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5 Questions Answered On The Legal Challenge To Obamacare Subsidies

Protestors against the Affordable Care Act rallied outside the Supreme Court in March, before arguments in the second major challenge to the law.

Protestors against the Affordable Care Act rallied outside the Supreme Court in March, before arguments in the second major challenge to the law. Jim Lo Scalzo/EPA/Landov hide caption

itoggle caption Jim Lo Scalzo/EPA/Landov

By the end of June, the Supreme Court is expected to rule on King v. Burwell, a case challenging the validity of federal tax subsidies helping millions of Americans buy health insurance if they don’t get coverage through an employer. If the court rules against the Obama administration, those subsidies could be cut off for people in about three dozen states using HealthCare.gov, the federal exchange website.

Here are answers to some frequently asked questions about the case.

1) What is this case about?

The case challenges the federal government’s ability to provide subsidies to individuals who buy health insurance on the federal marketplace, sometimes called an exchange. Those subsidies are provided to lower- and middle-income customers since the health law mandates that most people have insurance. At issue is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In the heated politics following the health law’s passage, a majority of states opted not to set up their own exchanges and instead rely on the federal government.

In regulations issued in 2012, the Internal Revenue Service said the subsidies would be available to those enrolling through both the state and the federal health insurance exchanges. Those challenging the law insist that Congress intended to limit the subsidies to state exchanges, but the Obama administration says the legislative history and other references in the law show that all exchanges are covered. Many lawmakers and staff members involved in the debate agree.

2) What happens if the court rules against the Obama administration?

According to the Department of Health and Human Services, more than 6 million people would lose their subsidies in the states where the federal government operates the health insurance exchanges.

An analysis from the Kaiser Family Foundation found that subsidized enrollees would face an average effective premium increase of 287 percent if the court rules against the administration. (Kaiser Health News is an editorially independent program of the foundation).

Florida would have the most people lose subsidies (1.3 million), worth nearly $400 million, with Texas ranked second in both categories (832,000 residents losing $206 million per month), according to the state-by-state analysis.

Even people who weren’t getting subsidies could be indirectly affected by a Supreme Court ruling against the administration. That’s because the elimination of subsidies would likely roil the insurance risk pool. Without the subsidies, many healthy people are likely to give up their coverage and that would drive up costs for those continuing to buy insurance.

Individuals in state-run exchanges and the District of Columbia would keep their federal subsidies.

3) If the Supreme Court rules against the Obama administration, when would subsidies disappear? Would those who lose subsidies still be required to buy health insurance under the law’s “individual mandate?”

Supreme Court decisions generally take effect 25 days after they are issued. That could mean subsidies would stop flowing as soon as August, assuming the decision is issued later this month, as expected.

Although the law’s requirement that individuals have health insurance would remain in effect, individuals aren’t required to purchase coverage if the lowest-priced plan in their area costs more than 8 percent of their income. So without the subsidies, many, if not most, people who had been receiving help would become exempt.

4) Will Congress fix this?

Congress could restore the subsidies by passing a bill striking the line about subsidies being available through exchanges “established by the state.” But given how many Republicans oppose the law, that sort of bipartisan cooperation is considered unlikely.

GOP lawmakers generally want to scrap the health law, but some back legislation that would keep the subsidies flowing temporarily.They would attach strings that Democrats and President BarackObama will surely object to. For example, a proposal from Sen. Ron Johnson, R-Wis., would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law’s individual and employer mandates and requirements for specific types of coverage. However, a report from the American Academy of Actuaries said some changes favored by Johnson and other Republicans, such as eliminating the individual mandate, “could threaten the viability” of the health insurance market. Republicans have not coalesced around a specific strategy.

States could consider setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. Many of those legislatures will likelynot be in session when the court rules and would have to be called back to take action.

Sylvia Burwell, the secretary of Health and Human Services, told Congress earlier this year that the administration has no authority to undo “massive damage” that would come if the court strikes down subsidies in federal exchanges. But she also has said the administration will work with states to help mitigate the effects.

5) Is this the last legal hurdle the health law will face?

No, but it’s probably the most significant one left. In other suits,House Republicans are challenging the money used for the law’s subsidies, saying it was not properly approved by Congress and that the administration did not have the power to delay the law’srequirements that larger employers provide coverage or face a penalty. Additional legal challenges include several dozen cases still pending over birth control coverage.

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5 Questions Answered On The Legal Challenge To Obamacare Subsidies

Protestors against the Affordable Care Act rallied outside the Supreme Court in March, before arguments in the second major challenge to the law.

