Once again, the Supreme Court will decide whether the Affordable Care Act lives or dies.

Defying expectations, the court announced Friday it has agreed to hear – during this term –  a case that challenges the heart of the law: subsidies to help people pay their insurance premiums. In about three dozen states, the federal government runs the online marketplaces where individuals can find health plans.

At issue is a phrase in the law stipulating that subsidies to help those with incomes under 400 percent of poverty are available only in “exchanges established by a state.” The authors of the law argue that the rest of the statute makes it clear that subsidies are available not only in state-run exchanges, but in those where the federal government is doing the work of the state.

When the law was written, most people expected that states would want to run their own exchanges. It was a surprise when most opted to let the federal government do it instead.

A decision to strike down the subsidies in federally-run exchange states could end up making insurance unaffordable for millions of people and threaten the viability of the law’s entire health insurance program.

In a rare Friday afternoon notice following their closed-door conference, the justices noted with no further comment that they have agreed to hear King v. Burwell. That is the case in which a three-judge Appeals Court panel in Richmond ruled unanimously that Congress did intend to allow subsidies to be available nationwide.

That same day, a panel  in the District of Columbia Court of Appeals ruled 2-1 the opposite way. But that case, Halbig v. Burwell, was vacated when the full court agreed to rehear the case. That is scheduled for December.  Because there are not yet contradictory decisions by appeals courts, most observers thought the Supreme Court would at least wait until the lower courts were finished considering the case before weighing in.

“We are disappointed that at least four Justices decided to hear this case despite the lack of a circuit split and while this issue is still being actively litigated in the lower courts,” said Doug Kendall of the Constitutional Accountability Center, which is representing the members of Congress who wrote the law. “But we remain very confident that the Court will ultimately find that both the text of the ACA and the intentions of Congress mandate a ruling for the federal government.”

Those who argue that the federal subsidies are illegal, however, say time is of the essence.

“In King there is a serious argument that it would be better to resolve the underlying question of statutory interpretation sooner rather than later,” wrote Jonathan Adler, a law professor at Case Western University, in The Washington Post last week. “The resolution of this litigation will alter the calculus for many political and private actors considering how to respond to the PPACA, and the statute contains various deadlines and timeframes that may become harder to navigate the longer this litigation drags on.”

The White House said in a statement that the lawsuits challenging the language would not stand in the way of the law’s implementation. “This lawsuit reflects just another partisan attempt to undermine the Affordable Care Act and to strip millions of American families of tax credits that Congress intended for them to have,” the White House statement said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

After strong pushback from ALS patients and lawmakers, the government has reversed a decision that could have blocked Medicare reimbursement for certain speech generation devices beginning Dec. 1.

The decision announced Thursday by the Centers for Medicare & Medicaid Services means Medicare will continue a longstanding policy to cover most of the cost of devices that can be upgraded by patients at their own expense.

Speech generation equipment is critically important to patients with ALS and similar neurodegenerative disorders – conditions that limit their capacity for movement and speech. Patients, since 2001, have had the option of paying themselves for upgrades, including those that enable them to connect to the Internet and open doors or adjust room temperatures. But in February, Medicare announced a policy interpretation that would have precluded coverage of the cost of upgradable devices.

Patients with ALS, amyotrophic lateral sclerosis, and their advocates strongly objected. On Thursday, the government backed off.

In reversing course, CMS “emphasized the importance of technology and how critical it really is, at this point, I think, to not make a new policy immediately,” said Kathleen Holt, associate director at the Center for Medicare Advocacy, which advocates for Medicare beneficiaries.

Advocates are still worried about the future. Medicare intends to update its National Coverage Determination – the federal rule that determines what Medicare can cover – so as to incorporate technological advances that weren’t around in 2001. Public comment will be solicited, and a revised rule is likely by July 2015, said Patrick Wildman, director of public policy at the ALS Association.

That means “there’s still the uncertainty of what is the coverage policy going to look like, come July 2015,” Wildman said. “Will it be something different?”

“One of the things I would say to beneficiaries is, we’ve got a temporary reprieve on this, but don’t stop fighting,” Holt said.

CMS did not immediately respond to requests for comment.

ALS patients had aggressive support from Congress on the question of speech generating devices. Some  200 members signed a bipartisan “Dear Colleague” letter in September, asking CMS to respond to patients’ concerns. On Tuesday, Rep. Tim Murphy, R-Pa., sent the agency another letter.

The letters also expressed concern about a recent pattern of Medicare denials of coverage of eye-tracking technology, which uses eye movements to generate commands for the speech devices. Those claim denials are routinely reversed on appeal, but the appeals process can take months.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The percentage of babies born prematurely fell to 11.4 percent in 2013, its lowest level in 17 years, according to an annual March of Dimes report released this week. While many factors contributed to the decline, officials say the health law’s expansion of Medicaid to adults with incomes up to 138 percent of the federal poverty level has played a role.

