First Edition: July 23, 2014

Today's headlines include coverage and analysis of yesterday's conflicting legal decisions regarding the health law.

Kaiser Health News: Appeals Courts Split On Legality Of Subsidies For Affordable Care Act
Kaiser Health News staff writer Julie Rovner reports: "Two U.S. appeals courts Tuesday reached opposite conclusions about the legality of subsidies in the Affordable Care Act, a key part of the law that brings down the cost of coverage for millions of Americans. In Washington, a three-judge panel at the U.S. Appeals Court for the D.C. Circuit ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states" (Rovner, 7/22). Read the story.

Kaiser Health News: Brief Consumer Guide To Health Law Court Decisions
On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that's important to millions of people: the availability of subsidies to help purchase coverage under the health-care law. Kaiser Health News' Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers (7/22). Read the story.

Kaiser Health News: California Nurses Union Braces For Contract Battle
Reporting for Kaiser Health News, in partnership with NPR, KQED's April Dembosky writes: "But this is no church service, and nurses are not here to worship. The California Nurses Association is rousing its troops for battle. California's powerful nurses' union will begin bargaining next week with Kaiser Permanente on a new four-year contract for nurses at its Northern California hospitals. (Kaiser Health News is not affiliated with Kaiser Permanente.) Kaiser operates the largest hospital system in the state, by number of hospitals and number of hospital beds, and is the eighth largest health system in the country" (Dembosky, 7/22). Read the story. 

Kaiser Health News: Capsules: Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits
Now on Kaiser Health News' blog, Shefali Luthra reports: "During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums" (Luthra, 7/23). Check out what else is on the blog.

The New York Times: New Questions On Health Law As Rulings On Subsidies Differ
Two federal appeals court panels issued conflicting rulings Tuesday on whether the government could subsidize health insurance premiums for millions of Americans, raising yet more questions about the future of the health care law four years after it was signed by President Obama. The contradictory rulings will apparently have no immediate impact on consumers. But they could inject uncertainty, confusion and turmoil into health insurance markets as the administration firms up plans for another open enrollment season starting in November (Pear, 7/22).

NPR: Obama's Health Care Law Has A Confusing Day In Court
Another wild legal ride for Obamacare on Tuesday: Two U.S. Court of Appeals panels issued conflicting decisions on an issue with the potential to gut the health care overhaul. The two rulings could lead to another U.S. Supreme Court showdown over the controversial law, all because of what one of the law's opponents initially called "a glitch" (Totenberg, 7/22).

The Washington Post: Federal Appeals Courts Issue Contradictory Rulings On Health-Law Subsidies
The conflicting rulings give traction to the most serious current threat to the Affordable Care Act, which has been battered by a series of legal challenges since it was enacted four years ago. The dispute centers on whether the subsidies may be awarded in states that chose not to set up their own insurance marketplaces and instead left the task to the federal government. About 5.4 million people had signed up for coverage on the federal exchange as of this spring, federal figures show. About 87 percent of them received subsidies (Somashekhar and Goldstein, 7/22).

The Wall Street Journal: Appeals Courts Issue Conflicting Rulings On Health-Law Subsidies
In a blow to President Barack Obama's signature legislative achievement, a panel of the U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 health law. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state or federally run exchange. Two hours later, a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va., reached the opposite conclusion, unanimously ruling that consumers in states relying on the federal marketplace could receive subsidies. That handed the White House a victory that counteracted the administration's loss in the other case (Kendall and Armour, 7/22).

Los Angeles Times: Federal Appeals Courts Issue Conflicting Rulings On Obamacare
The legal battle gives Obamacare's opponents another shot at trying to kill the law in the high court, a goal they fell one vote short of in 2012. In that case, four justices voted to strike down the entire legislation as unconstitutional. Chief Justice John G. Roberts Jr. joined the four liberal justices to uphold the core of the law. This time, the outcome at the high court would turn on whether at least one of the five conservative justices agreed to uphold Congress' broad goal of providing all Americans with insurance they can afford (Savage, 7/22).

Politico: Wild Day For Obamacare: Appeals Court Rulings Conflict
For now, no one will have their subsidies cut off while the legal battle continues. The Obama administration said it will appeal the D.C. ruling on Halbig v. Burwell by asking for an en banc review involving the full panel. "We are confident in the legal case that the Department of Justice will be making," said White House press secretary Josh Earnest. The plaintiffs in the fourth circuit's King v. Burwell in Virginia haven't yet said what they'll do next (Winfield Cunningham, 7/22).

USA Today: Appeals Court Panels Issue Split Decisions On Obamacare
The federal subsidies offered through the exchanges have reduced monthly insurance premiums by 76% for those who qualify, federal health officials say. The average monthly premium dropped from $346 to $82. In 2016, an estimated 7.3 million people in the 34 states with federal exchanges would receive subsidies totaling $36 billion, according to the Urban Institute. To qualify for subsidies, participants must have incomes below 400% of the federal poverty line, or $95,400 for a family of four (Wolf, 7/22).

Politico: Democrats Still Haven't Learned Obamacare Lesson
The conflicting rulings were another wake-up call for Democrats about the fragility of the health care law -; and a reminder that whenever they think a lawsuit is no threat to the law, it's probably a threat to the law. It's all because of what most Democrats insist is a drafting error in the law, but it's kind of a big one. The federal health insurance marketplace is now serving 36 states that couldn't or wouldn't set up their own exchanges (Nather and Haberkorn, 7/22).

