health law

Half of the 17 state-run insurance exchanges set up under President Barack Obama's health law are struggling financially, The Washington Post's Lena H. Sun and Niraj Chokshi report. The exchanges are facing financial distress because of "surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers." Federal funding for state-run exchanges has ended and exchanges now have to require their own costs of operation.

Some states are considering handing exchange functions over to the federal government but they are holding off until the U.S. Supreme Court rules by the end of June on whether the only way subsidies for health insurance can be provided to taxpayers is through coverage bought on state exchanges.

As many as 45,000 more Montanans will be get health coverage after legislators have passed a bill to expand Medicaid, The Huffington Post's Jeffrey Young reports. Gov. Steve Bullock, a Democrat, supports expanding Medicaid. The expansion also must be approved by the federal government because it includes new requirements for enrollees, including monthly premiums.

Two years ago, the expansion failed because a supporter cast the deciding vote the wrong way accidentally, Young reports.

The U.S. Court of the Appeals for the Eighth Circuit has ruled that Missouri can't limit the ability of insurance navigators in helping consumers sign up for coverage through the federally run online exchange, the St. Louis Post-Dispatch's Samantha Liss reports. Missouri legislators passed legislation barring navigators from providing advice to consumers about health plans sold outside of the federally-run exchange.

The Obama administration's Office of the National Coordinator for Health Information Technology has taken vendors of electronic health records "to task for making it costly and cumbersome to share patient information and frustrating a $30 billion push to use digital records to improve quality and cut costs," The Wall Street Journal's Melinda Beck reports.

For example, vendors are requiring customers to use proprietary platforms and making it too expensive to switch systems. Even though nearly 80 percent of doctors and 60 percent of hospitals have converted from paper files to EHRs, only 20 to 30 percent of providers are able to share records with other providers, Beck reports.

ONC could decertify EHR systems that block data-sharing, but the report says that would unduly penalize customers, Beck reports.

People with disabilities are fighting Wisconsin Governor Scott Walker's proposed changes to long-term managed care in the state's budget, The Marshfield News-Herald's Liz Welter reports. They are concerned that changes to managed care would trade a community-centered system with a state-wide approach run by out-of-state insurance companies. They also are concerned that the autonomy the current system gives them to direct how some of their care is carried out would be eliminated.

The U.S. Supreme Court, 5-4, ruled in the past week that healthcare providers can't force states to raise Medicaid rates to keep up with rising medical costs, the Associated Press' Sam Hananel reports. The mostly more conservative justices in the majority said that private medical providers have no private right to enforce Medicaid funding laws because Congress did not create such a right.

The case involved five centers in Idaho that provide care to developmentally disabled children and adults, which claim that Idaho ignoring rising costs by keeping reimbursement rates low.

A duel is being set up between the Utah Senate and the Utah House on how much to expand Medicaid, The Salt Lake Tribune's Kristen Moulton reports. A House committee voted down a plan backed by the governor and passed by the Senate. Instead, the House Business and Labor Committee passed a plan sponsored by the House majority leader that would cover 46,500 more people.

The consensus about the latest Supreme Court case involving the Affordable Care Act is that the two key votes are Justice Anthony M. Kennedy and Chief Justice John G. Roberts Jr. The rest of the Supreme Court justices appeared to be split along ideological lines during oral arguments yesterday over whether the statutory language in the health law only allows federal subsidies to consumers who bought their health insurance through a state-run exchange, not the federal exchange.

The Washington Post's Robert Barnes reports that Kennedy said there was a constitutional problem with the interpretation of Obamacare that states had to create their own exchanges or the federal government would "'send your insurance market into a death spiral'" by taking away their subsidies. That is coercive pressure that the federal government is not allowed to apply, Kennedy said. Barnes further reports that "Kennedy brought up the 'standard of constitutional avoidance.' That means that if there are two possible interpretations of a statute, judges should choose the one that is plainly constitutional instead of the one that raises constitutional questions."

Roberts, who was the swing vote in upholding the constitutionality of Obamacare, did not ask any questions that provided insight into his leanings on the case, Barnes reports.

A ruling against the Obama administration would result in 7.5 million Americans losing their subsidies, Barnes also reports.

The updates about the U.S. Supreme Court's arguments today in King v. Burwell are coming fast and furious. The petitioners are seeking to invalidate the insurance subsidies in states with federal exchanges. SCOTUSBlog reports that Justice Anthony Kennedy, often the swing justice on the court,  "expressed deep concern with a system where the statute would potentially destroy the insurance system in states that chose not to establish their own exchanges – likening this to an unconstitutional form of federal coercion. That made him seem skeptical of the petitioners’ reading of the statute, a hopeful point for defenders of the existing subsidies in all states."

ProPublica's Charles Ornstein reports that federal regulators are rarely fining health care organizations for data breaches. There have been more than 1,140 large breaches affecting more than 41 million people in the last 5.5 years. But there have been fines levied just 22 times, even though the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act, has required healthcare providers to report breaches involving at least 500 patients since 2009.