Supreme Court of the United States Upholds the Affordable Care Act’s Tax Credit Provision

In anticipation of a decision on the King v. Burwell case re: the Affordable Care Act’s (ACA) Tax Credit Provision, Northeast Delta Dental had completed scenario planning and I had speculated on the outcome in two earlier blogs.  Well, on Thursday, the Supreme Court of the United States (SCOTUS), released its decision on the applicability of the ACA’s tax credit provisions to people purchasing plans on the Federally Facilitated Marketplace and decided that yes, they do.  The government won.  The vote was 6-3 with Roberts, Kennedy, Ginsburg, Breyer, Sotomayor and Kagan voting in the affirmative (Roberts delivered the decision); Scalia wrote the dissenting opinion in which Thomas and Alito joined. This means life goes on for Northeast Delta Dental and oral health coverage for citizens who purchased our coverage on the New Hampshire and Maine exchanges, but more importantly, it solidifies the medical coverage for about six million United States citizens whose medical coverage is tied to these tax credits.

It’s an easy read – and not just by SCOTUS’ decision standards- so give it a go:  King v. Burwell decision.

Some excerpts of the SCOTUS’ King v. Burwell decision, released June 25, 2015:

“The issue in this case is whether the Act’s tax credits are available in States that have a Federal Exchange rather than a State Exchange. The Act initially provides that tax credits “shall be allowed” for any “applicable taxpayer.” 26 U. S. C. §36B(a). The Act then provides that the amount of the tax credit depends in part on whether the taxpayer has enrolled in an insurance plan through “an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act…”

“The parties dispute whether Section 36B authorizes tax credits for individuals who enroll in an insurance plan through a Federal Exchange. Petitioners argue that a Federal Exchange is not “an Exchange established by the State under [42 U. S. C. §18031],” and that the IRS Rule therefore contradicts Section 36B. [citation omitted] The Government responds that the IRS Rule is lawful because the phrase “an Exchange established by the State under [42 U. S. C. §18031]” should be read to include Federal Exchanges.”

“In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” Marbury v. Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan. Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt. The judgment of the United States Court of Appeals for the Fourth Circuit is Affirmed.          

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Father’s Day and the Northeast Delta Dental Mount Washington Road Race

First and foremost, I hope all Dads had a wonderful and peaceful Father’s Day on Sunday, as I did as you can see in the first photo. Dads and Moms are often our first role models or mentors; my Dad who died a few years ago was my role model for hard work and for giving back to the community. They didn’t call it social responsibility or “Paying in Forward” or community outreach back then but I remember at his wake that many heads of not for profits (YMCAs; Lions Club to name two) mentioned to me how my Dad was instrumental in making their organization successful via work on capital campaigns and other volunteer assignments.   I say this because not all young people may have a Mom or Dad as a role model, so I always say look for an opportunity to be a mentor — you can positively influence a young person’s life.

Tom_Fathers DayTom_Mount_Washington_Race

As for the Northeast Delta Dental Mount Washington Road Race, I didn’t quite make my time goal that I referenced in my last blog, but I did make two secondary goals. The two goals were completing the grueling 7.6 mile up the mountain race (Grade average 12%, extended 18%) in less than two hours and to do it without any walking.   (Note: many racers who finished ahead of me do speed walk, and a few speed walkers passed me as I was “running,” but for me, keeping running form, albeit very slow, works better for me).

With 6/10ths of a mile to go (see second photo; that’s me with the green shirt) I had just under 15 minutes to get in under two hours, which seems reasonable except the last portion of the race is extremely challenging, including the final 100 yards which is at a 22% grade. Well, it all worked out as I crossed the finish line at 1:57:11. Also, while tempted to walk a few times, I did keep a running/jogging form.

In preparing for the Northeast Delta Dental Mountain Washington Road Race, I did a lot of cross training (cross fit; spin) and stopped eating junk food and ice cream. But I did make a fun promise to myself: if I made it to the top in under two hours without any walking, I would treat myself to a soft serve vanilla ice cream at the Dairy Queen that sits near the traffic light as you make your way to Jackson or Story Land, close to the hotels where runners stay for the Northeast Delta Dental Mount Washington Road Race.   If you have ever been to North Conway or Story Land, or cross country ski in Jackson, you know this Dairy Queen. Thus, you see me in the third photo with a smile as I embark on eating an ice cream, double fisted, for the first time in a long time.   So, yes: train hard, work hard like my Dad taught me, but also have fun and treat yourself occasionally when you accomplish your compelling goal.


