2017 Open Enrollment for Covered California Individual and Family Plans

Although no official date has been sent as of yet, this is what is expected from Covered California:

You will receive information from Covered California asking you to update information that will include but not limited to:

 

change in modified adjusted gross income- this requires a discussion with your tax professional

change of address

change in marital status

change in the number of dependents in your house hold

please respond to all Covered California requests

Changes might require a new application.

If there are no changes and your income listed on your Covered California application will remain the same for 2017, your policy will passively renew unless you decide to make a change, for example, enroll with a different insurance company.

 

This year there will be premium increases, changes in benefits which are influenced by Affordable Care Act rules and changes that have been made as a result of insurance company decisions.

Keep in mind that your 2016 subsidy has been based on the Modified Adjusted Gross Income that was listed on your Covered California application. Covered California will issue you an IRS form 1095 A to be filed with your 2016 tax return which will then be reconciled with your income. You may receive a tax credit or debit depending on your actual income.

Covered California has not determined when Open Enrollment will begin. In all likelihood it will be November 1st. As soon as I know the exact date I will send you an e mail. I will be setting up phone appointments to begin during Open Enrollment. If you would like to review your policy please let me know.

Remember, your 2016 subsidy is related to your 2016 Modified Adjusted Gross Income. Covered California will send you a 1095 A IRS form to be filed with your taxes. Your subsidy will be adjusted with your taxes depending on whether your income is more or less than what was reported on the enrollment application with Covered California.

Rate Increases for 2017 Medical Insurance Plans

There will be a significant rate increase for 2017 plans. The reasons given are the end of funding that was available in the first three years to offset rates, the rise in specialty medication and claims from those who enroll during Special Enrollment Periods.

In regard to the specialty medication, sometimes pharmaceutical companies are raising prices of medications when the need for a medication increases. Newer specialty medications can approach $100,000 per course of treatment and/or per year.

Below is the press release from Covered California on July 19, 2016

SACRAMENTO, Calif. — Covered California unveiled its rates for 2017 on Tuesday and announced that some health insurance plans will be expanding into new areas throughout the state to compete for consumers in California.

The statewide weighted average change will be 13.2 percent, up from approximately four percent in each of the last two years. However, most consumers will see a much smaller increase — or pay less next year — if they switch to another plan.

“Shopping is going to be more important this year than ever before,” Covered California Executive Director Peter V. Lee said. “Almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”

Lee said the opportunities to shop and save show that California has succeeded in building a competitive marketplace for health insurance, with rate increases that are still below trends in the individual market before the Affordable Care Act was passed.

“This is a new era of health care, where the consumer is in the driver’s seat with the power to look easily for a better deal, and where subsidies help absorb the impact of rate changes,” Lee said. “These options did not exist before the Affordable Care Act.”

Some consumers who choose to keep their plan will see a significant increase in their premium for 2017, while others will see a more modest increase, depending on where they live and what insurance plan they have. Consumers will begin receiving notices in October, when they will have an opportunity to review their new rates and change plans for their 2017 health coverage.

For many of those insured, the bulk of the premium increase will be absorbed by the subsidy paid by the government to help enrollees buy health insurance. Approximately 90 percent of Covered California enrollees get help to pay for their premiums. The average subsidy covers roughly 77 percent of the consumer’s monthly premium, and while premiums will rise, the subsidies will rise as well.

“Even though the average rate increase is larger this year than the last two years, the three-year average increase is 7 percent — substantially better than rate trends before the Affordable Care Act was enacted,” Lee said.

Lee said the average rate increase reflects the cost of medical care for consumers, not excessive profit.

“Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance,” Lee said. “So, while all plans are experiencing different cost pressures, we can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”

For consumers who get a tax credit to lower their costs — which is about 90 percent of those who sign up through Covered California — the amount they pay is impacted not only by the premium choice, but by changes in their tax credit. While the average rate increase is higher than past years, Covered California’s risk mix — the ratio of consumers who are healthy vs. sick — remains one of the best in the nation according to the Centers for Medicare and Medicaid Services (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html).

Other reasons for rate increases include:
A one-year adjustment due to the end of a funding mechanism in the Affordable Care Act known as reinsurance, which was designed to moderate rate increases during the first three years when exchanges were being established. The American Academy of Actuaries estimates this will add between 4 percent and 7 percent to premiums for 2017.
Special enrollment by some consumers who may be enrolling in health insurance only after they become sick or need care, which seems to have had a significant impact on rates for two insurance plans.
The rising cost of health care, especially specialty drugs.
Pent-up demand for health care now being accessed by those who were locked out of the health care system before the Affordable Care Act was enacted.
Lee said Covered California is working to address some of these issues on multiple fronts. The exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances. It is also sampling the special enrollment population to better understand how to make any further improvements needed.

“We work hard to build a robust exchange that drives competition by attracting as many consumers as possible,” Lee said. “Now, consistent with the vision of the Affordable Care Act, we will redouble our efforts to make sure our consumers and potential consumers understand the importance of signing up during open enrollment and remaining covered throughout the year.”

Lee said Covered California’s 11 health insurers are competing across the state for its 1.4 million members.

“The sheer number of enrollees and their overall health means consumers in the individual market are benefiting from competition,” Lee said.