Politico: How Obama's Court Strategy May Help Save Obamacare
Last fall, President Barack Obama and Senate Majority Leader Harry Reid deployed the "nuclear option" to help get three liberal judges onto the D.C. Circuit appeals court. Tuesday's ruling on Obamacare is a dramatic example of why they forced the issue (Gerstein, 7/22).

The Wall Street Journal: Hospitals, Insurers Say Subsidies Rulings Further Confuse The Issue
Health-industry officials said Tuesday's dueling court rulings over federal health-law subsidies set the stage for another bout of confusion as consumers return to marketplaces this fall to shop for next year's coverage. "People are going to be coming in with more questions about these court cases," said Jason Stevenson, a spokesman for the Utah Health Policy Project, a nonprofit organization that has navigators that aid residents in enrolling on the federal exchange. "People are already asking about the long-term stability of the ACA" (Wilde Mathews, Weaver and Armour, 7/22).

The Wall Street Journal: Some Governors Face Fallout Over Health Law Ruling
The prospect of millions of people losing federal tax credits they obtained under the health law places some governors and legislators in a tough spot in the run-up to this fall's elections. Some 36 states turned over the task of running the health law's insurance exchanges to the federal government. If courts ultimately back Tuesday's decision by a federal appeals court in Washington, D.C., which held that Americans can obtain tax credits only if their state is operating its own exchange, then officials in these states may come under pressure to find ways to ensure residents keep subsidies (Radnofsky and Peters, 7/22).

The Washington Post: Federal Undercover Investigation Signs Up Fake Applicants For ACA Coverage
The results of the inquiry by the Government Accountability Office are evidence of still-imperfect work by specialists intended to assist new insurance customers as well as government contractors hired to verify that coverage and subsidies are legitimate. The GAO also pointed to flaws that linger in the marketplace's Web site, HealthCare.gov (Goldstein, 7/22).

The New York Times: Investigators Detail Missteps In Verification For Health Care
Federal investigators working undercover said Tuesday that they had been able to obtain subsidized health insurance under the Affordable Care Act using fictitious identities and false documents. The investigators, from the Government Accountability Office, said their tests indicated the Obama administration was not adequately verifying information submitted by applicants (7/22).

The Wall Street Journal: Fictitious Applicants Able To Get U.S. Health-Insurance Tax Credits
The investigation will be the focus of a House Ways and Means subcommittee hearing Wednesday on the potential for waste and fraud in the subsidies. Republicans opposed to the health law say the GAO's findings are evidence of the government's inability to verify information, which they say creates the potential for fraud and abuse (Armour, 7/22).

The Washington Post: In Response To Court Ruling, Administration Works To Ensure Contraceptive Coverage
The Obama administration said Tuesday that it is coming up with a work-around to ensure that employees of certain charities, hospitals and colleges whose leaders have religious objections to contraceptives can still get birth control through their employee health insurance plans. The administration made its plans known in a legal brief filed with the U.S. Court of Appeals for the 10th Circuit in Denver. The alternative plan, which is still being developed, is in response to a recent Supreme Court order questioning the government's current process for allowing nonprofit organizations to opt out of a requirement that their health plans cover all contraceptives that have been approved by the Food and Drug Administration (Somashekhar and Barnes, 7/22).

The Wall Street Journal: Obama Administration To Revise Part Of Contraception Rule
The Obama administration said Tuesday it will revise a compromise arrangement for religiously affiliated universities and charities that object to providing contraception in workers' health insurance plans, in response to a Supreme Court order earlier this month (Radnofsky, 7/22).

Politico: Administration To Broaden Contraception Accommodation For Religious Groups
The Obama administration will create a new option for certain religious nonprofits that object to both the Obamacare contraception mandate and the earlier administration efforts to find accommodation for them, according to a court document filed Tuesday. The brief filed in the U.S. Court of Appeals for the 10th Circuit says the administration is broadening the accommodation policy after the Supreme Court ruled that Wheaton College, a religious institution, did not have to provide contraception in employee health plans while the issue makes its way through the courts. Details were not spelled out Kenen, 7/22).

Politico: Poll: Most Say Obamacare Working
More than half of Americans believe that they or others are better off with Obamacare, a new poll shows. The CNN poll released Wednesday found that 18 percent of respondents said they or their family had benefited from the health care law, while an additional 35 percent said while they may not be better off, the lives of others have improved (McCalmont, 7/23).

The Washington Post: Obama Nominee McDonald Pledges To 'Transform' VA
President Barack Obama's choice to lead the Department of Veterans Affairs pledged Tuesday to transform the beleaguered agency, saying that "systematic failures" must be addressed. Robert McDonald cited problems with patient access to health care, transparency, accountability and integrity, among other issues (7/22).

The Wall Street Journal: VA Nominee Gets Warm Reception At Confirmation
If confirmed, Mr. McDonald would take over from Sloan Gibson, who has been acting as VA secretary since Eric Shinseki's resignation in late May following revelations of systemic problems including falsified reports about patient appointment wait times. Mr. McDonald was a paratrooper in the Army's 82nd Airborne Division before beginning a 33-year career at Procter & Gamble Co., including serving as CEO from 2009 to 2011 (Kesling and Schwarz, 7/22).

USA Today: VA Budget Request Snags Veterans Health Bill
After meeting last week, lawmakers say they won't send a stop gap veterans' health bill to the president's desk without working out details on longer term Veterans Affairs spending. The rift comes after VA acting Secretary Sloan Gibson sent Sen. Bernie Sanders, I-Vt., a memo detailing how VA would use the $17.6 billion Gibson requested last week as part of "additional resource needs" through fiscal year 2017 (Kennedy, 7/22).