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Only one hill…

The Northeast Delta Dental Mount Washington Road Race is this Saturday, June 20, and I’m ready to run it for the fifth time! My personal best is 1:50:51 (in 2011) for the 7.6 mile run and I’m hoping to better that result with a goal of 1:45.

At 9 am, more than 1,000 runners will tackle the Mt. Washington Auto Road with an average 12-percent grade.  The final 70 yards are a challenging 22-percent grade and runners will eventually finish at the 6,288 foot summit, and will be “on top of the world,” at the highest peak in the northeast.

Northeast Delta Dental is proud to be the title sponsor of this intense athletic challenge.  Our support of this race is in harmony with our mission to advance the oral health and overall wellness of our customers and the general public as half of the race proceeds will benefit Coos County Family Health Services’ oral health programs.

This year, four runners will be inducted into the Northeast Delta Dental Mount Washington Road Race Hall of Fame including Eric Blake of West Hartford, Conn.; Eleonora Mendonca of Cape Cod, Mass.; Eric Morse of Berlin, Vt.; and Peter Watson (in memoriam) of Cape Ann, Mass.

You’ll see many local athletes there, including professional triathletes, Amber Ferreira of Concord, and Ryan Kelly of Bow.

Hope to see you there this weekend or at races in the future! Remember, there’s only one hill.

Mount Washington Road Race

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King v. Burwell to be decided soon

Supreme Court of The United States (SCOTUS) will control the fate of the Affordable Care Act (ACA)

Whether you agree or disagree with the principles of the ACA, it is evident that a significant amount of human and financial capital has been spent on addressing the flaws in the bill. The section of the ACA being litigated in King v. Burwell was first called into question in 2010. Congress and the Obama administration have yet to make any progress since then in addressing these issues. However, the Secretary of Health and Human Services and the Internal Revenue Service have made administrative decisions that have now forced the SCOTUS to hear the case. They will render their decision this month.

How the court is expected to rule:

I believe that Justices Kagan, Ginsburg, Sotomayor, and Breyer will side with the government and uphold a tax subsidy for individuals who have any exchange-based health coverage. I expect that Justices Alito and Thomas will side with King and strike down these tax subsidies. Therefore, the decision will come down to Justices Kennedy, Scalia and Roberts. I will speculate on each Justice’s ruling below:

Justice Kennedy

In the case of King v. Burwell, Justice Kennedy previously questioned attorneys regarding whether the federal government had coerced the states into participating in health care exchanges. This same argument was used to strike down the Medicaid expansion in 2012. The difference in this case is that the federal government would not be withholding funds from the states, but rather from individuals. Therefore, it is unlikely Justice Kennedy would use this rationale in making his decision regarding King v. Burwell. Most experts believe that Justice Kennedy could rule either way.

Justice Scalia

Contemporary societal values and congressional intent will likely influence Justice Scalia’s decision. Therefore, he may determine that the tax subsidies are constitutional as written since they are vital to the success of the ACA. Although Congress may not have intended to coerce the states, it has been reported that one of the architects (i.e., a consultant) of the ACA said on several occasions that the verbiage was specifically written to coerce states to set up their own exchanges to enable individuals to receive tax subsidies. However, in order to rule that the tax subsidies are unconstitutional, Justice Scalia would have to believe that it was actually Congress’ intent to coerce the states, not just the architects of the bill. Most likely, Justice Scalia’s opinion will be determined based on the actual language used in the ACA.

Chief Justice Roberts

Chief Justice Roberts ruled that the “individual mandate” case in 2012 could be heard by SCOTUS because the repercussions for individuals without health coverage were referred to as a “penalty” paid to the IRS as opposed to a “tax.” However, in this same 2012 ACA case, Chief Justice Roberts wrote for the majority opinion that the individual mandate was actually a tax, and Congress has the sole right to tax. Therefore, the individual mandate was upheld as constitutional. Based on this previous ruling in 2012, there is no sure way to determine which way he will decide in the case of King v. Burwell.

In the next few days or weeks we will find out how this Supreme Court will rule.

It will certainly be interesting to see how Justices Kennedy, Scalia and Roberts rule.

