In King v. Burwell, the United States Supreme Court had to decide on the newest challenge to the Affordable Care Act (“ACA”).  As stated in my first post, King argued that, as written, the ACA only provides support to states that set up their own exchange.  On the other hand, Burwell argued that the ACA meant to treat all health exchange markets the same, whether state-managed or not.

On July 25, 2015, the Court issued their opinion and ruled in favor of Burwell, saying that Congress meant to treat all exchanges the same.  This ruling means that those Hoosiers who received aid from the government to help purchase a health plan under the Federal Exchange will be able to keep this aid.

The 6 Justices who ruled in favor of Burwell explained that the words “established by a state” really meant to include Federal Exchanges as well.  Their 21-page ruling argued many points to help build their case, but one of their most basic points was that the ACA would fall apart if they read those words in favor of King.

King v. Burwell Broken Down

To help clarify this case, let’s think of the ACA as a 3-legged stool.  Each of the 3 legs, which are listed below, relies on the other in order hold the ACA up.  If one leg falls, however, then the entire stool will also fall over.   There are three key points, or legs, which make the ACA stand up:

1. People are given government aid (tax subsidies) to purchase a health plan.
2. The ACA says people must have insurance or pay a fee;
3. Insurance groups must accept every person in the State that applies for a plan, even if sick;

The Court said that if the ACA was read in favor of King then the ACA would collapse.  The points below make up what the Court called the “death spiral” of King’s argument.

1. No person in a federal exchange state would get any government aid in buying a plan.
2. If no one got any government aid, then many would not have to purchase any insurance at all, since the ACA says it would cost too much (over 8% of income).
3. If no one bought insurance, then insurance groups would have to a lot charge more money and many more people would lose coverage.

Conclusion

The Court said that Congress would not have meant for this “death spiral” to happen.  Congress would only pass the ACA in order for it to work; they would not have passed it if it was doomed to fail.  This is one of the many key reasons that the Court again found the ACA legal.  This was the second time the ACA has been in front of the Supreme Court, and the second time that it has been upheld.

Post by Dan Wegg

In August of 2013 a change started to take place. HealthNet staff were given the opportunity to train as Federal Navigators to help people enroll in the Market Place under the Affordable Care Act.  After many hours, weeks, and months our team all became official “Navigators”. So what does that mean?

For the first month we waited patiently for referrals (people interested in signing up for health insurance).  As a way to increase referrals, the Outreach and Enrollment Team attended staff meetings at each HealthNet Center to explain the health insurance referral process.

As navigators we meet with individuals who are in need of health care insurance for FREE. These individuals, who become our clients, can need  different types of health insurance, such as the Marketplace, Healthy Indiana Plan or Medicaid. The Navigators will meet with clients to discuss their health insurance options ANYWHERE that is convenient for them (even McDonalds)! Navigators might show up thinking they are going to do one enrollment and end up doing 3 or 4, because other people in the household need insurance as well.

As Navigators we “navigate” clients through the health insurance enrollment process.  We help clients understand what plans they qualify for and give them follow up information to check on their enrollment status. The enrollment time varies with each client. As Navigators, we have the flexibility to take extra time to meet with clients if needed since we are located throughout the community.

Where the Outreach & Enrollment Team is now is a big change from those first couple months. There are now seven certified Navigators on the Outreach and Enrollment Team and we are still growing. We have two bilingual navigators and are steadily receiving referrals. We are receiving more training on a regular basis to ensure that all clients are served regardless of their need. We have laptops, printers, shirts, jackets, and cool rolling bags to carry it all in. So if you see someone coming through the clinic looking like a pilot on a mission with a bag rolling behind them that would be a Navigator. As Navigators, we will meet you anywhere in the community that is convenient for you.

The enrollment period ends on March 31, 2014! If you or someone you know is in need of our free services please call:

317-957-2676
insurance@indyhealthnet.org
www.indyhealthnet.org 

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