Big win for Obamacare, Wyomingites keep subsidies

by patti carpenter

Like a cat with nine lives Obamacare has, once again, survived a near death experience with last week’s U.S. Supreme Court decision to uphold subsidies in states that opted not to set up their own health insurance buying exchanges.

The 6-3 ruling interprets the Affordable Care Act, known to many as Obamacare, to allow eligible citizens living in 34 states without a marketplace of their own to receive subsidies through the federal government’s exchange.

In the state of Wyoming, that means that the federal subsidies going to about 17,000 citizens are safe for now. Had the ruling gone the other way, the law would have literally been gutted, since most people would not be able to afford insurance without the subsidy.

The argument centered on a three-word phrase “established by state” in the context of a very lengthy and complicated law. In his majority opinion, Justice Roberts wrote that though the phrase is “ambiguous” the meaning “in context” clearly allows the subsidies.

Republican lawmakers from Wyoming weighed in after the decision, with most expressing extreme disappointment with the ruling.

Representative Elaine Harvey of Lovell said she was disappointed in the ruling.

“I think the Supreme Court is trashing the Constitution,” she said. “Their job is not to legislate; it’s to interpret legislation. They’re supposed to go by the strict words of the law. Instead, they were trying to go by what the words mean. That’s not their job.”

Harvey expressed concern that the ruling may cause insurance rates to increase dramatically because the heavily controlled marketplace has so many restrictions on insurers affecting their ability to make a profit on policies purchased through the exchange. She said those purchasing policies through the exchange are typically heavy users of their policies. She said that fact, coupled with the fact that the ACA dictates the percentage of the premium an insurance company has to pay out (80 percent) and percentage it keeps to administer the policy (20 percent), creates a disincentive for the companies and she predicts that they will leverage against hospitals by giving them less on PPO (preferred provider) claims. She said she expects that employers who pay for private insurance for their employees will also see spikes in rates, because those rates, unless purchased on the exchange, are not regulated.

She said to compound matters, oftentimes those patients buying on the exchange have high deductibles and are unable to pay their share, leaving providers with a loss.

“There are a lot of people who are very bright who were waiting for the court to strike down this part of the law,” she said. “These are people that have some solutions to rebuild our broken medical system, but by the Supreme Court upholding this part of the law, we don’t get those chances.”

Senator Ray Peterson had a similar take on the decision, noting “I guess we’ll just continue business as usual right now, with those who qualify receiving subsidies through the government exchange.

“But, with only a couple of players (insurance companies) in Wyoming, one has already told our health insurance commissioner that they will be pulling out altogether in another year or so. So, it’s having a drastic effect on the insurance companies, in that there just isn’t any money to be made in the business anymore. That takes us just one step closer to socialized medicine. I know some people aren’t concerned with that, but I’m very concerned.

“The problem is that it (ACA) so ingrained right now that I’d be concerned if it were repealed that a lot of people would be left without insurance. It would take a while for companies to fire back up and do things the old way.

“I think in Wyoming, we’re holding on and hoping things will work themselves out. We’re constantly looking for a Wyoming solution. We don’t have a very populated state, but I think we can certainly come up with some solutions that meet the needs of our citizens in Wyoming.

“I’ve never been a big fan of this (ACA). I’ve never been a big fan of Medicaid expansion, either. I just don’t know where it’s all going to end up. I wish I knew but I don’t.”

Governor Matt Mead issued the following statement on the U.S. Supreme Court’s decision: “I challenged the ACA because I did not think this was a good law or a good approach to health care for the United States or for Wyoming. Wyoming and other states lost this challenge in the Supreme Court. The Supreme Court has again spoken, upholding key provisions of the ACA. We recognize the ACA is the law of the land and that the United States Supreme Court’s ruling confirms it is the law of the land.

“This decision allows 17,000 people in Wyoming to continue to receive a tax credit for health insurance and avoids many potential complications of those individuals losing that credit. Simply stated, this ruling maintains the status quo. It will still be necessary for Wyoming to develop its own path forward for better health care access and better health care for our citizens. I will continue to work with the legislature on these important issues.”

Senator John Barrasso remarked, “There are incredible Republican plans out there, each of which is much better than the president’s health care law.

“We still have 30 million Americans without insurance, concerned about the fact that they still need care. So, we are going to continue to work to repeal and replace this health care law with a law that will allow people to get what Senator Enzi has been talking about. We need people and we need patients to get the care they need from a doctor they choose at lower costs. That’s what Republicans are committed to and that’s what Republicans, in spite of today’s ruling by the Supreme Court, will continue to work for.”

U.S. Senator Mike Enzi, weighed in as well, with the release of the following statement: “For too long, the debate over health care has placed politics before the best interests of patients. No matter the court’s ruling, it is time for Democrats and Republicans to deliver what the president promised but ultimately failed to deliver. We need a health system that expands coverage and promotes quality patient-centered care, while actually bringing costs down.

“We must allow states the freedom and flexibility to ensure hardworking Americans have access to the care that they need. It is time for both parties to work together on real solutions that rely on these principles. We should move forward on a bipartisan basis to provide more choices and a better health care system for hardworking Americans.”

Though Congress can repeal the law, it is highly likely that the current administration would veto it.

“I don’t think our lawmakers in Washington are going to quit trying,” said Harvey. “I think their ideas are good. I really like Senator Enzi’s 10-step plan to a healthy United States program.”

Harvey, who chairs the House Labor, Health and Social Services committee, said her committee will continue to work on solutions that are better fit for Wyoming.

“Here’s the bottom line, the ACA is a one-size-fits-all solution,” said Harvey. “It was designed for urban areas, which we are not, and it gives us little opportunity to go outside of the law and find better and more workable solutions that work for Wyoming people.”