House Repeal of Obamacare, States Question Medicaid Expansions & State Exchange Subsidies

House to vote on repeal of Obamacare this week — Immediately following the ruling by the United States Supreme Court upholding the majority of Obamacare, House Republicans detailed their plan to vote on repealing the controversial health law.  This week, the House will vote on a bill to repeal the Patient Protection Affordable Care Act (PPACA, Obamacare). The House  passed a bill repealing Obamacare in January 2011 after winning a sizable majority in the 2010 elections, however the repeal bill failed to get a vote on the floor of the Senate.  Congressional Republicans are hoping the Supreme Court ruling will place additional pressure on Senate Democrats to allow a vote on the repeal bill, but most find it unlikely the Senate will bring the bill forward with the 2012 elections fast approaching. MORE (NPR, July 9th)

States Work to Determine Fate on Medicaid Expansions — Earlier this month the Supreme Court upheld most of the controversial health care law, but did limit a key component designed to expand state Medicaid programs by nearly 17 million recipients over 10 years.  The bill would have forced individual states to expand their Medicaid enrollment criteria to 133% of the Federal Poverty Level (FPL), if they chose not to expand, the bill gave The Department of Health and Human Services (HHS) the power to strip all existing Medicaid funds dispersed to the state.  The court ruled that the Medicaid expansion can move forward, but that HHS could not use existing Medicaid funds paid to the state as a bludgeon to enforce the expansions, a liking it to a public extortion.  States now have the option to participate in the Medicaid enrollment expansions; federal funds would cover 100% of the costs of the new enrollee’s for three years, then gradually decrease to 95%, then 90% after 2020.  Eight states have thus far announced they will not be participating in the expansions (FL, IA, KS, LA, SC, NE, WI), while twelve have announced they intend to participate (CA, CT, HI, IL, MA, MN, MD, NY, OR, VT, RI, WA).  All other states are considering their immediate and long-term options.  The immediate deal to states, 100% funding for new enrollee’s and 90-95% match after the initial period, could be seen as a very good deal to certain states, while others may have to come up with billions of additional funds to pay for the new Medicaid patients after the initial three-year, 100% federally financed period.  MORE (The Hill, July 3rd)

States, HHS Feud over Subsidies for State Exchanges — Several states are challenging the assertion that federal subsidies can be offered to Americans seeking to purchase health insurance on state-based health exchanges if the exchange is being setup by the federal government.  Obamacare stipulates that each state must create a “state-based health exchange”, an online portal where consumers can compare and purchase insurance policies depending on their needs beginning in 2014, when the individual mandate is activated.  However, if states fail to set up their own exchange, as many have intimated they will not, the federal government will setup an exchange for them. At issue is whether in states that fail to set up their own exchange and are forced to use a federally created one, can consumers using the federally created exchange receive subsidies to purchase the insurance policy of their choice.  Subsidies are available from 134%-400% of the Federal Poverty Level (FPL). Also at issue, is whether in states that choose not to expand their Medicaid enrollment criteria to 133% of FPL, will subsidies be available for those 100%-133% FPL on the state exchanges? MORE (NY Times, July 9th)

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