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2018 Ohio Health Insurance Rate Increase Requests From All Companies

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Affordable Care Act Legislation requires all health insurance companies to submit their price increase requests to the federal or state government. Carriers across the US have requested rate changes for 2018 individual and employer-provided plans. Many companies are no longer offering private medical coverage.

Below, we have provided details of the proposed price increases (and decreases). The Ohio Department of Insurance will determine what amount (full or partial) will be granted for January 1, 2018 effective dates.  Companies and their requests are listed in alphabetical order.

Ohio health insurance Open Enrollment for persons under age 65 begins  November 1, and ends December 15th. Senior Open Enrollment for Medicare products begins October 15th and ends December 7th.

Aetna

20.47% – HMO  Small Group

12.97% – PPO Small Group

 

AultCare

4.49% – HMO Small Group

5.29% – Small Group

11.45% – Individual

 

Buckeye Community Health Plan

29.11% – Ambetter Individual + Vision + Adult Dental

28.70% – Ambetter Individual  + Vision

29.28% – Ambetter Individual

 

CareSource

11.69% – Enhanced Individual

26.02% – Product 3 Individual

16.99% – HMO Basic Individual

 

Anthem BCBS

22.20% – HMO Off-Exchange Small Group

13.00% – PPO Off-Exchange Small Group

21.44% – HMO Individual

 

Federated Mutual

-4.25% – Small Group

 

Humana

14.57% – Cincinnati/N.KY. Small Group

8.94% – NPOS Small Group

8.80% – PPO 14 Small Group

 

MedMutual

20.60% – Off-Exchange Individual

20.20% – HMO Individual

3.32% – Small Group POS

4.27% – Small Group HMO

-2.47% – Small Group

36.10% – Individual POS

 

Molina

14.46% – Individual Marketplace Options

24.06% – Individual

 

Paramount

27.54% – Small Group 74313OH022

26.71% – Small Group 74313OH025

31.71% – Small Group 74313OH023

29.21% – Small Group 74313OH026

20.53% – Small Group 74313OH027

19.97% – Small Group 74313OH021

 

Premier

33.34% – Individual

 

Summa

6.96% – QHP Group Qualified – Small Group

2.19% – QHP Group – Small Group

28.43% – QHP Individual Qualified

17.07% – QHP Individual

 

The Health Plan Of The Upper Ohio Valley

5.83% – Silver HMO Small Group

7.27% – Bronze HMO Small Group

6.51% – Gold HMO Small Group

12.32% – Platinum HMO Small Group

18.76% – Bronze Individual

 

THP Insurance Company

6.51% – Silver HSA Small Group

6.50% – Gold PPO Small Group

7.82% – Gold HRA Small Group

4.04% – Platinum PPO Small Group

0.28% – Silver PPO Small Group

11.11% – Bronze PPO Small Group

15.35% – Bronze HSA Small Group

 

UnitedHealthcare Of River Valley

12.04% – Heritage Plus Small Group

 

Anthem BCBS And Premier Exit 2018 Ohio Health Insurance Marketplace

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Ohio health insurance availability has taken another major hit with the exit of Anthem Blue Cross Blue Shield and Premier. Suddenly, the Buckeye State, in many counties, will no longer offer a plentiful number of medical plan options through the subsidized Marketplace. Previously, Aetna, UnitedHealthcare, and Humana announced they will not offer private individual or family plans through the Exchanges. More than 10,000 persons in 18 counties no longer have any participating carriers offering Marketplace coverage. Rate volatility and unpredictable company choices are continuing concerns.

However, Senior Medigap contracts, including Advantage, Supplement, and Part D prescription drug plans remain unaffected. Other ancillary products will continue to be offered, including dental, vision, life, critical-illness, and short-term plans. Group coverage offered by small and large businesses will also not be impacted by the erosion of the Affordable Care Act (Obamacare). Grandfathered and grandmothered plans are also not affected. Short-term health insurance plans continue to be available, although they are not compliant with current legislation, and do not cover pre-existing conditions.