Protestors against the Affordable Care Act rallied outside the Supreme Court in March, before arguments in the second major challenge to the law. Jim Lo Scalzo/EPA/Landov hide caption

itoggle caption Jim Lo Scalzo/EPA/Landov

By the end of June, the Supreme Court is expected to rule on King v. Burwell, a case challenging the validity of federal tax subsidies helping millions of Americans buy health insurance if they don’t get coverage through an employer. If the court rules against the Obama administration, those subsidies could be cut off for people in about three dozen states using HealthCare.gov, the federal exchange website.

Here are answers to some frequently asked questions about the case.

1) What is this case about?

The case challenges the federal government’s ability to provide subsidies to individuals who buy health insurance on the federal marketplace, sometimes called an exchange. Those subsidies are provided to lower- and middle-income customers since the health law mandates that most people have insurance. At issue is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In the heated politics following the health law’s passage, a majority of states opted not to set up their own exchanges and instead rely on the federal government.

In regulations issued in 2012, the Internal Revenue Service said the subsidies would be available to those enrolling through both the state and the federal health insurance exchanges. Those challenging the law insist that Congress intended to limit the subsidies to state exchanges, but the Obama administration says the legislative history and other references in the law show that all exchanges are covered. Many lawmakers and staff members involved in the debate agree.

2) What happens if the court rules against the Obama administration?

According to the Department of Health and Human Services, more than 6 million people would lose their subsidies in the states where the federal government operates the health insurance exchanges.

An analysis from the Kaiser Family Foundation found that subsidized enrollees would face an average effective premium increase of 287 percent if the court rules against the administration. (Kaiser Health News is an editorially independent program of the foundation).

Florida would have the most people lose subsidies (1.3 million), worth nearly $400 million, with Texas ranked second in both categories (832,000 residents losing $206 million per month), according to the state-by-state analysis.

Even people who weren’t getting subsidies could be indirectly affected by a Supreme Court ruling against the administration. That’s because the elimination of subsidies would likely roil the insurance risk pool. Without the subsidies, many healthy people are likely to give up their coverage and that would drive up costs for those continuing to buy insurance.

Individuals in state-run exchanges and the District of Columbia would keep their federal subsidies.

3) If the Supreme Court rules against the Obama administration, when would subsidies disappear? Would those who lose subsidies still be required to buy health insurance under the law’s “individual mandate?”

Supreme Court decisions generally take effect 25 days after they are issued. That could mean subsidies would stop flowing as soon as August, assuming the decision is issued later this month, as expected.

Although the law’s requirement that individuals have health insurance would remain in effect, individuals aren’t required to purchase coverage if the lowest-priced plan in their area costs more than 8 percent of their income. So without the subsidies, many, if not most, people who had been receiving help would become exempt.

4) Will Congress fix this?

Congress could restore the subsidies by passing a bill striking the line about subsidies being available through exchanges “established by the state.” But given how many Republicans oppose the law, that sort of bipartisan cooperation is considered unlikely.

GOP lawmakers generally want to scrap the health law, but some back legislation that would keep the subsidies flowing temporarily.They would attach strings that Democrats and President BarackObama will surely object to. For example, a proposal from Sen. Ron Johnson, R-Wis., would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law’s individual and employer mandates and requirements for specific types of coverage. However, a report from the American Academy of Actuaries said some changes favored by Johnson and other Republicans, such as eliminating the individual mandate, “could threaten the viability” of the health insurance market. Republicans have not coalesced around a specific strategy.

States could consider setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. Many of those legislatures will likelynot be in session when the court rules and would have to be called back to take action.

Sylvia Burwell, the secretary of Health and Human Services, told Congress earlier this year that the administration has no authority to undo “massive damage” that would come if the court strikes down subsidies in federal exchanges. But she also has said the administration will work with states to help mitigate the effects.

5) Is this the last legal hurdle the health law will face?

No, but it’s probably the most significant one left. In other suits,House Republicans are challenging the money used for the law’s subsidies, saying it was not properly approved by Congress and that the administration did not have the power to delay the law’srequirements that larger employers provide coverage or face a penalty. Additional legal challenges include several dozen cases still pending over birth control coverage.

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U.S. Women's World Cup Opens Tonight Against Australia

United States women's soccer players (from left) Hope Solo, Megan Rapinoe and Abby Wambach take questions during the U.S. women's national team World Cup media day last month in New York.

