Latest news with #healthcoverage
New York Times
a day ago
- Health
- New York Times
Justices Uphold Preventive Care Provision in Affordable Care Act
The Supreme Court on Friday upheld a provision of the Affordable Care Act that requires insurance companies to offer some kinds of preventive care for free. In a 6-to-3 decision, written by Justice Brett Kavanaugh, the justices ruled that a federal task force that determines which preventive health measures insurance companies must cover at no cost to the insured was constitutional. The decision appears to safeguard coverage for tens of millions of Americans who receive some free health care services, including cancer and diabetes screenings, medications to reduce heart disease and strokes, and eye ointment for newborns to prevent infections causing blindness. Justice Kavanaugh's decision was joined by two other conservatives, Chief Justice John G. Roberts Jr. and Justice Amy Coney Barrett, as well as the three liberals: Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson. The court's other three conservative justices — Clarence Thomas, Samuel A. Alito Jr., and Neil M. Gorsuch — dissented. The case is the latest lawsuit targeting the Affordable Care Act, President Barack Obama's central legislative achievement. The heath care law survived three previous major challenges at the Supreme Court, in 2012, 2015 and 2021. Chief Justice John G. Roberts Jr. cast the decisive vote to save the law in 2012, a crucial milestone in which the justices upheld the law's core mandate that most employers provide health insurance for their workers. This dispute centered on the U.S. Preventive Services Task Force, a panel of experts in the Department of Health and Human Services that recommends preventive medical services, including screenings and medications to prevent serious diseases. The task force was devised to determine preventive health services that insurance companies are required to offer for free under the Affordable Care Act. The challenge to the task force focused on the process for selecting its members. The task force is composed of 16 volunteers, all nationally recognized experts in prevention and primary care, including family medicine, geriatrics and obstetrics. Members are appointed by the secretary of Health and Human Services to serve four-year terms. At issue was whether these members are legally considered 'inferior' or 'principal' officers. Under the Constitution, 'principal officers' must be appointed by the president and confirmed by the Senate.
Yahoo
19-06-2025
- Health
- Yahoo
ICHRA adoption grows as Congress mulls codifying the coverage into law
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. A nascent form of health coverage that creates an alternative gateway for employers to offer Affordable Care Act coverage to their workers is seeing rising uptake, especially among midsize to large employers. Adoption of individual coverage health reimbursement arrangements, or ICHRA plans, rose 34% from 2024 to 2025 among employers with 50 or more full-time employees, according to a new report from trade association the HRA Council. Still, the vast majority of ICHRA users remain companies with fewer than 20 employees, most of which are providing health coverage for the first time through the arrangements, the HRA Council said. ICHRA allows employees to shop and choose between plans on the ACA exchanges and have some or all of the cost offset by their employer through a stipend. Unlike in traditional group health plans, businesses can set a fixed amount to help their workers cover healthcare costs, defraying some financial risk from offering insurance. ICHRAs were first available as a coverage option in 2020, and have grown rapidly since, according to research. However, the lack of industry-wide data collection makes it difficult to get a clear picture of adoption nationwide — market experts estimate about 500,000 to one million Americans are covered in ICHRA arrangements. About 450,000 U.S. employees and their dependents were offered ICHRA or a qualified small employer HRA for the 2025 plan year, according to the new report. However, that estimate should be taken as a floor for the larger overall market, which could encompass one million people or more, the HRA Council said. Proponents of ICHRAs argue they create an avenue for employers to offer benefits that they may not be able to otherwise afford. The share of small businesses offering health insurance has dropped significantly over the past two decades, from upwards of 47% in 2000 to about 30% in 2023, according to an analysis by health software company TakeCommand. That decline has coincided with an increase in the cost of providing employer-sponsored insurance. As for employees, ICHRAs give them freedom to choose from a variety of plans based on their needs, instead of from a smaller range of choices set up by their employer. People who enroll in ACA plans via ICHRA tend to be younger as well, a population that's usually healthier — so, their enrollment helps stabilize the risk pools and keep marketplace plans affordable, ICHRA advocates say. The coverage arrangements were expanded by President Donald Trump during his first term in rulemaking in 2019, as the president promoted policy alternatives to traditional ACA coverage. However, unlike many of the Trump administration's healthcare priorities, ICHRAs enjoy relatively bipartisan support. Democrats generally approve of ICHRAs because they add new members to the ACA marketplaces, while Republicans support the expanded choices they provide employees. Though ICHRAs are backed by regulation, the plans have never been backed by law. However, that could soon change. Republicans in Congress are currently considering codifying ICHRAs as 'Custom Health Option and Individual Care Expense' or 'CHOICE' plans. Massive reconciliation