Donate

Health

From KQED

San Jose Police Crack Down On Violence

The San Jose Police Department is cracking down on violent crime after the city's 25th homicide this year.

KQED Launches Affordable Care Act Guide

Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

Millions of California Kids Missing Out on Meals During the Summer

School's out for summer, and for some kids that means carefree summer days. For others, it can mean going hungry. Thousands of schools, community centers and libraries serve free meals to kids during the summer. But they only reach one in five children who qualify for free or reduced-price lunch during the school year.

Admissions Resume at Nation's Largest Medical Prison

The nation's largest medical prison in Stockton, designed to care for California's sickest inmates, is once again accepting new admissions after a court-ordered hiatus. Earlier in the year, the court-appointed monitor suspended all transfers to the $800 million California Health Care Facility (CHCF) because of unsanitary conditions.

PBS NewsHour

Will conflicting federal health care law rulings head to the Supreme Court?

A ruling Tuesday by the U.S. Appeals Court for the D.C. Circuit could put at
         immediate risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are
         run by the federal government. Photo by Andrew Harrer/Bloomberg via Getty Images

Watch Video | Listen to the Audio

GWEN IFILL: Now conflicting court rulings on the health care law.

The federal court of appeals based in Washington ruled today that the law doesn’t allow policy holders who get their insurance through the federal exchange to qualify for subsidies that would reduce the cost. But a separate ruling, issued hours later by a federal appeals court in Richmond, said those getting policies through the federal exchanges do qualify for the subsidies.

The rulings come down to different interpretations of the same passage of the law. Congress said if a state didn’t create its own insurance exchange, the federal government should. But the law also reads that subsidies be provided by — quote — “an exchange established by the state.”

Just 14 states, plus the District of Columbia, created their own exchanges. Five million enrollees now receive subsidies through the federal exchange.

So, what do these conflicting rulings mean for the future of the health care law?

For that, we turn to Julie Rovner of Kaiser Health News and Tom Goldstein, founder of SCOTUSblog.com.

Let’s go back to the root of this challenge, Julie. Why did this come up?

JULIE ROVNER, Kaiser Health News: Well, because people who opposed the law found this, what appeared to be a drafting area, saying that subsidies were only available in the state-based exchange, and decided that they would sue over it to perhaps get another bite at the apple of trying to invalidate or really kind of make a mess of the rest of the law.

That’s what this comes down to. It’s whether or not this was a mistake or whether this was something that Congress intended to do when it wrote just that — just that one sentence about…

GWEN IFILL: And the whole point of these subsidies was to put the A in affordable care, right?

JULIE ROVNER: That’s exactly right.

And if this were to go away, there’s an estimate out now that about five million people would see premium increases of about 76 percent. Most of the people who are buying insurance on the exchanges are getting subsidies. Those subsidies are fairly large.

If the subsidies were not available, then basically insurance would become unaffordable and the individual mandate, the requirement for people to have insurance, does not apply to people for whom insurance is unaffordable.

GWEN IFILL: Now, Tom, the D.C. court ruled today that theirs was an unambiguous reading of the law, but yet this other reading of the law seems to open the whole thing to ambiguity.

TOM GOLDSTEIN, SCOTUSblog.com: Yes, that’s right.

It’s shocked everyone, I’m sure, that this huge, sweeping law that takes up thousands of pages might not be perfectly clear to everyone. What the court of appeals in Washington today said is, the language says a state-created exchange. And even if it wouldn’t make a ton of sense necessarily for Congress to say part of the country has subsidies available to it and a large part of the country doesn’t, that’s the law that Congress wrote, and our job is just to enforce it.

The court of appeals in Richmond said, this statute is a mess. There are things that point in different directions about what Congress wanted. And because it’s unclear, it’s the administration’s job to figure it out.

GWEN IFILL: So, Congress was the one that opened the door for this kind of a challenge?

TOM GOLDSTEIN: Yes, absolutely.

Congress did say when there were supposed to be subsidies, but it’s just although unclear whether it literally meant only a state-created exchange or if instead it meant, if you buy your health care through the exchange and you can’t afford health insurance, we will help you out.