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The Affordable Care Act in front of the Supreme Court of The United States again

The latest constitutional question related to the Affordable Care Act was addressed on March 4, 2015 when the United State Supreme Court heard oral arguments in the case of King vs. Burwell. This decision could affect 38,000 enrollees in New Hampshire and 67,000 enrollees in Maine but none in Vermont. This case calls into question just part of the law and not the Affordable Care Act in its entirety.

If the court agrees with the plaintiff, residents of New Hampshire and Maine would not be eligible for tax subsidies through Health Care Exchanges because they are operated by the federal government rather than the state. Since Vermont is a state run exchange Vermont residents would not be affected by the outcome.

The controversy all comes down a single line in a very lengthy law stating, people could receive a tax subsidy for health coverage if they enroll “through an exchange established by the State.” Only 14 states qualify by that narrow definition, Vermont being one of them. However New Hampshire and Maine do not. The Internal Revenue Service ruled that the law applies to each exchange regardless of whether the exchange is set up by a state or the federal government.

Attorneys for King argue that Congress intentionally put this in the law as a carrot to encourage states to establish their own state run Health Exchanges. The attorneys arguing for the government agree with the Internal Revenue Service’s interpretation, in that the law applies to all of the state Health Care Exchanges regardless of whether they are state-based, federally-facilitated partnership, or federally-supported state-based exchange.

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Challenge yourself to improve your oral health

This month was National Children’s Dental Health month and with a busy spring ahead of us, I wanted to take the time to stress the importance of oral health. Unfortunately, childhood caries (otherwise known as tooth decay), is a health crisis in the United States – in fact, it’s the most common chronic disease of children from ages six to eleven and adolescents from ages twelve to nineteen*. The good news is that tooth decay is preventable at any age. By brushing twice a day and flossing once a day, and making smart food and beverage choices, you can make a world of difference in you and your child’s oral and overall health. To learn more about how you can improve your oral and overall health, view our Life Stages of Oral Health resources here.

To promote healthy dental habits, we are once again, partnering with the New Hampshire Fisher Cats to present the Oral Health Challenge. The program encourages children to brush twice and floss once daily during a one-week period to earn free tickets for a 2015 New Hampshire Fisher Cats game at Northeast Delta Dental Stadium in Manchester. To participate, children must be 12 years of age of younger; brush twice and floss once daily for seven consecutive days; and complete the downloadable form here.

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New Year, New Ventures

Fourth quarter of 2014 has come and gone and because of some important initiatives here at Northeast Delta Dental, it went by fast. I truly can’t believe January of 2015 is halfway over. We had a great year at Northeast Delta Dental and the New Year looks bright. I hope that your New Year is off to a great start, too.

For starters, we successfully entered the Health Insurance Marketplaces created by the federal Affordable Care Act in Maine and New Hampshire and Vermont’s private exchange, Vermont Health Connect. We have nearly 3,500 subscribers and more than 6,500 covered lives through these exchanges. In keeping with our mission to improve access to oral health care and education, it was critical that we offered dental plans on these exchanges. We also offer coverage through our private exchange,

This past year we entered a partnership with medical carrier Maine Community Health Options (MCHO) which presents new options for New Hampshire’s consumers.  The consumer operated and oriented health insurance plan recently expanded to offer medical plans in New Hampshire for 2015 after capturing more than 83% of the enrollees on the federally facilitated health insurance marketplace in 2014.  Northeast Delta Dental is handling the claims processing for the pediatric dental benefit MCHO is including in three of its medical plans being offered on

Also in 2014, the Northeast Delta Dental Foundation supported a number of oral health initiatives and projects in Maine, New Hampshire, and Vermont. These included the New York University Oral Health Outreach program in Washington County (Machias, Maine); New Hampshire Oral Health Plan; Red Logan Dental Clinic (White River Junction, Vermont); the Vermont State Education Loan Repayment Program for dentists (AHEC); the University of Vermont Dental Residency Program at the University of Vermont Medical Center (formerly Fletcher Allen Health Care); Vermont Head Start Early Head Start Tooth Tutor Program; and the Finance Authority of Maine (FAME) Dentist Loan Repayment Program.

We are proud to partner with these organizations to increase access to, and the quality of, oral health care and education in Maine, New Hampshire, and Vermont. I will continue to keep you all informed of new developments here at Northeast Delta Dental.

Wishing you a happy and healthy New Year!

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