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.
Democratic presidential candidates are proposing a variety of new taxes to pay for their preferred social programs. Bloomberg’s Laura Davison and Misyrlena Egkolfopoulou took a look at how the top four candidates would fare under their own tax proposals.
“The fact is very little medical care is shoppable. We become good shoppers when we are repeat shoppers. If you buy a new car every three years, you can become an informed shopper. There is no way to become an informed shopper for your appendix. You only get your appendix out once.”
— David Newman, former director of the Health Care Cost Institute, quoted in an article Thursday by Noam Levey of the Los Angeles Times. Levey says the “consumer revolution” in health care – in which patients shop around for the best prices, forcing doctors, hospitals and pharmaceutical firms to compete with lower prices – hasn’t materialized, but the higher deductibles that were part of the effort are very much in effect. “High-deductible health insurance was supposed to make American patients into smart shoppers,” Levey writes. “Instead, they got stuck with medical bills they can't afford.”
The House Ways and Means Committee released a new analysis of drug prices in the U.S. compared to 11 other developed nations, and the results, though predictable, aren’t pretty. Here are the key findings from the report:
- The U.S. pays the most for drugs, though prices varied widely.
- U.S. drug prices were nearly four times higher than average prices compared to similar countries.
- U.S. consumers pay significantly more for drugs than other countries, even when accounting for rebates.
- The U.S. could save $49 billion annually on Medicare Part D alone by using average drug prices for comparator countries.
The U.S. ranks 18th for retiree well-being among developed nations, according to the latest Global Retirement Index from Natixis, the French corporate and investment bank. The U.S. fell two spots in the ranking this year, due in part to rising economic inequality and poor performance for life expectancy.