Going forward, other health law provisions will likely contribute to further reductions in preterm births, defined as live births at less than 37 full weeks, women’s health advocates suggest.

“This decline can’t be attributed to the marketplaces, which haven’t even had a full year of enrollment yet,” says Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes. “But there were places that did the Medicaid expansion earlier,” after the law passed in 2010.

So far, 27 states and the District of Columbia have decided to expand their state Medicaid programs to adults as permitted under the health law.

The report card measures states’ preterm birth rates against the March of Dimes’ 9.6 percent goal and assigns letter grades. This year, grades for 27 states improved from the previous year. The United States’ 11.4 percent rate earned it a “C” grade.

Preterm birth is the number one cause of death in newborns. In 2013, more than 450,000 babies were born prematurely.

The report card tracks states’ progress in implementing strategies that reduce the risk of preterm birth. In 2013, 30 states and the District of Columbia reduced the percentage of women of childbearing age who were uninsured. The percentage of younger women who smoke fell in 34 states and the District, and the late preterm birth rate, meaning babies born between 34 and 36 weeks gestation, came down in 30 states.

The health law’s expansion of public and private health insurance coverage to millions of women will likely have the largest impact on reducing preterm births, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. Pregnant women who meet their state’s income eligibility standards (typically at or near 200 percent of the federal poverty level, or $23,340), can receive Medicaid services until 60 days after they give birth, but more consistent coverage helps ensure that women are healthy before they become pregnant and that they receive early prenatal care.

Other health law provisions will make inroads as well, according to Sonfield, who authored a Guttmacher brief on pregnancy-related services shortly after the law passed in 2010. Maternity and newborn care is now required coverage in plans sold on the individual and small group markets. A range of preventive services must be provided free of charge to pregnant women, including folic acid supplements, smoking cessation counseling, screening for gestational diabetes and prenatal care.

“Better access to insurance helps you plan and space your pregnancies, and better access to preventive care helps make sure you’re healthy” before and between pregnancies, says Sonfield.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The health law’s open enrollment season is just around the corner. Are you ready?

Here’s a quick checklist for people who don’t get their health insurance at work and plan to shop for coverage on the health law’s online exchanges, or marketplaces, starting Nov. 15. You can compare plans and prices at healthcare.gov or, if your state has its own exchange, shop there to find out which coverage is best for you. And you may be eligible for subsidies to help pay your premium.

Keep these five things in mind as the three-month open enrollment period begins.

– Shop Around: Just because you’re enrolled in a policy now doesn’t means it’s the best deal for you next year. If you’re currently in the federal marketplace and don’t take any action, you’ll be re-enrolled in the same plan you’re in now. Federal officials, as well as many analysts, are urging consumers to go back to the exchanges to compare plans and prices. You might discover that you have more –or different – choices than you had a year ago.

– Don’t Get Billed Twice: Insurers have expressed concerns that if a consumer changes plans, problems with the federal website might keep insurers from learning of the change and consumers could get billed for both plans. “It’s an issue we’re aware of and we’re working with exchange officials to make sure there’s a solution for consumers,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry trade group. Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services, said insurers will get lists of individuals who have been automatically enrolled into their current plan as well as those who chose to re-enroll. He also said that the agency is “examining options” on how to provide insurers the names of people who picked another plan during open enrollment.

Just in case, keep proof of payment to answer any billing questions and once you’ve cancelled the old policy watch your credit card statements or, if the payment was deducted directly from a bank account, watch those charges to make sure you aren’t paying for two policies. And don’t cancel your current insurance until you have confirmation from your new carrier that you’re covered.

– Find Out If You Qualify For Financial Help: Enter your most up-to-date income information on healthcare.gov or with your state exchange to see if you are entitled to receive a tax credit toward the cost of your health insurance. Even if you are like the majority of those enrolling in marketplace plans who receive a subsidy, update your income to make sure you get the correct amount next year. This is important because if you get too much of a subsidy, you’ll have to repay it when you file your taxes the following year.

– Know All Costs: It’s not just the monthly premium that will cost you. Understand a policy’s out-of-pocket costs, things like co-pays, co-insurance and deductibles, before you enroll. The health law allows out-of-pocket maximum caps of $6,600 for an individual policy and $13,200 for a family policy in 2015 but some of your health care expenses – including out-of-network care – might not be included in that cap.

– Get Help If You Need It: Confused? There are several ways to get help. Work with a local insurance agent or broker. Find one of the law’s trained navigators or assistors. Or call the federal consumer assistance center at 800-318-2596 for extra help or to find out if you eligible for a subsidy. Folks there can also help you enroll in a health plan or if you qualify, Medicaid, the federal-state program for low-income people.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.