Below is the complete list of the companies selected for the 2017 exchange:
Anthem Blue Cross of California
Blue Shield of California
Chinese Community Health Plan
Health Net
Kaiser Permanente
L.A. Care Health Plan
Molina Healthcare
Oscar Health Plan of California
Sharp Health Plan
Valley Health Plan
Western Health Advantage
Rate details by pricing regions can be found in “Covered California’s Health Insurance Companies and Plan Rates for 2017,” posted online at:http://coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf

The preliminary rates are subject to a 60-day public comment period and regulatory review by the California Department of Managed Health Care. In addition, the California Department of Insurance will review Health Net’s EPO.

Some insurance carriers will be increasing their coverage areas in 2017:
Oscar will be entering the market in San Francisco, Santa Clara and San Mateo counties.
Molina will expand into Orange County.
Kaiser will be available in Santa Cruz County.
With the expansion of its current carriers, almost all consumers (92.6 percent) will be able to choose from three or more carriers, and all will have at least two to select from.

In addition, more than 93 percent of hospitals in California will be available through at least one Covered California health insurance company in 2017, and 74 percent will be available in three or more plans.

Covered California also is improving its patient-centered benefit designs by increasing a consumer’s access to care by reducing the number of services that are subject to a consumer’s deductible.

Starting in 2017, consumers in Silver 70 plans will save as much as $55 on an urgent care visit and $10 on a primary care visit. In addition, consumers in Silver, Gold and Platinum plans will pay a flat copay for emergency room visits without having to satisfy a deductible, which could save them thousands of dollars.

These improvements build on features already in place that ensure most outpatient services in Silver, Gold and Platinum plans are not subject to a deductible, including primary care visits, specialist visits, lab tests, X-rays and imaging. In addition, some Enhanced Silver plans have little or no deductible and very low copays, such as $3 for an office visit. Even consumers in Covered California’s most affordable Bronze plans are allowed to see their doctor or a specialist three times before the visits are subject to the deductible.

In addition, the contract with health insurers for 2017 ensures consumers select or are provisionally assigned a primary care physician within 60 days of effectuation so they have an established source of care.

“Health care reform isn’t just about making insurance affordable, it’s about doing things to make it easier for consumers to get the right care at the right time,” Lee said.

In May, the Centers for Disease Control and Prevention announced that California’s uninsured rate had fallen to 8.1 percent at the end of 2015, down from 17 percent at the end of 2013, right before the Affordable Care Act began offering coverage.

“We can all be very proud of the extraordinary gains we have made in reducing California’s uninsured rate to a historic low,” Lee said.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

This article is from the Los Angeles Times date July 20, 2016

California Obamacare rates to jump

Premiums are set to go up an average of 13.2% next year. Rising medical costs are one reason, officials say.

BY MELODY PETERSEN AND NOAM N. LEVEY

Premiums for Californians’ Obamacare health coverage will rise an average of 13.2% next year — more than three times the increase of the last two years and a jump that is bound to stir debate in an election year.

The big increases come after two years in which California officials had boasted that the program helped insure hundreds of thousands people in the state while keeping costs moderately in check.

Premiums in the insurance program called Covered California rose just 4% in 2016 after rising 4.2% in 2015 — the first year that exchange officials negotiated with insurers. The program insures 1.4 million Californians.

On Tuesday, officials blamed next year’s premium hikes in the program on rising costs of medical care, including expensive specialty drugs and the end of a mechanism that held down rates for the first three years of Obamacare.

Two of the state’s biggest insurers — Blue Shield of California and Anthem Inc. — asked for the biggest hikes. Blue Shield’s premiums will jump an average of more than 19%, according to officials, and Anthem’s rates will rise more than 16%.

For consumers, the effect will depend on whether they get taxpayer-supported subsidies for their premiums and whether they are willing to switch to less-expensive plans that may come with higher co-pays and deductibles. Changing plans could also mean a new network of physicians, which could be disruptive to care for those with chronic conditions.

The rates vary significantly by region and insurer. Los Angeles and the rest of southwest Los Angeles County will see an average increase of almost 14%.

Blue Shield’s preferred provider organization rate in Los Angeles, chosen by 21% of those using the exchange, is increasing by an average of 19.5%. For a 40-year-old single person making $17,820 to $23,760, choosing a silver level plan, the monthly rate currently is $122, while the government pays Blue Shield $196. Next year that same person would pay $170, while the government would chip in $211 a month.

“We’re paying more for less,” said Jamie Court, president of Consumer Watchdog in Santa Monica. “Insurers are limiting access to doctors and hospitals while also demanding a higher price.”

Horacio Chavez, 34, of Boyle Heights said he made less than $25,000 last year as an education coordinator at a youth center. He currently pays a $100 premium for a Covered California plan that he uses for an annual checkup and a safety net in case of emergencies.

“I do want healthcare — I want the peace of mind that if anything happens to me that there’s some kind of coverage,” Chavez said. But “a 13% hike … that’s going to affect people.”

He said he’s already barely making ends meet trying to pay his rent, student loans from the University of Chicago, car payments and his health insurance premium.

“I’m already living check to check,” Chavez said.

Covered California officials defended the system Tuesday, saying that the competition among insurers offering coverage on the exchange was working to keep rates lower than they otherwise would be.