 

Anthem BC Plans In Ohio

Hey Kid! You Won’t Find Anthem Or Premier Down There!

 

Anthem

Current policyholders will be receiving an email detailing the effective date of termination (December 31), and verification that their current coverage is compliant with ACA guidelines. “Continual changes” and lack of predictability”  were reasons cited by Anthem for their exit. Wisconsin and Indiana are two additional states that Anthem will either leave or only offer coverage in limited areas.

Although Anthem’s Ohio rates have not been especially competitive the last few years, 2017 coverage is offered in every county, and they are one of the few carriers that offer HSA plans through the federal Exchange. Popular plan options available that will not be offered in 2018 include Bronze Pathway PPO 5150, Bronze Pathway PPO 0% For HSA, Bronze Pathway HMO 5000, Silver Pathway PPO 2000, and Silver Pathway PPO 3000.

Premier

Dayton-based Premier Health Plan serves areas of Southwestern Ohio with individual, family, Senior, and Group coverage. Rates have been most competitive in Warren, Montgomery, and Greene Counties. An additional six counties are in the service area. However, after featuring extremely competitive rates in 2016, Premier substantially raised premiums for 2017 effective dates, and still has been struggling in the Under-65 market. Although customer satisfaction has been high, competition from other carriers kept Premier from sustaining significant growth.

Policies no longer available for 2018 include Health One Bronze 7150, Health One Bronze 6550, Health One Bronze 6250, Health One Bronze 6500, Health One Silver 5000, Health One Silver 4750, Health One Silver 4500, Health One Silver 3250, Health One Silver 3000, and Health One Gold 1750. Current customers can retain their existing policies through December 31st.

Future Healthcare Legislation

The current Administration, is attempting to repeal and replace The Affordable Care Act (aka Obamacare), with new legislation that could possibly reduce health insurance costs, and offer more customized low-cost plans. With less than three weeks left until a summer recess, Senate Majority Leader Mitch McConnell needs further compromises to pass a partisan bill.

Paramount Health Insurance Plans And Rates In Ohio

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Low-cost health insurance in Northwest Ohio is offered by Paramount. Plans are available to individuals and groups, both on and off the Marketplace Exchange. Residents can choose affordable HMO, Elite, and Advantage options that provide quality coverage at a competitive price. The rates you view on our website from your free quote request, are the lowest offered prices since the Department of Insurance regulates pricing.

Paramount has offered policies for more than 25 years, and features popular consumer-driven products to applicants under the age of 65, along with Seniors that are eligible for Medicare. A National Committee for Quality Assurance (NCQA) accreditation was originally awarded in 1995. A “Quality Improvement Program” has been implemented, and is designed to improve patient treatment and service, and review the effectiveness and efficiency of their providers. Affiliated with ProMedica, plans are also offered to small and large companies that are providing group benefits to their employees.

Policies are offered in 4o counties in Northeastern Ohio and Southern Michigan. Partial benefits are provided in Delaware, Hardin, Knox, Allen, and Paulding counties. If additional areas are added to their network coverage area, we will update the map below.

Paramount Health Insurance Ohio Network

Paramount Ohio Service Area

Available Individual And Family Plans – Under Age 65

Exchange (and off-Exchange) coverage is offered during Open Enrollment, and after the OE period has ended (with a special exemption). A large Paramount Ohio Insurance Provider Network (doctors, specialists, hospitals, and medical facilities) gives state residents many local options for treatment. Shown below are single and family policies that are not medically underwritten.

 

Bronze 1 HSA – HSA-eligible plan with $6,500 deductible and 0% coinsurance. You may choose a financial institution to administer your tax-free deposits that can pay for qualified medical, dental and vision expenses. Generally, this option is most cost-effective if there are no major medical conditions, and you do not anticipate that any family member is likely to meet the deductible. One annual eye exam and a pair of glasses each year are provided at no cost.

Bronze Standard – $45 primary care physician (pcp) office visit copay with no limit on the number of allowed visits. Specialist and Urgent Care visits are subject to 50% coinsurance. Deductible is $6,650 with maximum out0of-pocket expenses of $7,150 and 50% coinsurance. Preferred and non-preferred generic drugs are subject to a $35 copay. Other drugs are subject to 35%-45% coinsurance.

Silver 1 – $30 and $75 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,250 deductible with maximum out-of-pocket expenses of $7,150 and 40% coinsurance. $10, $20, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance.

Silver Standard – $30 and $65 office visit copays (no deductible or coinsurance) with $75 copay also for Urgent Care Visits. $3,500 deductible with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. $15, $15, $50, and $100 copays on preferred generic, non-preferred generic, preferred brand, and non-preferred brand drugs. Oral chemotherapy, specialty drugs, and injectables are subject to 40% coinsurance. Very similar to previous plan, but slightly more expensive.

Silver 3 – Same rate as Silver 2 plan but with a $500 higher deductible ($3,500), but also a higher specialist copay ($75 vs. $65).

Gold 1 – Low $1,000 deductible with $20 and $30 office visit copays. Generic drug copay is only $7, and Brand drugs do not have to meet a deductible.

Gold 2 – Slightly more expensive than previous plan. $1,500 deductible with $10 and $20 office visit copays. $6 generic drug copay with $5,000 maximum out-of-pocket expenses. Specialty prescriptions are subject to a 20% copay.

Sample Rates (Under Age 65)

Since the cost of coverage varies, depending on several factors, we have illustrated below monthly rates for specific household situations. If a federal subsidy is available, it has automatically been applied to reduce the premium. However, any applicant can choose to decline the Obamcare subsidy. This federal aid is only offered during Open Enrollment and SEP situations. If you missed Ohio Open Enrollment, many options are available, including inexpensive (but non-compliant) short-term plans.

 

25 Year-Old Male Living In Zip Code 43617 – $15,000 Income (Sylvania – Lucas County)

$78 – Bronze 2

$107 – Silver 1

$153 – Gold 1

 

40 Year-Old Couple Living In Zip Code 43608 – $27,000 Income (Toledo – Lucas County)

$176 – Bronze 2

$250 – Silver 1

$366 – Gold 1

 

50 Year-Old Couple Living In Zip Code 45840 – $45,000 Income (Findlay – Hancock County )

$219 – Bronze 2

$326 – Silver 1

$492 – Gold 1

 

45 Year-Old Couple With Two Children Living In Zip Code 44870 – $55,000 Income (Sandusky – Erie County )

$195 – Bronze 2

$318 – Silver 1

$508 – Gold 1

 Medigap Plans In Northern Ohio

Affordable Senior Ohio Health Plans Are Available

Senior Medicare Plans And Medigap Supplements

Medigap coverage can help policyholders pay deductibles, and reduce out-of-pocket expenses. Typically, you can choose and physician, specialist, or hospital that accepts Medicare patients. Four plans are available to eligible applicants residing in the service area. The monthly rates shown below are for selected ages that do not use tobacco products.

Age 65

$102 – Plan A

$119 – Plan N

$147 – Plan C

$155 – Plan F

Age 70

$122 – Plan A

$142 – Plan N

$175 – Plan C

$185 – Plan F

Age 75

$148 – Plan A

$172 – Plan N

$213 – Plan C

$224 – Plan F

 

Advantage Plans

Three Ohio  options are shown below. “Advantage” contracts are issued by private carriers who have contracted with Medicare to provide Parts A and B coverage. Depending on the company, HMO, PPO, Fee-For-Service, and Medicare Savings Accounts are available. If you have End-Stage Renal Disease (ESRD), unfortunately, you are not eligible. The official enrollment period begins on October 7th and ends on December 15th.

