Private Insurance

This issue brief examines the major questions raised by King v. Burwell, explains the parties’ legal arguments, and considers the potential effects of a Supreme Court decision about the availability of the Affordable Care Act’s premium subsidies in states with a Federally-run Marketplace.

This perspective addresses how insurance markets might respond if the US Supreme Court sides with the plaintiffs in the King v. Burwell case. The case challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA).

This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.

The Halbig case, if it prevails, would have far-reaching side effects on the Affordable Care Act’s employer mandate and the functioning of the individual insurance market.

The slide show provides an initial look at the deductibles for medical care and the specific deductibles applied to prescription drugs for the plans offered in the federally facilitated and partnership Marketplaces for 2015 operating with healthcare.gov.

This was published as a Wall Street Journal Think Tank column on November 19, 2014. The Supreme Court is expected to rule next year on King v. Burwell, the lawsuit in which the federal government’s authority to provide financial assistance to people who buy insurance in federally operated insurance exchanges is being challenged…

This analysis provides an early look at premium changes for individuals in the health insurance marketplaces, created under the Affordable Care Act (ACA), in major cities across 15 states plus DC. Although premium changes vary across and within states, premium changes for 2015 in general are modest when looking at low-cost plans. On average, individuals will pay slightly less in premiums for the benchmark silver plan in 2015 than in 2014.

Analysis of 15 States and D.C. Also Finds Changes Vary Across States and Insurers Results Suggest Consumers Should Shop Carefully When Open Enrollment Begins November 15 MENLO PARK, Calif. — An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark…