The State Journal-Register reports:
“Conflicting federal court rulings Tuesday pose no immediate financial threat for the 168,000 Illinoisans receiving reduced-price health insurance through the federal Affordable Care Act, an aide to Gov. Pat Quinn says.
The legality of the subsidies in states such as Illinois, which doesn’t operate its own health insurance “exchange,” was called into question by one of the rulings.
“The bottom line for now is that nothing has changed, and the subsidies created under the law to help people cover the cost of their health care remain in effect,” said Jennifer Koehler, executive director of Get Covered Illinois.
State Rep. Robyn Gabel, D-Evanston, said the rulings could inject new urgency into legislative efforts by her and others to create a state-based exchange for Illinois.
“There’s a more compelling reason to look at it,” she said, adding that she is considering calling for a vote on her proposal in the fall veto session, which begins Nov. 11.
Steve Brown, spokesman for House Speaker Michael Madigan, D-Chicago, said a lack of consensus on the matter in the Democratic-controlled Illinois General Assembly has prevented a state exchange from moving forward.
He said he doesn’t know whether Tuesday’s rulings will change any minds.
“It seems like there’s a ways to go in the court process,” Brown said. “Time will tell.”
Illinois operates Get Covered Illinois as a partnership with the federal government for private insurance plans that began covering 217,000 Illinoisans after Jan. 1. Seventy-seven percent of those enrollees qualified for a subsidy.
Koehler and Brown’s comments came as President Barack Obama’s health-care law became snarled in another big legal battle. But the split rulings don’t necessarily mean another trip to the U.S. Supreme Court for the ACA.
White House spokesman Josh Earnest immediately announced that millions of consumers will keep getting financial aid for their premiums — billions of dollars in all — as the administration appeals the one adverse decision.
Conflicting decisions
In the first ruling, a divided three-judge panel in Washington, D.C., said financial aid can be provided only in states that have set up their own insurance markets, or exchanges. The ruling, if allowed to stand, questions the subsidies that help millions of low- and middle-income people afford their premiums.
About 100 miles to the south in Richmond, Virginia, another appeals court panel unanimously came to the opposite conclusion, ruling that the Internal Revenue Service correctly interpreted the will of Congress when it issued regulations allowing health insurance tax credits for consumers in all 50 states.
Split appeals court decisions are a classic route to the Supreme Court. But in this situation, it’s far from clear what will happen because the administration still has a legal card to play.
Since the Washington case was decided by a three-judge panel, the administration will ask the full 11-member appeals court to hear the case. The full U.S. Court of Appeals for the District of Columbia Circuit has seven judges appointed by Democratic presidents, including four by Obama.
If the full court comes out in favor of the administration, the prospect of Supreme Court involvement would be greatly diminished. On the other hand, if the full Washington court stays out of it or, after a hearing, essentially leaves the panel’s decision in place, then the Supreme Court would almost certainly weigh in.
Both cases are part of a long-running political and legal campaign to overturn Obama’s signature domestic legislation by Republicans and other opponents of the law.
Four key words
Rural Rochester resident Alon Roller said he hopes the federal subsidies don’t go away. Roller, a cross-country truck driver, and his wife, Charla, both 56, were uninsured and couldn’t afford health insurance before buying an Illinois Blue Cross and Blue Shield plan through Get Covered Illinois with a $408 total monthly premium.
Without a federal subsidy, the coverage would have been unaffordable for them at $1,100 a month, Alon Roller said. With the coverage, the couple were spared from thousands of dollars in medical bills for tests, surgery and an emergency-room visit for Charla since January, her husband said. Charla has eye problems and chronic obstructive pulmonary disease.
“We need insurance,” Alon Roller said. “It’s helped us. I don’t know what the alternative would be.”
In the president’s home state, the legislature has been unwilling to form a state-based exchange, though the Illinois Senate passed a bill in May 2013 that would set one up.
Quinn, a Democrat and ACA supporter, worked with the federal government to make Illinois one of a handful of states to operate an exchange as a partnership. That option is expected to end in mid-2015.
The legal disputes all revolve around four words in the 900-page law, which says tax credits to help pay premiums are available to people who enroll through an exchange “established by the state.”
The challengers to the law say a literal reading of that language invalidates the IRS subsidy to people in the federal exchanges.
The Obama administration and congressional and state legislative supporters of the ACA say the challengers are failing to consider the words of the statute in its entirety.
As part of the health-care law, Illinois also expanded Medicaid eligibility. About 369,000 low-income adults have enrolled in Medicaid through that provision so far, Quinn aide Mike Claffey said.
Successful launch?
It’s unknown how many of Illinois’ 1.7 million to 1.9 million uninsured citizens have received coverage — private insurance or Medicaid — since ACA enrollment began Oct. 1.
Naomi Lopez Bauman, director of health policy for the Illinois Policy Institute, which opposes the ACA, said the District of Columbia court ruling makes it clear that the federal government should go “back to the drawing board” on how to expand health-care coverage. She said the law “isn’t delivering on its promises.”
But Koehler said Illinois “has carried out a successful launch” of the law, which she said “is making real, positive impact on people’s lives and well-being.”
Koehler said the Quinn administration was monitoring Tuesday’s court decisions and preparing for the year two of enrollment, which runs from Nov. 15, 2014, through Feb. 15, 2015.
Illinois shouldn’t create its own insurance exchange in response to the court rulings, Lopez Bauman said. For one thing, she said an exchange would cost state taxpayers more than $100 million to establish.
But Jim Duffett, executive director of the Champaign-based Campaign for Better Health Care, which supports the ACA, said the federal government would provide hundreds of millions of dollars to Illinois for set-up costs if the legislature approves a state-based exchange by Nov. 15.
Illinois would have more options for improving customer services and benefits if it operated its own exchange, and costs associated with a state-based exchange wouldn’t have to be passed on to consumers, Duffett said.
A lack of political courage on the part of legislative leaders has stopped Gabel’s legislation from moving forward, Duffett said. He said the Campaign has secured commitments from more than enough Democrats in the House to pass the legislation.
No Republicans in the Illinois House and Senate voted to expand Medicaid, and no Republicans in the Senate voted for a state-based exchange.”