“California has a very competitive marketplace,” said Peter Lee, executive director of Covered California.

Obamacare has significantly reduced the number of uninsured Californians. Since the state’s health insurance exchange began offering coverage in 2014, the share of Californians without health insurance has fallen from 17% at the end of 2013 to 8.1% at the end of last year, according to officials.

Rates are expected to jump in other states too, although complete details won’t be available until later this year.

An analysis of 14 metro areas that have already announced their 2017 premiums found an average jump of 11%. The changes ranged from a decrease of 14% in Providence, R.I., to an increase of 26% in Portland, Ore., according to the analysis by the nonpartisan Kaiser Family Foundation.

The federal healthcare-  .gov   exchange provides insurance under the Affordable Care Act in 38 states. California and a few other states operate their own exchanges.

Around the country, several insurers, including giant UnitedHealth, have stopped selling health plans on the exchanges, and a number of new nonprofit health insurance co-ops have gone out of business.

Those decisions have fueled charges from the law’s critics that Obamacare isn’t working.

Former Secretary of State Hillary Clinton, the presumptive Democratic presidential nominee, is pushing a number of specific steps to ease price pressure on consumers, including allowing Americans ages 55 to 64 to buy into Medicare.

Republican presidential nominee Donald Trump has argued the health law should be repealed.

The health law’s next enrollment period begins a week before election day.

The state and federal health insurance exchanges provide coverage to about 12 million people nationally, representing just a fraction of the nation’s total insurance market. The vast majority of Americans — more than 250 million people — are in health plans purchased through an employer or provided by a government plan such as Medicare or Medicaid.

But the exchanges are a pillar of the Affordable Care Act’s program for guaranteeing Americans’ insurance coverage. And monthly premiums have become a closely watched barometer of how the law is performing.

Covered California’s Lee told the House Ways and Means Committee on July 12 that 2017 would be “a transitional year” for Obamacare, with rates seeing “significant adjustments” across the nation.

He said one reason for the increase was the end of a program designed to keep rates down during the insurance exchange’s first three years. The program had assessed a fee on all health insurers and then redistributed those funds among carriers whose members had the highest medical expenses, Lee said.

Lee added that some insurers had also not charged enough in the first two years because they didn’t have full data on the medical costs or health status of those signing up. Now they’re adjusting to account for those higher costs.

Mia Campitelli, a Blue Shield spokeswoman, said Tuesday that the insurer’s average 19.9% premium increase was “driven by our members using more healthcare services than we expected,” as well as the phaseout of the federal mechanism that had kept rates down in the law’s early years.

Anthem spokesman Darrel Ng said: “Factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in healthcare costs.”

The financial pain for most Californians getting insurance through the exchange will be muted because 90% get taxpayer assistance to cover the premiums.

Americans making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for the assistance.

Nonetheless, Americans who make too much to qualify for subsidies are likely to feel the brunt of the higher premiums. That will probably increase pressure on the new president — Democrat or Republican — to review the exchanges in 2017 for ways to make health plans more affordable.

A year ago, Lee wrote an op-ed in The Times saying that Covered California’s power in negotiating with insurers was allowing Obamacare to work in the state.

“We now have the full picture in California, where we are proving that health insurance exchanges can keep prices in check,” he wrote.

Though the Affordable Care Act has improved care for millions of Americans — for example, insurance companies can no longer set lifetime limits on care or exclude anyone because of a preexisting condition — the 6-year-old law contains few controls on overall costs.

Spending on the country’s medical system averages more than $10,000 for every American, according to statistics released by the Obama administration this month, far higher than any other nation. melody.petersen

@ latimes.com   noam.levey@latimes.com   Times staff writer Soumya Karlamangla contributed to this report.

RICH PEDRONCELLI Associated Press

“CALIFORNIA has a very competitive marketplace,” said Peter Lee, executive director of Covered California. Above, Lee discusses the program last year.

Medicare Plans to Pay Doctors for Counseling on End of Life

This article is taken from the Los Angeles Times, dated July 9, 2015

Proposal to plan for life’s end

BY NOAM N. LEVEY

WASHINGTON — Six years after end-of-life planning nearly derailed development of the Affordable Care Act amid charges of “death panels,” the Obama administration has revived a proposal to reimburse physicians for talking with Medicare patients about how they want to be cared for as they near death.

The proposal, contained in Medicare regulations unveiled Wednesday, comes amid growing public discussion about medical care that better reflects patients’ wishes as they age.

The American Medical Assn. has recommended the Medicare billing change.

The Department of Health and Human Services’ proposal would not require patients to sign any order or even to talk with their physicians about end-of-life care. Rather, it would allow medical providers to bill Medicare for “advance care planning” if a patient wants to have the discussion. noam.levey@latimes.com 

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Dennis is the most professional and knowledgable insurance broker I have ever known. He makes it a point to stay informed with the latest changes in the industry that effects me. He is exceptional in staying in good contact with me. His very high ethical standards are apparent at all times.

I have been very happy dealing with insurance companies because I have Dennis David to help me. I have had an awesome experience with Dennis L. David insurance company. Every time there is an issue or a billing error, they instantly attend to it and take care of it for me. I would recommend this company to everybody.

I have worked with Dennis for many years and as an Insurance Broker his knowledge and service is second to none! He provides his clients with competitive products to meet all of their insurance needs. For Dennis, helping clients is his priority!