GWEN IFILL: So, if the first ruling were to stand, Julie, we’re assuming that it would — the only way to address it would be for every state to set up its own exchange, instead of relying on the federal one.

JULIE ROVNER: That would be the idea, that there — and there is a lot of discussion already about states could do that.

In some states, though, they actually passed constitutional amendments barring them from creating their own exchanges. You remember a lot of these states run by Republicans really want nothing to do with this law.

GWEN IFILL: Are there other ripple effects that affect other parts of the law as well?

JULIE ROVNER: Yes, it actually also affects the employer mandate, the requirement for employers to provide insurance, because that’s actually tied to the subsidies that individuals get.

The way the employer mandate works is, it says that employers only have to pay a fine if one of the — if they don’t offer insurance and one of their employees goes to the exchange and gets a subsidy. So, if there’s no subsidy, then there’s no way to enforce the employer part of this either.

GWEN IFILL: Tom, it seems that we have seen enough challenges now to the health care law, including the part that was upheld by the Supreme Court, and the Hobby Lobby decision about contraceptive coverage that we saw decided in the final days of the court. It seems like death by a thousand cuts?

TOM GOLDSTEIN: Well, so far.

GWEN IFILL: Or attempted death by…

TOM GOLDSTEIN: Exactly right.

There are certainly a lot of people who are very critical of the law. They have brought very sophisticated legal challenges. The statute has been upheld, by and large. This is the single greatest threat to the reach of the statute, to the attempt to help a lot of people be able to afford health care through insurance.

But it is a part of the law that people find offensive in many parts of the country because they don’t want the federal government so involved. It’s probably going to be up to the Supreme Court, just like the last major challenges.

GWEN IFILL: Are there other challenges in the pipeline, Julie?

JULIE ROVNER: There are a couple at lower courts. It’s not entirely clear that this would produce a requirement for the Supreme Court to take the case. The administration is going to appeal to the full appeals court in D.C.

GWEN IFILL: Tell me how that process works. We’re talking about two different courts and two different circuits today, and then what?

JULIE ROVNER: Well, right now, immediately, this was a three-judge panel of the court of appeals. And they will appeal to the en banc, to the entire appeals court. And generally there are more Democratic appointees than Republican appointees there.

There is at least a perception that it’s likely to be reversed by the full appeals court. And then you would have basically two appeals courts having ruled and not disagreeing. So, in that case, the Supreme Court would not have to take the case, but not clear whether they would.

GWEN IFILL: Well, explain. Remind us again, Tom, the way this works. The court then — at what point does the court have to decide whether it would intervene in this?

TOM GOLDSTEIN: Well, someone has to ask. So the plaintiffs who lost in Richmond today are inevitably going to ask the Supreme Court to step in.

The government could go straight to the Supreme Court, but the White House said today that it’s going to ask the full court of appeals in Washington to hear the case. So, we’re probably a year to 18 months away from getting a final answer. The Supreme Court could stay out.

I think it’s a little bit more likely that they will just say, this is so important and there will be enough people on the court, enough justices who are concerned about this issue, that they will decide to take it up. But it’s an open question.

GWEN IFILL: Why would this be as important or more important than any of the other challenges we have seen so far? Why would the court feel compelled? You don’t think the court would be compelled?

JULIE ROVNER: My guess would be is that if there’s no split in the circuits that the court wouldn’t really want to go back and revisit this again, unless they think they could change the decision that they got in 2012.

GWEN IFILL: The most immediate question, however, Julie, for people who are watching this tonight is, how does this affect me?  If they have their employer-covered insurance, it doesn’t affect them at all?

JULIE ROVNER: No.

And actually, even if they have subsidies in the federal exchange states, it doesn’t affect them immediately. The way the rules work in the D.C. circuit is that they don’t even send the requirement back down to the district court, which is who would actually implement this, for 45 days to give the government full time to appeal to the full appeals court, which we know that the government is going to do.