legislation passed by the House in June would also provide small employers offering ICHRAs with a tax credit. However, the Senate Finance Committee stripped the ICHRA provisions from the upper house's version of the bill released on Monday. To date, Indiana is the only state that's established a tax credit for ICHRA adoption, though a handful of others — including Ohio, Texas and Georgia — are considering the legislation that would create incentives for small employers to offer the arrangements, according to the HRA Council. The legislative uncertainty hasn't stopped private equity, venture capital and some major insurance companies from investing heavily into ICHRAs, betting that the market for the products will continue to grow. Investors have funneled millions of dollars into companies providing ICHRA administration and health benefits technology. Funding rounds this year alone include upwards of $100 million for Remodel Health, $40 million for Thatch and $20 million for Venteur, for example. Meanwhile Centene, the largest marketplace carrier in the U.S., is embarking on a full-court press to introduce more employees to its ICHRA plans. The insurer recently created a division wholly dedicated to promoting ICHRA and launched the arrangements in six states during open enrollment for 2025. 'Large-scale ICHRA adoption will be a journey of several years ... but considering the small group health insurance market covers 62 million Americans and the full commercial group market covers 170 million, we see a healthy addressable market over the long term,' Centene CEO Sarah London said during the payer's investor day in December. 'Aggressively pursuing this line of business is an easy choice,' London added. Similarly, Oscar Health has worked to expand its ICHRA membership, viewing it as a valuable alternative for smaller businesses to provide insurance as medical costs continue to rise, CEO Mark Bertolini said during an Axios event in Washington, D.C. in May. Recommended Reading Centene appoints first head of ICHRA products
CTV News
17-06-2025
- Health
- CTV News
Pregnant woman facing $20K bill to have baby in Manitoba after health-care coverage denied
A pregnant woman has been denied health coverage in Manitoba as she's still waiting for her permanent residency to be approved. Danton Unger explains.
CTV News
17-06-2025
- Health
- CTV News
Pregnant woman denied health coverage, facing $20K bill to have baby in Manitoba
Nikka Worth has been denied health coverage and is expecting to pay thousands of dollars out of pocket to have her baby in Manitoba. Uploaded June 16, 2025. (Danton Unger/CTV News Winnipeg) A pregnant woman will have to pay thousands of dollars to have her baby in Manitoba after being denied health coverage and losing an appeal. Nikka and Andrew Worth are expecting their first child, a baby girl, at the end of the month. However, the pregnancy is being paid for out of pocket after Manitoba Health denied coverage to Nikka. 'We are at the last stretch. I'm nine months pregnant and no matter what – we will be taken care of,' Nikka told CTV News. 'But it's just that we want to fight for what's fair.' As CTV News first reported, the couple met last year while Nikka was visiting Canada from the Philippines. They fell in love and got married in September. Shortly after, they found out their little family was about to grow. Read more: 'It doesn't feel right': Pregnant woman denied health coverage over provincial 'grey area' The problem is Nikka – a Filipino citizen – is currently in Canada on a visitor record – an extended visitor visa that expires in November. She has been waiting for her permanent residence to be approved. Until it is, Nikka said she's been told she is not eligible for provincial health coverage – despite the fact she's married to a Manitoba resident and the child she's carrying will be a Canadian citizen. 'Canadian health care, I think, is a real point of pride for a lot of Canadians,' said Andrew. 'This has been kind of disillusioning to myself.' Andrew said what makes the situation even more frustrating, is the fact that there are exceptions in Manitoba's rules. According to the province, the spouse of a work permit holder would be eligible for health coverage, but not the spouse of a Canadian citizen. The couple took their case to the Manitoba Health Appeal Board, but it was dismissed earlier this month. 'Unfortunately, the specific wording found within the Act… does not allow for health benefits to be extended to the spouse until they are determined to be a 'resident,'' the board said in a decision obtained by CTV News. CTV News reached out to the Health Minister for comment. A spokesperson from the provincial cabinet communications team responded by email. 'Manitoba provides insurance based on your residency status, which is determined by the federal government,' the email reads, adding if the federal government determines you are a resident, you would be covered by Manitoba. 'Manitoba stipulates that insurance is tied to residency in the Health Services Insurance Act.' All this means Nikka and Andrew will have to cover the cost of the pregnancy. They've already spent about $5,000 on prenatal care and ultrasounds. As for the actual delivery, they've been told a single night in hospital will cost nearly $6,000. If there are any complications, a night in the ICU would cost them more than $16,000. Altogether, in order to bring their baby home, Nikka and Andrew are expecting to pay more than $20,000. They say there is a silver lining, as they've been told the baby will be covered by Manitoba Health. To cover the costs, the couple have taken out a line of credit from the bank and launched a GoFundMe. 'We would just have to pay it off like you pay off a car,' Andrew said. 'We're going to have to take on debt to have a child in Canada, which seems almost ludicrous.'