I have worked with Dennis David for over 15 years. He always takes care of me and my needs. Now he also takes care of members of my family. Dennis has been especially wonderful during the changes in our healthcare system. I mean, who can figure it out? I am grateful to have him to explain it all. I am well taken care of.

I have worked with a number of insurance agents through the years, but without a doubt, this agency has been by far the best. Dennis David, in particular, is exceptional in his knowledge and expertise, and when he doesn’t know the answer, he researches it and in a timely manner reconnects with you. There is a true conscientiousness and concern for the client. As for me, with the dramatic and sweeping changes that occurred in health insurance, I felt very unclear as to what direction I should take. He was able to significantly help me sort through the morass of choices, and help land an insurance plan that was the best fit for me. I very much appreciated his guidance and I learned later that his suggestions were offered irrespective of the commission he could potentially receive. I highly recommend this agency.

Health insurance concerns can be difficult to navigate at times. Whenever I call Dennis he has always created time to patiently explain all aspects of my insurance plan. He collects all the information and addresses the pros and cons to answer my specific questions which I truly appreciate! He is wonderful to work with and I highly recommend him!

I have known Dennis David for many years and he is the most professional and honest insurance agent. I highly recommend his services for all of your insurance needs.

“Dennis has worked with my family for years. He’s consistent and reliable along with being very nice and easy to work with! Insurance can be complicated and costly, it’s of so much value have someone like Dennis on your side during the process. I would recommend him time and time again! I’m grateful to have him on my team. I always feel like my needs are met and that I’ve accomplished what I wanted after our phone meetings. He’s also great on email which is a plus for me!”

– Lucy F.
“Dennis is very knowledgeable, friendly and helpful when it comes to sorting through the confusing world of insurance. I highly recommendation Dennis.”
Hi Dennis, I wanted to let you know that of May 1, 2016  I need to cancel our insurance with Anthem Blue Cross. I would like to thank you again for all your help at a time we had no idea what we were going to do. You walked us through every option and helped us make the best choice and decision for our family. I don’t know what we would have done with out you. Thank you again for always being there to help with our many questions.
Thank you so much Dennis for your dedication in helping us.

Insurance premiums spark new front in Obamacare war

In this the second year of implementation of the Affordable Care Act, premiums have not stabilized but it is probably an unreasonable expectation of the giant upheaval in a the health insurance system. The coming years will be the litmus test, hopefully the trend of large rate increases will turn around.

Below is an article from the Washington Examiner, date July 6, 2015.

Republicans target big increases as evidence that healthcare law isn’t working

Insurance premiums have quickly become a new front in the Obamacare fight, with opponents pouncing on big increases and supporters and experts countering the increases won’t be so bad.

The fight started last month when insurers were required to disclose estimated 2016 rates of 10 percent or more for Obamacare customers. Some figures grabbed headlines, especially with certain insurers calling for 50 to 70 percent increases.

The premium spikes vary by state and insurer. For instance, some plans in Florida are actually proposing reduced premiums, but 13 plans want rate increases of 10 percent or more, including Time Insurance Co.’s 63 percent hike.

Republicans say the higher rates are evidence that the law is hurting Americans and not lowering healthcare costs.

“The whole point of Obamacare was to make health care more affordable. But premiums aren’t going down; they’re going up — way up,” said Rep. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee, in a recent hearing.

“The model we’re on in the Affordable Care Act is not sustainable,” said Rep. Mike Kelly, R-Pa., at the same hearing.

This is the first time since Obamacare’s passage that insurers can look at a full year’s worth of claims data and calculate premiums, Rep. Pete Roskam, R-Ill., said at the hearing. He added that the premium spikes are not growing pains.

“The law created a number of temporary programs to pay out billions in taxpayer funds during the first few years to lower costs seen by individuals and to protect big insurance companies against financial losses,” he said. “But those programs are beginning to phase out, and as the government is slowly taking off the training wheels, Obamacare is looking pretty wobbly.”

Supporters counter that any increases aren’t finalized and will have a modest impact overall.

“We have just the bad news,” said Kathy Hempstead, who directs coverage issues for the Robert Wood Johnson Foundation.

One analysis found that Obamacare customers as a whole may only see a modest increase.

The research firm Avalere looked at proposed rate filings in seven states and the District of Columbia. The average premiums for silver plans, the second cheapest option and a popular choice for Obamacare enrollees, will increase nearly 6 percent, Avalere said.

Avalere also noted that the low-cost silver plan options are likely to be smaller than the silver plan as a whole. Premiums for the lowest- and second-lowest silver plans in the seven states and D.C. will increase on average 4.5 percent and 1 percent.

A separate analysis from the nonpartisan Kaiser Family Foundation found that in 11 major cities the cost of a regular silver plan would be on average 4.4 percent higher in 2016 than this year.

Premiums must be finalized by October. That way customers facing a high premium can choose a different plan during the next open enrollment this fall.

Another reason why the rates could change is states need to conduct reviews themselves.

Obamacare requires states to report on any premium increase trends and recommend whether certain plans should be excluded from the exchanges, according to the National Conference on State Legislatures.