United States women’s soccer players (from left) Hope Solo, Megan Rapinoe and Abby Wambach take questions during the U.S. women’s national team World Cup media day last month in New York. Bebeto Matthews/AP hide caption

itoggle caption Bebeto Matthews/AP

The United States women’s national soccer team begins its quest for a third World Cup championship today when the U.S. takes on Australia. It’s the first game for both teams and should be one of the best in the tournament so far. The U.S. is ranked second in the world and Australia is 10th.

Hundreds of rabid U.S. fans from the group American Outlaws and thousands of others wearing red, white and blue are expected to pack the stadium for the Group D opener in Winnipeg, Canada. One of the biggest questions is the health of the U.S. squad. The team has been hobbled by injuries to several key players, including forward Alex Morgan and midfielder Megan Rapinoe. Still, the U.S. team is deep and the coaches have tinkered with various starting lineups over the past few games.

Those aren’t the only issues swirling around the team. At a pre-game news conference on Sunday, questions surfaced again about star goalkeeper Hope Solo. Solo is widely considered the best goalkeeper in the world and, arguably, of all-time. But she’s been dogged by brushes with the law, and over the years some teammates have been frustrated by the distractions. U.S. head coach Jill Ellis says she’s standing by Solo despite media reports that surfaced this weekend detailing the goalkeeper’s demeanor during a domestic violence arrest last summer.

“That was a long time ago. We’ve moved on,” Ellis told reporters.

Even if the latest drama in the Solo-saga spills onto the field, Australia won’t have much of an upper-hand. The Americans have played the Aussies 24 times — and never lost (beating them 22 times and tying twice). One reason for that success is forward Abby Wambach. She’s scored the most goals (182) of any woman in international play.

Another player to watch on the U.S. squad is Julie Johnston who is playing in her first World Cup. At 23, she’s the second-youngest person on the team and has appeared in only nine international games. But as my colleague Shereen Marisol Meraji reported today on Morning Edition, Johnston is a player to watch:

“A couple of injuries on the back line of the U.S. National Team cleared room for Johnston to show off ahead of the tournament. As a defender she scored three goals. She hasn’t always played defense – she was a midfielder and forward at Santa Clara University.

“In an NPR interview, she said ‘I loved being an attacker so much, it wasn’t so much that I didn’t think defending was fun or anything like that. It’s just that growing up, all I knew was attack, attack, attack.’ It’s that drive that her fans can’t get enough of — U.S. team coach Jill Ellis calls her a warrior. And she brings that fire to the defensive line, sometimes going on 60-yard runs up the field.”

The last time the U.S. won the World Cup was 1999. Many believe that if the U.S. doesn’t win this year, it will be a disappointment. The march to a third victory begins tonight at 7:30 p.m. ET. You can watch it on Fox Sports 1.

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Spain's Air Traffic Controllers Go On Strike; Pay Isn't The Big Complaint

Two Spanish Iberia airplanes stand on the the tarmac at the Adolfo Suarez Madrid-Barajas airport in Madrid Monday. Spanish air traffic controllers started a four-day partial strike that could affect some 5,300 flights.

Two Spanish Iberia airplanes stand on the the tarmac at the Adolfo Suarez Madrid-Barajas airport in Madrid Monday. Spanish air traffic controllers started a four-day partial strike that could affect some 5,300 flights. J.J. Guillen/EPA /LANDOV hide caption

itoggle caption J.J. Guillen/EPA /LANDOV

Despite being among the best-paid public workers in Spain, the country’s air traffic controllers started a strike Monday. Their union is protesting the punishment of dozens of controllers who were involved in a 2010 strike that sparked a national state of alarm.

“Some 5,300 flights to and from Spain are expected to be affected,” NPR’s Lauren Frayer reports from Madrid. “This is the first of four days of work stoppage by Spain’s air traffic controllers.”

Lauren adds, “But the workers get little sympathy in Spain. They’re among the best-paid civil servants, with average salaries almost half a million dollars a year.”

The 2010 strike created chaos for travelers in Spain and beyond; Enaire, the company that administers Spain’s commercial air navigation, recently ordered dozens of controllers to be suspended for a month without pay over the incident.

Unlike the action five years ago, today’s strike was announced well in advance; it also coincides with the start of the busy summertime tourist season.

So far, only minimal delays have been reported, according to Europa Press. The government has set a minimum staffing rate of at least 70 percent for the strike, which will occur in eight two-hour windows over the course of four days.

Spain’s air traffic controller union, the USCA, has set the strike for June 8 10, 12 and 14.