Associated Press
09-06-2025
- Health
- Associated Press
Georgia's experience raises red flags for Medicaid work requirement moving through Congress
ATLANTA (AP) — Georgia's experiment with a work requirement for Medicaid offers a test of a similar mandate Republicans in Congress want to implement nationally, and advocates say the results so far should serve as a warning. Just days shy of its two-year anniversary, the Georgia Medicaid program is providing health coverage to about 7,500 low-income residents, up from 4,300 in the first year, but far fewer than the estimated 240,000 people who could qualify. The state had predicted at least 25,000 enrollees in the first year and nearly 50,000 in the second year. Applicants and beneficiaries have faced technical glitches and found it nearly impossible at times to reach staff for help, despite more than $50 million in federal and state spending on computer software and administration. The program, dubbed Georgia Pathways, had a backlog of more than 16,000 applications 14 months after its July 2023 launch, according to a renewal application Georgia submitted to the Trump administration in April. 'The data on the Pathways program speaks for itself,' said Laura Colbert, executive director of Georgians for a Healthy Future, an advocacy group that has called for a broader expansion of Medicaid without work requirements. 'There are just so many hurdles at every step of the way that it's just a really difficult program for people to enroll in and then to stay enrolled in too.' Georgia's rules A tax and spending bill backed by President Donald Trump and Republican lawmakers that passed the U.S. House in May would require many able-bodied Medicaid enrollees under 65 to show that they work, volunteer or go to school. The bill is now in the Senate, where Republicans want significant changes. Pathways requires beneficiaries to perform 80 hours a month of work, volunteer activity, schooling or vocational rehabilitation. It's the only Medicaid program in the nation with a work requirement. But Georgia recently stopped checking each month whether beneficiaries were meeting the mandate. Colbert and other advocates view that as evidence that state staff was overburdened with reviewing proof-of-work documents. Fiona Roberts, a spokeswoman for the state Department of Community Health, said Gov. Brian Kemp has mandated that state agencies 'continually seek ways to make government more efficient and accessible.' Georgia's governor defends Pathways The governor's office defended the enrollment numbers. Kemp spokesman Garrison Douglas said the early projections for Pathways were made in 2019, when the state had a much larger pool of uninsured residents who could qualify for the program. In a statement, Douglas credited the Republican governor with bringing that number down significantly through 'historic job growth,' and said the decline in uninsured residents proved 'the governor's plan to address our healthcare needs is working.' For BeShea Terry, Pathways was a 'godsend.' After going without insurance for more than a year, Terry, 51, said Pathways allowed her to get a mammogram and other screening tests. Terry touts Pathways in a video on the program's website. But in a phone interview with The Associated Press, she said she also experienced problems. Numerous times, she received erroneous messages that she hadn't uploaded proof of her work hours. Then in December, her coverage was abruptly canceled — a mistake that took months of calls to a caseworker and visits to a state office to resolve, she said. 'It's a process,' she said. 'Keep continuing to call because your health is very important.' Health advocates say many low-income Americans may not have the time or resources. They are often struggling with food and housing needs. They are also more likely to have limited access to the internet and work informal jobs that don't produce pay stubs. Republican lawmakers have promoted work requirements as a way to boost employment, but most Medicaid recipients already work, and the vast majority who don't are in school, caring for someone, or sick or disabled. Kemp's administration has defended Pathways as a way to transition people to private health care. At least 1,000 people have left the program and obtained private insurance because their income increased, according to the governor's office. After a slow start, advertising and outreach efforts for Pathways have picked up over the last year. At a job fair in Atlanta on Thursday, staff handed out information about the program at a table with mints, hand sanitizer and other swag with the Pathways' logo. A wheel that people could spin for a prize sat on one end. Since Pathways imposed the work requirement only on newly eligible state residents, no one lost coverage. The Arkansas experiment That's a contrast with Arkansas, where 18,000 people were pushed off Medicaid within the first seven months of a 2018 work mandate that applied to some existing beneficiaries. A federal judge later blocked the requirement. The bill that passed the U.S. House would likely cause an estimated 5.2 million people to lose health coverage, according to an analysis from the nonpartisan Congressional Budget Office released Wednesday. Arkansas Republican Gov. Sarah Huckabee Sanders has proposed reviving the work mandate but without requiring people to regularly report employment hours. Instead, the state would rely on existing data to determine enrollees who were not meeting goals for employment and other markers and refer those people to coaches before any decision to suspend them. Arkansas is among at least 10 states pursuing work requirements for their Medicaid programs separate from the effort in Congress. Republican state Sen. Missy Irvin said Arkansas' new initiative aims to understand who the beneficiaries are and what challenges they face. 'We want you to be able to take care of yourself and your family, your loved ones and everybody else,' Irvin said. 'How can we help you? Being a successful individual is a healthy individual.' ___ Associated Press writers Jonathan Mattise in Nashville, Tennessee, Andrew DeMillo in Little Rock, Arkansas, and Geoff Mulvihill in Philadelphia contributed to this report.