In 2011, the federal government started to work with states to strengthen or alter their rate review programs. If a state doesn’t have the resources to conduct the required review, the Department of Health and Human Services will do it, the National Conference on State Legislatures said.

“The carriers really have to be able to explain their rates, and that is part of the point of the whole medical loss-ratio regulations,” Hempstead said.

The medical loss ratio is another new regulation installed under Obamacare. It requires insurers to devote 85 percent of the cost of a premium on medical care and the other 15 percent on administrative costs.

The ratio ensures that insurers don’t devote too much of their costs to overhead.

Amid the rhetoric over the premium increases are certain trends that could affect the insurance market as a whole.

Many Blue Cross Blue Shield insurers kept premiums in marketplaces comparatively low with small increases from year to year, but that varies considerably across the country, according to a study of trends for market place plans done by the foundation and the left-leaning think tank Urban Institute.

The report looked at the cheapest silver plans in 30 states. Some insurance companies were reluctant to enter the Obamacare marketplaces in 2014 and when they did the plans were more expensive.

However, the report projects insurers will lower premiums to keep prices low to attract enough customers buying insurance through the Obamacare marketplaces.

But for opponents of Obamacare, the proposed increases represent a long-standing criticism about the law’s ability to battle healthcare costs, which was levied even before the exchanges opened in 2014.

Roberts again shows independent streak

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This article from the Los Angeles Times dated June 26, 2015 is a follow up to the Supreme Court decision to uphold the Affordable Care Act.

WASHINGTON — Since becoming chief justice 10 years ago, John G. Roberts Jr. has been determined to show that the court he leads is made up of impartial jurists, not politicians in robes.   In the phrase he used at his confirmation hearings, each justice is “like an umpire” at a baseball game — not favoring one team over the other.   On Thursday, Roberts showed again his willingness to brush aside partisan politics and forge a middle ground on some of nation’s most divisive issues, writing a 6-3 decision that upheld the broad reach of President Obama’s healthcare law.   It was the second time in three years that Roberts had led the Supreme Court to uphold the Affordable Care Act, also known as Obama-care. The decision surprised and disappointed some of the conservatives who had once hailed his appointment.   “We might as well call the law … RobertsCare,” said Ilya Shapiro, a lawyer at the Cato Institute, a libertarian think tank in Washington.   When Roberts spoke of being an umpire, “a lot of people on the left sneered,” said Neal Katyal, who served as acting U.S. solicitor general in Obama’s first term. “Today’s decision shows he really meant what he said. It’s a profound statement about the difference between law and politics.”   Roberts cringes at the regular references to the “conservative bloc” or the “liberal wing” of the court. Last year, he was pleased when the justices were able to agree unanimously in a much higher percentage of their cases.   Thursday’s decision sent a particularly loud message about a nonpartisan court because the chief justice gave a generous reading to a liberal law passed by a Democratic-controlled Congress.   But the decision is not a sign that Roberts has become a liberal or shifted strongly to the left, as some allege.   On the same day, Roberts joined three conservatives in dissent when the majority held that the Fair Housing Act forbids practices that have a “discriminatory effect” on racial minorities even if there is no intentional discrimination. In 2013, he voted with conservatives to strike down part of the Voting Rights Act.   His decisions on easing campaign finance rules, including Citizens United, which gave corporations and unions the ability to make unlimited contributions to political causes, firmly established Roberts’ record as a conservative.   But on most issues, the chief justice has shown himself to be most comfortable in the moderate middle and unwilling to push the law too far to the right or too quickly.   In April, he joined with the court’s four liberal justices to uphold a Florida law that prohibited elected judges from personally soliciting campaign contributions. Roberts supports the 1st Amendment right to spend freely on campaigns, but judges are not politicians, he said.   In other alliances with liberals, he helped forge a 6-3 majority to rule that a police officer may not detain a car stopped for a traffic violation so a drug-sniffing dog may be brought to the scene. He also joined a 5-4 opinion by Justice Ruth Bader Ginsburg that freed a Florida fisherman from federal obstruction-of-justice charges for having tossed overboard several undersized red grouper.   Further evidence on how Roberts sees his role could come as early as Friday in the court’s decision on gay marriage. It’s widely expected that a majority of justices will declare the right of gays and lesbians to marry nationwide, but given Roberts’ growing independent streak, combined with the impact that case will undoubtedly have on his legacy, some are wondering whether the chief justice will find a way to side with liberals in what would be a landmark decision.   Roberts’ reasoning in the healthcare case showed several of his characteristic traits — a desire for moderation as well as a concern over the real-world impact of the court’s decisions, particularly on business.   Had the justices ruled for the conservative activists who sued the administration, more than 6.4 million people could have lost their health coverage. That in turn could “well push a state’s individual insurance market into a death spiral,” Roberts said.   It would be “implausible,” he said, to think the Congress that passed the healthcare law intended to limit its tax subsidies to the 13 states that established an exchange, or marketplace, of their own.   He rejected the claim brought by conservative activists who pointed to one part of the law that said subsidies were limited to insurance policies bought on an exchange “established by the state.” This hyper-technical reading of one phrase did not make sense and was contradicted by other parts of the law, he said.   “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he wrote.   Duke Law professor Neil Siegel called the majority opinion “a masterpiece of legal craft, good sense and fidelity to the law at a time when political polarization threatens to spill over into the judiciary.”   But the three conservative dissenters accused the majority of “interpretive jiggery-pokery” and “somersaults of statutory interpretation” to fix a political, not legal, problem.   “This court’s two decisions on the [healthcare] act will surely be remembered through the years,” wrote Justice Antonin Scalia, joined by Justices Clarence Thomas and Samuel A. Alito Jr. “And the cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”   In most cases, Roberts is still more likely to vote with the court’s conservatives. University of Chicago Law professor David Strauss said the final word about the Roberts court wouldn’t come until it weighs in on broad major issues like abortion and race.   “But the chief justice has made it clear that he meant what he said in his confirmation hearings: The big decisions should be made by the people who won an election, whether the court agrees with them or not, as long the justices don’t have to distort the law to do that,” Strauss said. david.savage@latimes.com