So, obviously, this is not going to happen right away. It would be a very long time before people would actually start losing their subsidies that they’re getting now.

GWEN IFILL: And potentially how many people are we talking who would be affected by these rulings?

TOM GOLDSTEIN: Five million.

GWEN IFILL: Five million who are currently in the federal exchange.

TOM GOLDSTEIN: That’s exactly right.

GWEN IFILL: But are there others who are lined up?  Do we know how many people — there was so much discussion about who was registering at what pace for a long time there, but do we know if there are others who will also be affected?

JULIE ROVNER: As more people would join the federal exchanges, obviously it would affect more people.

I have seen some numbers that go into 2016, so it’s everybody who is getting the subsidies now and everybody who’s potentially eligible in those 36 states where the federal government is running the exchange.

TOM GOLDSTEIN: And then we have all the employers, as you mentioned, who wouldn’t be subject to the mandate that’s going to come into effect in the future that they provide health insurance, because none of their employees would be getting subsidies in those states.

GWEN IFILL: Is there a timetable for the courts to act again?

TOM GOLDSTEIN: No, the court of appeals can take its time in deciding whether to have the whole court hear the case. Most likely, everyone is sensitive to the question of whether it will go to the Supreme Court. I think you’re looking at 18 months is the best guess for when we will have a final answer.

GWEN IFILL: Oh, good. Oh, joy. Can’t wait.

Tom Goldstein of SCOTUSblog, Julie Rovner of Kaiser Health News, thank you both very much.

TOM GOLDSTEIN: Thanks so much.

JULIE ROVNER: Thank you.

The post Will conflicting federal health care law rulings head to the Supreme Court? appeared first on PBS NewsHour.

What do the health law court decisions mean for consumers?

A U.S. Court of Appeals ruling Tuesday may affect certain subsidies available for Affordable Care Act enrollees. What
         does this mean for consumers? Kaiser Health News' Mary Agnes Carey has a breakdown. Photo by Andrew Harrer/Getty Images

A U.S. Court of Appeals ruling Tuesday may affect certain subsidies available for Affordable Care Act enrollees. What does this mean for consumers? Kaiser Health News’ Mary Agnes Carey has a breakdown. Photo by Andrew Harrer/Getty Images

On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people: the availability of subsidies to help purchase coverage under the healthcare law. KHN’s Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers.

Q: What did the courts decide?

A: In a blow to the health law, the U.S. Court of Appeals for the District of Columbia Circuit ruled that the health law’s subsidies are available only to individuals in the 14 states and the District of Columbia now operating their own health insurance exchanges. The federal government now runs the exchanges in 36 states. Judge Thomas Griffith, writing the majority opinion in the 2-1 decision, said they concluded “that the ACA unambiguously restricts” the subsidies to “exchanges ‘established by the state.’ ”

In a separate ruling, a three-judge panel for the Fourth Circuit Court of Appeals in Richmond, Virginia, ruled unanimously for the Obama administration, allowing subsidies to be available to residents in all states. Judge Roger Gregory, writing the opinion, said while the health law is “ambiguous and subject to multiple interpretations,” the court decided to uphold the IRS’s interpretation of the law that residents of states using the federal exchange are entitled to subsidies.

Q: What was the issue the courts decided on?

A: The case centers on a brief description in the health law that says subsidies will be available “through an exchange established by the state.”

In implementing the law, the Internal Revenue Service (IRS) interpreted the law to allow eligible consumers to receive subsidies to help purchase coverage, regardless of whether they are in an exchange run by their state or by the federal government.

Opponents of the law questioned that interpretation, saying that the law as written clearly directs subsidies to state-based exchanges only. But proponents — including several lawmakers who helped write it — said lawmakers fully intended that subsidies be offered on all exchanges no matter if they were administered by the feds or state officials.

Q: I don’t know if my state runs its own exchange. Which states do?

A: California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, Washington and the District of Columbia all run their own exchanges.

Idaho and New Mexico intend to set up their own marketplace for the next enrollment period, which begins in November, but used healthcare.gov this year.

