CBO estimates court ruling will mean 3 million fewer people than predicted will get insurance, saving federal government $84 billion

The Congressional Budget Office estimates 3 million fewer people will get health insurance than expected before the U.S. Supreme Court's decision on the Patient Protection and Affordable Care Act. The CBO forecasts that will reduce the law's estimated cost by $84 billion over the next 10 years.

Fewer people will have coverage because some states will opt not to expand their Medicaid programs up to 138 percent the federal poverty level — an option states now have because of the decision. This runs counter to a report by the conservative American Action Forum that predicted states declining to expand Medicaid would increase the law's cost.

Sarah Kliff of The Washington Post breaks down the nonpartisan congressional agency's calculation: "The CBO estimates that for every person who does not enroll in Medicaid, and because of that goes uninsured, the federal government saves $6,000 in spending by 2022. For the average person who does not enroll in Medicaid, but instead gets subsidized coverage from the health-insurance exchange, the federal government spends $9,000 — $3,000 more than they would have had those individuals been on Medicaid."

Thus, the CBO says it will be more expensive for taxpayers if more people are on Medicaid instead of getting their insurance from the exchanges. With about 6 million fewer people than expected on Medicaid, and only about 3 million signing up for insurance exchanges, leaving 3 million more uninsured than expected, "The projected decrease in total federal spending on Medicaid is larger than the anticipated increase in total exchange subsidies," the CBO notes. Here is its graphic representation:

Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)

Useful list helps explain health care law and Supreme Court ruling

To learn more about the U.S. Supreme Court ruling on the federal health-care reform law, as well as the Affordable Care Act itself, the Detroit Free Press has put together a list of helpful websites that elucidate the issues.

The list would be helpful to reporters interested in localizing the impact of the law.

Click here for the list, compiled by reporter Pat Anstett.

Expert: Health care landscape already changed, despite what Supreme Court decision is this week

Whether or not the federal health-care reform law is upheld by the U.S. Supreme Court tomorrow, initiatives are already in place that will change the way health care is delivered, an expert said at a Lexington conference Tuesday. Gregg Nunziata, senior director at research and consulting firm The Advisory Board in Washington, D.C., "said the burgeoning number of baby boomers entering retirement, the ever-accelerating advances in technology and the increasing public health crisis that finds more and more Americans with chronic illness such as diabetes, are fundamentally changing how health care works in America," reports Mary Meehan for the Lexington Herald-Leader. As people age, they are "demanding a different kind of care, and they will be living long into their golden years," he said. When they become seniors, who already tend to cast their vote, they will become a powerful voting bloc.

Health officials are looking at ways to cut down on costs, which is necessary because "the government is the major funding source, and the major funding source is broke," Nunziata said. To cut costs, the government and insurers are looking at new ways to pay for health care. One example is the Centers for Medicaid and Medicare scoring hospitals based on their performance and paying them accordingly. "A low score could reduce payments by only 1 percent or 2 percent," Meehan reports, but that can translate to a multi-million dollar loss. "Every hospital is being judged and Washington is keeping score," he said.
Bundling payments is another method being tried, in which one flat fee covers all of the care that is provided in a procedure. "The idea would be to force more efficient and cost-effective care by encouraging cooperation," Meehan reports. (Read more)

A summary of what to expect when the Supreme Court hears arguments about the health-care reform law

How big a deal will it be when the U.S. Supreme Court hears arguments about the constitutionality of the new federal health-care reform law later this month? Big, concludes Stuart Taylor Jr. for Kaiser Health News.

"It's big enough for the justices to schedule six hours of arguments — more time than given to any case since 1966," he reports. "It's also big enough to attract more briefs than any other case in history ... and, finally, it's big enough to cause the justices to postpone until October half of the 12 cases that they were ordinarily going to hear in April in order to clear time to get started on the health care opinions."

The most pressing issues deal with the individual mandate of the law, which requires people without insurance to buy some or pay fines. The question is whether the mandate "represents an unconstitutional exercise on Congress' power to regulate commerce and to levy taxes," Taylor notes. There is also the question of state sovereignty, since the law requires states "to spend more of their own money or forfeit all of the federal Medicaid money they now receive," Taylor reports.

As for the outcome, that's the million-dollar question, Taylor writes. "It's clear that the court's four more liberal members, like almost all other liberal legal experts, will find the law constitutional in all respects. It's also clear that conservative Justice Clarence Thomas will vote to strike down much or all of the law. It's less clear what swing-voting Justice Anthony Kennedy and conservative Chief Justice John Roberts as well as Justices Antonin Scalia and Samuel Alito will do."

As for the major arguments regarding Medicaid and for and against the individual mandate, Taylor provides an excellent summary that is worth reading in its entirety. (Read more)