Getty Images   CHIEF JUSTICE reenforced his statement that each justice is “like an umpire.”

WIN MCNAMEE Associated Press   JOHN G. ROBERTS JR. says he dislikes the references to the “conservative bloc” or the “liberal wing” of the U.S. Supreme Court, which he’s led for a decade.

Supreme Court Upholds the Affordable Care Act

The article below from the Los Angeles Times, dated June 26, 2015 explains the decision
OBAMACARE APPEARS CEMENTED INTO LAW
Supreme Court rejects serious threat to health reform
BY NOAM N. LEVEY

WASHINGTON — The Affordable Care Act, upheld in a decisive 6-3 Supreme Court ruling Thursday, is now virtually assured of surviving as a permanent feature of the American healthcare system.   Republicans’ chances of repealing the law, which provides health coverage to more than 20 million Americans, all but evaporated after the strongly worded decision written by Chief Justice John G. Roberts Jr.   It was the second time in three years that the high court had turned aside a legal threat to the law, one of President Obama’s signature achievements.   With no serious Republican alternatives and a historic expansion in medical coverage well underway, Obamacare is about as firmly ensconced as a new law can be in a politically divided country.   The ruling came in a lawsuit that had threatened to strip insurance subsidies from more than 6 million Americans in at least 34 states.   The law’s wording was at times “inartful,” the majority said, but Congress clearly intended for the aid for low- and moderate-income Americans to be available everywhere. The justices rejected claims from the challengers that a handful of words in the statute made subsidies available only in a few states.   “We must read the words in their context,” the chief justice wrote.   In the decision, Roberts also explicitly blessed the law’s sweeping system for guaranteeing coverage, noting that the model, pioneered in Massachusetts, had accomplished what other attempts to extend insurance protections to Americans had not.   “The Affordable Care Act adopts a version of the … reforms that made the Massachusetts system a success,” he wrote.   Congressional Republicans, meanwhile, still have no plan to replace the law enacted more than five years ago.   Speaking to reporters after the court’s decision, House Speaker John A. Boehner (R-Ohio) repeatedly refused to commit to any new strategy to repeal or revise the health law.   And across the country, as millions of previously uninsured Americans have gained coverage, a growing number of Republican governors are signaling their interest in moving on.   Still, political battles over the law won’t end anytime soon.   In the presidential campaign, Republican hopefuls need to appeal to conservative voters — many of whom deeply dislike the law and the president who championed it. That guarantees that cries for repeal will remain prominent, particularly during next year’s primaries.   “This is not the end of the fight,” former Florida Gov. Jeb Bush said Thursday. “We need to repeal and replace Obamacare.”   Nearly all of the other major candidates for the nomination echoed Bush’s statement.   But away from the campaign trail, implementation of the law and its coverage expansion will continue.   “We appreciate that the deep uncertainty of this issue has been resolved,” Michigan Gov. Rick Snyder, a Republican, said Thursday after the court issued its decision. “The health and well-being of the people of Michigan is always a top priority.”   In his state, more than 200,000 low- and moderate-income residents stood to lose insurance assistance if the court backed the challengers, who argued that no subsidies should be available in any state that did not establish its own insurance marketplace through the law.   Michigan is one of the 34 states that instead deferred to the federal HealthCare  .gov   marketplace.   Like many other Republican governors, Snyder has been more focused on expanding access to healthcare than continuing the battle over the law.   Michigan is working to secure approval from the Obama administration for further changes to the state’s Medicaid program, which was expanded under the law to guarantee coverage to the poorest residents .   Michigan is one of 29 states that have accepted federal aid in the law to broaden Medicaid coverage   — a number that has steadily grown over the last several years to include even very conservative states such as Indiana.   In the last two years, some 11 million people have newly enrolled in Medicaid, mostly in states that expanded their programs.   An additional 10 million Americans, many of them previously uninsured, now get health coverage through marketplaces created by the law.   That has fueled a historic coverage expansion. In the first quarter of this year, 11.9% of adults in the U.S. lacked insurance, down from 18% in the third quarter of 2013, before the current expansion began, according to Gallup.   And more red states, including Utah, Tennessee and Wyoming, have been exploring ways to expand Medicaid coverage.   In Washington, by contrast, GOP congressional leaders kept up their criticism of the law.   “Republicans are ready to reduce the cost of healthcare so more people can afford it, put patients back in charge, and restore freedom and choice to the healthcare market,” said Senate Health Committee Chairman Lamar Alexander (R-Tenn.).   But it is unlikely there will be significant new legislation, at least until after next year’s presidential election.   To date, Alexander and most other congressional Republicans have offered little more than general outlines rather than real legislation that would fulfill such promises.   Several GOP blueprints even incorporate key protections from the current law, including guaranteeing coverage and providing government assistance to help consumers purchase insurance.   On the other side of the debate, supporters of the health law redoubled their calls on Republicans to stop fighting.   “It’s time for people on both sides of the aisle to accept that the law is working and take important steps to fully implement it,” said Sue Berkowitz, head of South Carolina Appleseed Legal Justice Center, a nonprofit that has been working to expand coverage in that state despite Republican officials’ resistance to Medicaid expansion.   The president joined the chorus, speaking from the White House Rose Garden on Thursday afternoon.   “The Affordable Care Act is here to stay,” he said. noam.levey@latimes.com   Twitter: @NoamLevey