In addition to arguments over the punishments for workers over the 2010 strike, the union and Enaire have recently been in a dispute over attempts to boost the number of work hours and cut the pay of Spain’s air traffic controllers.

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Julie Johnson: Player To Watch On U.S. Women's World Cup Team

Julie Johnston, 23, didn’t make the World Cup qualifier, but is now a starting defender on the team. She protects the goal, but is known to go on 60 yard runs from the back line to score goals.

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Wawrinka Upsets Djokovic At French Open Final

Stan Wawrinka thwarted Novak Djokovic’s bid to complete a career Grand Slam. Serena Williams won her third French Open title. Renee Montagne talks to freelance tennis writer Courtney Nguyen.

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The Forces Behind The Decline Of For-Profit Colleges

Dragons XXX

Dragons XXX LA Johnson/NPR hide caption

itoggle caption LA Johnson/NPR

Barring a last-minute legal decision, as of July 1, the nation’s for-profit colleges are going to be subject to a new Education Department rule known as gainful employment. That is: Do students end up earning enough to pay off their loans?

A trade group of career colleges is suing to stop the rule, but this is far from the only monkey on the sector’s back. As recently as 2010, these schools enrolled one in nine college students. Today, some are shutting down, cutting back, tanking in the stock market, even going bankrupt. The bellwether was the giant Corinthian Colleges a year ago, but many others are in trouble as well. Even the University of Phoenix, which five years ago had 460,000 students, has seen that number fall by half.

Part of this is thanks to government crackdowns. The Consumer Financial Protection Bureau, formed in the wake of the 2008 financial crisis, is the new watchdog in town. And it has taken a particular interest in for-profits that market student loans directly to their own students, sometimes in misleading and aggressive ways.

Officials at the bureau sued Corinthian Colleges, alleging predatory lending and illegal debt collection tactics, and in the wake of the Corinthian shutdown they arranged for $480 million in private student loans to be forgiven.

Student activists have also been vocal in criticizing the industry and demanding relief from their loans.

But government enforcement and political debate is not the only reason that these colleges are having problems. Market forces should be considered too.

In the 1990s and early 2000s, if you were a working adult who needed flexibility, in most parts of the country, your best — or maybe your only option — for finishing your degree was probably an online program from a for-profit college. It was hard to ride public transit or turn on a TV during the day without seeing an ad for one of the schools, and they were sophisticated in online advertising as well.

Today, public institutions like Arizona State University and nonprofits like Southern New Hampshire University and Western Governors University have gotten into the game. They are trying to meet the needs of this same student population by offering online, go-at-your-own-pace programs.

They are enrolling tens of thousands of students. And they are partnering with employers, such as Starbucks with ASU, to defray tuition costs. Their tuition tends to be lower in any case than what the for-profits charge.

“I think the market’s been educated,” says Paul LeBlanc, the president of Southern New Hampshire. “People used to not be aware of the difference between for-profits and nonprofits.”

Seven years ago he began the process of building a large online program at his regionally accredited private college. Today it enrolls 22,500 students and has partnerships with 78 employers. Recently Anthem, the health insurer, agreed to offer SNHU’s College for America bachelor’s program to employees for free.

About half of the company’s 55,000 workers — call center employees, administrative assistants, and the like — may be eligible.

So what is the upshot for students and prospective students here?

There are still hundreds of thousands, if not millions, of current and former for-profit college students from over the last two decades who are saddled with high loan debt and degrees of potentially dubious value.

The Education Department says it’s working to develop a process for providing debt relief to defrauded borrowers, including many at Corinthian. But critics say that these processes are too onerous and too slow.

At the same time, with the gainful employment rule, observers say the Department of Education is opening a can of worms. Right now, the rule applies only to for-profits. But there are a lot of public and nonprofit privates out there too that may be graduating too few students and leaving them with loans that are too high.

For example, across the country the graduation rate at public community colleges is still just one in five. Nor have the new big online institutions furnished hard evidence about the life experiences or employment prospects of their graduates.

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Federal Judge To Assess Damages In Chinese Drywall Lawsuit

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Residents are still fighting Chinese manufacturers who sold bad drywall that went into the post-Katrina rebuilding effort. On Tuesday their case picks up again in a New Orleans federal courtroom.

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Cavaliers Even Up NBA Finals, Beating Warriors In Overtime

LeBron James celebrates the Cleveland Cavaliers' 95 to 93 win over the Golden State Warriors in overtime during Game 2 of the 2015 NBA Finals in Oakland, California.

