease.  For those at risk of kidney disease, the ACA has provided more opportunities to gain coverage and the care needed to lower blood pressure, control diabetes, and also to get regular kidney checkups.

Since the Administration will appeal today’s DC Circuit Court decision, the tax credits will continue this year and likely into next. People with Marketplace plans can keep them and those still needing coverage will have an opportunity to get it, along with premium assistance, no matter where they live.   Open enrollment for next year begins November 15, 2014.  That’s when everyone who qualifies will be able to choose a plan for the first time or to renew the Marketplace plan they have currently for coverage to begin January 1, 2015.  If you have experienced a life changing event, you may be able to enroll in coverage (and get a tax credit) now if you meet the requirements.

While coverage in the Marketplace has not been perfect, NKF has and will continue to advocate for improvements to ensure kidney patients have access to the medications and services they need in their Marketplace plan. We will also advocate to protect patients against insurers who discriminate against those with kidney disease by canceling or limiting coverage of dialysis and transplant, charging higher cost-sharing for immunosuppressive drugs, or restricting provider networks in which patients have difficulty finding a doctor and limited access to transplant or dialysis treatment. We have already had some success in our efforts, but we continue our work to ensure that the Marketplace offers valuable options for health insurance coverage for kidney patients.

About nkf _advocacy

The National Kidney Foundation's advocacy movement is for all people affected by CKD, transplant candidates and recipients, living and potential donors, donor families and caregivers. We empower, educate and encourage you to get involved on issues relating to CKD, donation and transplantation.
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