Q: I live in a state with a federally run exchange, and I get a subsidy to help me buy coverage. Am I going to lose it?

A: Nothing is happening immediately. Justice Department officials said Tuesday they plan to seek an en banc review from the D.C. Appeals Court, meaning that the panel’s full contingent of 11 judges would hear the case. Six of the court’s judges would have to agree for the full panel to review the case. The full panel is dominated by judges appointed by Democrats, 7-4.

Eventually the case could be considered by the Supreme Court, but the current subsidies would likely remain in place until there is a final legal decision on the matter.

“In the meantime, to be clear, people getting premium tax credits should know that nothing has changed; tax credits remain available,” said Emily Pierce, deputy director of the Justice Department’s office of public affairs.

White House spokesman Josh Earnest said the administration was confident it would prevail. “You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace.”

Supporters of the court challenge to the IRS interpretation on subsidies also maintain their case is strong. “The executive branch does not get to rewrite statutes just because it thinks those statutes would work better a certain way,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute who championed the subsidy appeals. “If people lose those subsidies it is because the courts have ruled that those subsidies are and always have been unlawful — that the administration had no authority to administer those in the first place.”

Q: Are these the only two court cases?

A: No. There are two other similar cases pending in courts in Oklahoma and Indiana.

Q: If there are legal disputes ongoing about who qualifies to receive a subsidy, do I still have to buy health insurance?

A: Yes. The law’s “individual mandate,” which requires most people to purchase health insurance or pay a fine, is still in place.

Q. What if I get my insurance through work?

This decision applies only to policies sold on the online marketplaces. It does not affect work-based insurance, Medicare or Medicaid, regardless of where you live.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

The post What do the health law court decisions mean for consumers? appeared first on PBS NewsHour.

New food scandal hard to swallow for KFC, McDonald’s in China

Xiamen, China. Photo by Flickr user Sara Yeomans

Xiamen, China. Photo by Flickr user Sara Yeomans

McDonald’s and KFC in China are reeling from another food safety scare Monday after a local TV station reported that a supplier had been selling expired meat to the restaurants.

According to the report , Hushi Food Co. was using expired and contaminated meats in the products they sent to KFC, McDonald’s and Pizza Hut restaurants in China.

McDonald’s and Yum, which owns both KFC and Pizza Hut, apologized and said they immediately stopped using meat from the Hushi supplier as the investigation continues. Hushi Food Co. is owned by the Illinois-based OSI group which has looked to capitalize on growing demand for fast-food overseas.

Chinese television station Dragon TV had an undercover reporter who allegedly found the packaging plant using 18 tons of expired chicken skin to make chicken nuggets. The Dragon TV footage shows workers “picking up food from the floor and throwing it into processing machines.”

This is not the first time in recent years that Yum has faced public image problems. KFC, China’s largest chain restaurant, saw a 37 percent drop in sales last December after reports of suppliers using illegal amounts of antibiotics in their chicken made headlines.

“I think this is going to be really challenging for both these firms,” said Benjamin Cavender, Shanghai-based principal at China Market Research Group.

“If proven, the practices outlined in the reports are completely unacceptable to McDonald’s anywhere in the world,” a China-based spokeswoman for McDonald’s told Reuters. Both McDonald’s and Yum promised better precautions to ensure high quality meat in their Chinese locations.

The post New food scandal hard to swallow for KFC, McDonald’s in China appeared first on PBS NewsHour.

Older, sicker enrollees will likely drive up rates at Florida’s biggest health insurer

Leading Insurance Agency in Miami, Fla. offers enrollment services for Affordable Care Act plans. Photo by Joe Raedle/Getty
         Images

Leading Insurance Agency in Miami, Fla. offers enrollment services for Affordable Care Act plans. Photo by Joe Raedle/Getty Images

Florida Blue, the state’s dominant health insurer, snagged more than one in three consumers on the health law’s exchange this year, but many could face rate hikes as the carrier struggles with an influx of older and sicker enrollees, said the company’s top executive.