JIM LO SCALZO European Pressphoto Agency   SUPPORTERS of the Affordable Care Act cheer outside the Supreme Court after justices ruled 6 to 3 that the healthcare law’s tax credits can go to residents of any state.

CHIP SOMODEVILLA Getty Images   HOUSE SPEAKER John A. Boehner (R-Ohio), at a news conference after the decision, wouldn’t commit to any new strategy to repeal or revise the law.

ALEX WONG Getty Images   “THE AFFORDABLE Care Act is here to stay,” said President Obama, with Vice President Biden at the White House Rose Garden after the ruling was announced.

Cancellation of Individual and Family Medical Policies For Non Payment of Premium

Insurance Companies no longer reinstate individual and family plans for non payment of premium.

Individual and family plans can only be purchased during open enrollment which is closed until November2015.

Individuals and families who qualify for a Special Enrollment Period can purchase plans. Non payment of premium is not a qualification for a Special Enrollment Period.

The Internal Revenue Service will impose a penalty if you do not have a medical insurance plan that may amount to thousands of dollars.

Please pay your premiums when your bill is received.

If you have not paid your premium by this time of the month, I would strongly encourage you to call the membership services number on your ID card and pay the bill. A late or lost check may result in a cancellation for non payment.

Healthcare law defense tailored for key justices

The Supreme Court is about to hear arguments concerning the Patient Protection and Affordable Care Act,  also referred to as Obamacare. The issue is whether those who purchase their health insurance from federal exchanges are entitled to receive subsidies. Language for this allowance was left out of the original law which states that subsidies are available through state exchanges/marketplaces such as Covered California.

The following article from the Los Angeles Times, dated February 26, 2015 is a very good discussion on this issue.

Healthcare law defense tailored for key justices

Subsidy backers may argue states’ rights in the Supreme Court.
BY DAVID G. SAVAGE

WASHINGTON — With President Obama’s healthcare law once again facing possible unraveling at the hands of the Supreme Court, the administration and its allies have developed a novel argument tailor-made to appeal to conservative justices: states’ rights.

The high court is set to hear arguments March 4 to determine the legality of Affordable Care Act subsidies for approximately 7 million Americans who receive coverage from federally run health insurance marketplaces, also known as exchanges.

Lawyers for the Competitive Enterprise Institute, a small libertarian group in Washington, are challenging the subsidies, pointing to a passage in the law that says such tax credits may go to those who buy insurance on an “Exchange established by the state.”

Only 13 states fully operate their own online healthcare marketplaces.

The other 37 rely on the HealthCare.gov   site run by the federal government. If the justices rule for the challengers, consumers in most or all of those states would lose their subsidies, making health coverage unaffordable for most of them.

The Obama administration and healthcare advocates are arguing that the law, when read as a whole, makes clear that the subsidies were intended to be available nationwide for low-and moderate-income people, not just those in certain states.

But if the justices doubt that reading, supporters of the law have a legal backup plan that highlights the “clear notice” rule for states. It says that when Congress passes a new law and seeks cooperation from the states, it must not withhold important information.

The principle was spelled out in a 1981 opinion by then-Justice William H. Rehnquist, the same year John G. Roberts Jr. served as one of his law clerks.

Liberals hope it will persuade Roberts, now chief justice, and some of his colleagues to uphold the tax subsidies in the 37 states that rely on the federal exchange.

This focus on the federal-state balance of power appears targeted at Roberts, whose vote was crucial in upholding the law’s constitutionality in 2012, and Justice Anthony M. Kennedy, a longtime champion of the states who has cited the “clear notice” principle in the past.

Supporters of the law say that even if Congress meant to restrict subsidies to marketplaces created by the state, no one warned state officials that relying on the federal version would deprive their residents of millions of dollars in insurance subsidies.

Late last month, lawyers for 22 states, including Virginia, Illinois, Pennsylvania and North Carolina, told the justices they were blindsided by the claim that federal subsidies might be cut off because they failed to establish state marketplaces.

“Surprising states with a dramatic hidden consequence” violates a basic principle of fair dealing between Washington and the states, the state lawyers said in the court brief. Congress “does not hide elephants in mouse holes,” they added, quoting a comment by Justice Antonin Scalia in a previous case.

Oklahoma and five other states sided with opponents of the law. Their lawyers said the “plain text” bars subsidies for their residents, since they did not establish state marketplaces.

