House Republicans are gearing up to grill Health and Human Services Secretary Sylvia Mathews Burwell this week over how the administration will handle any potential fallout if the Supreme Court strikes down federal subsidies for health insurance coverage in 34 states operating on the federal exchange. Burwell will testify before the House Ways and Means Committee on Wednesday, ahead of the high court’s ruling in the high-stakes case of King v. Burwell, expected later this month.
The plaintiffs in that case contend that the law’s language only provides for subsidies to people in states that created their own exchange. The Obama administration and authors of the law maintain that the law was intended to offer subsidies to all enrollees who are eligible based on their income regardless of which exchange they used.
If the court rules against the administration, an estimated 6.5 million people could lose their subsidized health coverage. If that happens, experts say it could create a ripple effect throughout health insurance markets in federal exchange states. Nearly everyone agrees that such a ruling would be devastating for millions of Americans. However, there is little agreement over what, if anything, to do to stem such fallout if the court rules for the plaintiffs.
Asked why his administration has given little guidance to states on how to prepare for the potential loss of federal insurance subsidies, President Obama on Monday said, “there is no reason why the existing exchanges should be overturned through a court case.”
King v. Burwell “should be an easy case,” Obama said. “Frankly, it probably shouldn’t even have been taken up. And since we’re going to get a ruling pretty quick, I think it’s important for us to go ahead and assume that the Supreme Court is going to do what most legal scholars who’ve looked at this would expect them to do.”
Obama added that Congress could also resolve any problems raised by a court ruling “with a one-sentence provision.”
That kind of response is unlikely to satisfy House Republicans, who are likely to again question Burwell’s previous claims that the administration does not have a “Plan B” in place if the court strikes down federal subsidies for millions of Americans.
Last week, during a Wall Street Journal breakfast, Burwell explained that the administration’s authority is limited. She added that her agency would work with states that are considering creating their own exchanges or using workarounds to avoid losing out on the federal subsidies.
“As always, we will stand ready to work with states, but in terms of administrative authority, we can’t do much,” Burwell said.
Republicans, who have long sought to repeal Obamacare, have criticized the administration for not having a contingency plan in place if the subsidies get struck down.
The cost of insulin used to treat Type 1 diabetes nearly doubled between 2012 and 2016, according to an analysis released this week by the Health Care Cost Institute. Researchers found that the average point-of-sale price increased “from $7.80 a day in 2012 to $15 a day in 2016 for someone using an average amount of insulin (60 units per day).” Annual spending per person on insulin rose from $2,864 to $5,705 over the five-year period. And by 2016, insulin costs accounted for nearly a third of all heath care spending for those with Type 1 diabetes (see the chart below), which rose from $12,467 in 2012 to $18,494.
The partial government shutdown has hit the economy like a hurricane – and not just metaphorically. Analysts at the Committee for a Responsible Federal Budget said Tuesday that the shutdown has now cost the economy about $26 billion, close to the average cost of $27 billion per hurricane calculated by the Congressional Budget Office for storms striking the U.S. between 2000 and 2015. From an economic point of view, it’s basically “a self-imposed natural disaster,” CRFB said.
The U.S. could save billions of dollars a year if Medicare were empowered to negotiate drug prices directly with pharmaceutical companies, according to a paper published by JAMA Internal Medicine earlier this week. Researchers compared the prices of the top 50 oral drugs in Medicare Part D to the prices for the same drugs at the Department of Veterans Affairs, which negotiates its own prices and uses a national formulary. They found that Medicare’s total spending was much higher than it would have been with VA pricing.
In 2016, for example, Medicare Part D spent $32.5 billion on the top 50 drugs but would have spent $18 billion if VA prices were in effect – or roughly 45 percent less. And the savings would likely be larger still, Axios’s Bob Herman said, since the study did not consider high-cost injectable drugs such as insulin.