Several factors could drive up rates next year — including a paucity of younger and healthy enrollees and a greater-than-expected surge in people seeking expensive health services, CEO Patrick Geraghty said in an interview.

“We will be under tremendous financial pressure initially given the age, risk profile and high utilization of the new membership,” he said. “It is far from clear that large enrollment in the marketplace is a financially beneficial place to be.”

Nonetheless, Geraghty said Florida Blue remains committed to the individual health insurance market where it is the only carrier serving consumers in every county in the state.

The nonprofit Blue Cross and Blue Shield affiliate added 339,000 customers through the Affordable Care Act’s federal marketplace this year— or about 34 percent of the nearly 1 million who signed up in the state, Geraghty said.

Republican critics of the health law have predicted Obamacare rates would spike in 2015 as health plans try to make up for higher costs associated with mostly older and sicker people. But in the past,health insurance premiums have increased virtually every year in the individual market. Republican critics of the health law have predicted Obamacare rates would spike in 2015 as health plans try to make up for higher costs associated with mostly older and sicker people. But in the past,health insurance premiums have increased virtually every year in the individual market.

Florida Blue would not reveal its proposed 2015 rates, which were submitted to state regulators last month. State officials are expected to disclose the rates for the nearly dozen carriers in the marketplaceat the end of July. Open enrollment begins Nov. 15 and goes through Feb. 15.

To date, only two insurers have disclosed their 2015 rate proposals. Humana proposed an average 14.1 percent increase in two separate filings for its health maintenance organizations (HMOs), while its preferred provider organizations (PPO) have a 2.2 percent average rate increase. Molina has proposed an 11.6 percent average rate decrease for all its plans.

Florida Blue has been one of the nation’s most fiscally stable health insurers. In 2012, the latest year for which data is available, Florida Blue achieved its 24th consecutive profitable year, as the company made $217 million net income on about $9 billion in revenue. It has about 4 million customers in Florida across all lines of health insurance.

About 23 percent of those who bought exchange policies from Florida Blue this year were in the 18-to-34 age category, Geraghty said. That compares to 28 percent nationally. Initial federal projections were that 40 percent of enrollees nationally would be young adults.

Geraghty said he knew the percentage of young adults signing up in Florida would be lower than the national average because of the state’s older population. Still, 23 percent was lower than the company projected.

“It’s a concern certainly, as any market would want lower-age healthier individuals … because it balances the risk pool,” he said.

It was also harder to sign up younger adults in Florida, he said, because they faced higher rates under the law’s requirement that the oldest person buying coverage pay no more than three times the rate paid by the youngest enrollee.

Another factor that could lead to higher premiums in 2015 is that demand for expensive health services exceeded the insurer’s expectations, Geraghty said.

The Obama administration’s decision earlier this year to allow people to stay in so-called “grandfathered” plans until October 2016 also added financial pressure, he said.

About 300,000 Florida Blue customers were given that option and 90 percent kept the grandfathered plans, Geraghty said. Because they are healthier as a group than the broader market, the company underpriced its marketplace plans, he said.

Despite these challenges, Geraghty said he was generally pleased with the results of the exchange’s first year of enrollment. The company had about 50 percent of the individual state insurance market in 2014, and today has about a 40 percent share, including people buying on and off the exchange. While losing some market share, the company gained many new members.

Sabrina Corlette, senior research fellow at Georgetown University’s Center on Health Insurance Reforms, said Florida Blue’s assessment of its 2014 projection errors is telling. “They may be trying to prepare the public and the market for an increase in prices,” she said.

She said she was not surprised the insurer was below the national average for young adult enrollment, given the state’s demographics. She said the company also may have struggled to get younger adults because the Blue Cross and Blue Shield brand tends to attract older people who trust it.

Geraghty said he believes the law is here to stay.

“With many people benefiting from new coverage and subsidies, it will be difficult to reverse the tide,” he said. “The better path going forward is working on … how to improve the ACA so it works best for the largest number of our citizens.”


Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

The post Older, sicker enrollees will likely drive up rates at Florida’s biggest health insurer appeared first on PBS NewsHour.