California, New York, Connecticut and Maryland, which are among the 13 states that fully operate their own marketplaces, have endorsed the broad view that tax subsidies should be available nationwide.

Of the 37 states using the federal healthcare site, a few have either technically established their own marketplaces or have partnership agreements with the federal government. The justices could choose to treat those states differently than the rest, allowing their residents to keep subsidies.

But supporters of the healthcare law say they are more hopeful now of prevailing entirely in the high court, in part because of the “clear notice” argument. Washington lawyer Walter Dellinger, a solicitor general under President Clinton, said this federalism or states’ rights argument is likely to get the attention of several justices.

“If you are Congress, you don’t impose a penalty on the states and then hide it in an obscure provision involving the tax code that no one noticed at the time,” he said. This strongly suggests, he said, that Congress did not intend to punish states that decided to rely on a federal marketplace.

Other provisions of the law carry the same message, supporters say. A section titled “State flexibility” says that states shall establish an exchange so residents can compare prices for insurance and buy policies, and that if states elect not to do so, “the secretary [of Health and Human Services] shall establish and operate such exchange” within the state.

Citing this passage, officials from the 22 states said they understood this to mean they could run an exchange on their own, or use the federal version, but the choice would have no effect on their residents.

Attorneys for the Obama administration argue that the term “such exchange” means that the federally run exchange would simply function in place of one created by the state, with no differences in operation.

Defenders of the law recognize they face a struggle in winning over the court’s conservatives, who have been skeptical of Obama’s signature healthcare program.

Four justices — Scalia, Kennedy, Clarence Thomas and Samuel A. Alito Jr. — voted to strike down the entire law in 2012. If Roberts joins them this time, they could deal it a severe blow.

In 2012, a majority led by Roberts rendered a split decision. They upheld the mandate to buy insurance, but they also said states may refuse to expand free health insurance under the Medicaid program.

In a second decision last year, they ruled by a 5-4 vote that corporate employers citing their religious faith may refuse to pay to cover certain contraceptives for their female employees.

The latest case began with what some called a “glitch” or “wording flaw” in the long and complicated bill. Jonathan Adler, a libertarian law professor at Case Western Reserve University who helped launch the suit, argued the law should be interpreted based on its exact words, not the grand aims of its Democratic sponsors.

“The proper question is: What did Congress say? And the words ‘established by the state’ are pretty clear,” he said. “People didn’t focus on this in 2010 or 2011because no one took seriously that so many states would say ‘no.’”

Ilya Shapiro, a lawyer at the libertarian CATO Institute, says the blame lies with the Democrats who wrote the law.

“This is a consequence of the frenzy to get something passed on a razor-thin partisan vote,” he said. “No one knew what was in it. Maybe the states’ lawyers missed it, or they were misled by the feds.”

Administration officials were surprised when about three dozen states — both red and blue — chose not to establish marketplaces of their own. They were also alarmed when the Supreme Court voted Nov. 7 to take up the current case, King vs. Burwell, just three days after Republicans won full control of Congress.

Challengers won a round last summer when a U.S. appeals court panel in Washington, in a 2-1 vote, interpreted the law as limiting subsidies to the 13 states that fully run their own marketplaces. On the same day, an appellate court in Virginia reached the opposition conclusion, ruling that nationwide subsidies were allowed.

In recent weeks, a new round of legal briefs from the administration, state officials, former members ofCongress and leading law professors have argued that there was no glitch and that the law, read as a whole, provides insurance subsidies to eligible Americans regardless of where they live.

“They put the text of the statute front and center, and it shows the absurdity of the plaintiffs’ argument,” said Elizabeth Wydra, attorney for the Constitutional Accountability Center, a liberal group that supports the law. “When [the justices] read the briefs, I think it would be hard for them to rule against the government, even though they may not like the law.”

For instance, the law’s supporters say, one provision permits subsidies for any applicable taxpayer whose income is less than 400% of the poverty rate, without making reference to whether the marketplace was established by the state or federal government.

Another provision defines a “qualified individual” as someone who “resides in the state that established the exchange.”   The provisions show that the federally run exchange was intended to serve as the de facto state exchange, U.S. Solicitor Gen. Donald Verrilli Jr. said in a court brief. Otherwise, if the second provision were read in isolation, it would imply that a federal exchange “would literally have no customers” since no potential applicants would live in a “state that established the exchange.”   Why, he asked, would states have been told by Congress that they had the flexibility to rely on the federal exchange, only to learn later none of their residents could actually use it? david.savage@latimes.com   Twitter: @DavidGSavage

JOE RAEDLE Getty Images   HEALTHCARE ENROLLMENT is advertised this month in Miami. The Supreme Court is to hear a case next week on federal subsidies for 7 million people.

Covered California Special Enrollment Period

Covered California is offering a Special Enrollment Period for those who have not purchased individual or family coverage and did not know or understand there was a tax penalty for being uninsured in 2014 or who learned they may face a penalty for 2015. This Special Enrollment Period begins on February 23rd and ends on April 30, 2015. Consumers must attest to the fact that they did not have knowledge of the penalty.

Regular Open Enrollment is closed. If one has already enrolled in health insurance, the plan cannot be changed unless criteria is met for a different Special Enrollment period dictated by Qualifying Life Events.

For more information, contact my office.

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