LeBron James celebrates the Cleveland Cavaliers’ 95 to 93 win over the Golden State Warriors in overtime during Game 2 of the 2015 NBA Finals in Oakland, California. Ezra Shaw/Getty hide caption

itoggle caption Ezra Shaw/Getty

The Cleveland Cavaliers have evened the NBA Finals at one game apiece. Sunday night in Oakland, the Cavs won a thrilling game, beating the Golden State Warriors 95-93 in overtime. Both finals games have gone to an extra period.

Cleveland led by 11 points with a little over three minutes left in regulation, but the Warriors stormed back and tied the game with just seconds left to send it into overtime.

Cleveland took the lead quickly in the extra period. The Warriors fought back, but Cavs guard Matthew Dellavedova’s two free throws put Cleveland ahead for good.

The Cavs, once again, were led by 4-time league MVP Lebron James. He had a coveted triple double — with 39 points, 16 rebounds and 11 assists.

But equal if not more credit should go to Dellavedova. He started the game in place of injured all-star point guard Kyrie Irving, who broke his kneecap in game 1.

Dellavedova’s harassing defense on Golden State star point guard Steph Curry contributed to one of Curry’s worst nights of the season. He only sank 5 of 23 shots, and he was 2 for 15 from three point range — an abysmal percentage for the league’s best long-range shooter.

The teams now head to Cleveland for Game 3 on Tuesday

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What Makes Algorithms Go Awry?

By clicking “Like” and commenting on Facebook posts, users signal the social network’s algorithm that they care about something. That in turn helps influence what they see later. Algorithms like that happen all over the web — and the programs can reflect human biases. iStockphoto hide caption

itoggle caption iStockphoto

Like it or not, much of what we encounter online is mediated by computer-run algorithms — complex formulas that help determine our Facebook feeds, Netflix recommendations, Spotify playlists or Google ads.

But algorithms, like humans, can make mistakes. Last month, users found the photo-sharing site Flickr’s new image-recognition technology was labeling dark-skinned people as “apes” and auto-tagging photos of Nazi concentration camps as “jungle gym” and “sport.”

How does this happen? Zeynep Tufekci, an assistant professor at the University of North Carolina at Chapel Hill’s School of Information and Library Science, tells NPR’s Arun Rath that biases can enter algorithms in various ways — not just intentionally.

“More often,” she says, “they come through the complexity of the program and the limits of the data they have. And if there are some imperfections in your data — and there always [are] — that’s going to be reflected as a bias in your system.”


Interview Highlights

On bias in the Facebook “environment”

These systems have very limited input capacity. So for example, on Facebook, which is most people’s experience with an algorithm, the only thing you can do to signal to the algorithm that you care about something is to either click on “Like” or to comment on it. The algorithm, by forcing me to only “Like” something, it’s creating an environment — to be honest, my Facebook is full of babies and engagements and happy vacations, which I don’t mind. I mean, I like that. When I see it, I click on “Like” — and then Facebook shows me more babies.

And it doesn’t show me the desperate, sad news that I also care about a lot, that might be coming from a friend who doesn’t have “likable” news.

How biases creep into computer code

One, they can be programmed in directly, but I think that’s rare. I don’t think programmers sit around thinking, you know, “Let us make life hard for a certain group” or not. More often, they come through the complexity of the program and the limits of the data they have. And if there are some imperfections in your data — and there always [are] — that’s going to be reflected as a bias in your system.

Sometimes [biases] can come in through the confusing complexity. A modern program can be so multi-branch that no one person has all the scenarios in their head.

For example, increasingly, hiring is being done by algorithms. And an algorithm that looks at your social media output can figure out fairly reliably if you are likely to have a depressive episode in the next six months — before you’ve exhibited any clinical signs. So it’s completely possible for a hiring algorithm to discriminate and not hire people who might be in that category.

It’s also possible that the programmers and the hiring committee [have] no idea that’s what’s going on. All they know is, well, maybe we’ll have lower turnover. They can test that. So there’s these subtle but crucial biases that can creep into these systems that we need to talk about.

How to limit human bias in computer programs

We can test it under many different scenarios. We can look at the results and see if there’s discrimination patterns. In the same way that we try to judge decision-making in many fields, when the decision making is done by humans, we should apply a similar critical lens — but with a computational bent to it, too.

The fear I have is that every time this is talked about, people talk about it as if it’s math or physics, therefore some natural, neutral world. And they’re programs! They’re complex programs. They’re not like laws of physics or laws of nature. They’re created by us. We should look into what they do and not let them do everything. We should make those decisions explicitly.

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