All three “Elite” plan options include an annual routine vision exam, 100% preventative benefits, health and wellness programs, and a Silver Sneakers membership. The negotiated network discounts should always be used for any expenses that are subject to a deductible and/or out-of-pocket expenses. The Elite contracts also received a 4-Star rating from Medicare for 2016. An overall and summary star rating is assigned.

Dental Benefits

An optional Delta Dental rider is available for $18.50 per month. Two exams and cleanings are covered each year. The annual maximum benefit is $500 and Full-Mouth x-rays are covered every three years. Emergency palliative benefits and a brush biopsy (for oral cancer detection)are also included. NOTE: Delta dental plans are not offered outside of the Open Enrollment period.

DentaQuest and EyeQuest Networks are used with Advantage contracts. Elite plans are available in the following counties: Allen, Cuyahoga, Defiance, Erie, Fulton, Henry, Lake, Lorain, Lucas, Medina, Ottawa, Sandusky, Williams, and Wood.

Elite Standard Medical And Drug – $36 per month.  Office visit copays are only $5 and $40 with maximum policy out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $5 and $20 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.

Elite Enhanced Medical Only – $0 per month. Yes, that premium is correct. Office visit copays are $20 and $45 with maximum out-of-pocket expenses of $6,100. There is no deductible to meet and most lab tests, diagnostic tests and x-rays must only meet a small copay of $0-$10. The hospital outpatient copay is $200 and the Urgent Care copay is $45.

Elite Enhanced Medical And Drug – $78 per month. Office visit copays are $5 and $40 with maximum out-of-pocket expenses of $3,400. ER copay is $75. Enhanced vision hardware benefit included. $2 and $15 copays on preferred generic and generic drugs. Preferred brand copay is $45. Outpatient physical, occupational, speech/language copay is $40.

2016 Healthcare Changes In Ohio – What To Expect

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2016 Ohio health insurance plans will look different in 2016. The rates will change. Some plans will be added, while others will be eliminated. New carriers may enter the Marketplace, while others, such as Assurant, will exit the Exchanges. Federal tax subsidies will be different, depending on your projected household income.

Who knows what Ohio healthcare will look like in 2016. Well, We think we do! Our tongue and cheek predictions below may not come true, but we had a lot of fun writing them!

 

January – In an unprecedented move, all major Ohio health insurance companies offer to slash their 2016 rates by 60%. However, there is a big caveat. The stipulation is that the Cleveland Browns must win the Super Bowl on February 7th if prices are to decrease.

The problem is that the Browns finished the season with a  7-9 record, missed the playoffs, and aren’t even playing in the Super Bowl! When asked to comment, a Humana spokesman stated that  they will extend the offer to 2017 since the risk would still be “incredibly low.” Thankfully, the Bengals were not included in this offer.

February – Open Enrollment ends on January 31st, and millions of Americans, including many households in the Buckeye State, are still without coverage. However, on February 1, the Department of Health and Human Services announces that OE will be extended until December 31st.

To ease the burden on Department employees, consumers must apply for coverage only during designated times. These times are between 3:00 am and 4:00 am Tuesdays and Fridays, and only on odd-numbered days. General maintenance is expected to be performed between 3:10 and 3:50 am on these designated days.

March – Of course, that means March Madness, so during the NCAA Basketball Tournament, no new applications will be taken, no claims will be paid, no payments will be processed, and phone calls and emails will not be returned from any health insurance company in Ohio.

Funny Health Insurance Websites

Ohio March Madness!

However, there’s some good news! If any Ohio University (Ohio State, Miami, Xavier, Toledo, Kent State etc…) makes it to the “Final Four,” a $250 rebate will be given to all customers. If they win the National Championship, a $1,000 rebate will be given.

April – Is it an April Fool’s joke? Nobody seems to know. Apparently, Ohio grocers are offering to pay 50% of your health insurance bill on the first day of April. Your only requirement is to bring in your statement, and 16 forms of identification and the bill is instantly paid.

Ah. OK. It’s quite clear now. 16 forms of identification. Well…if you have plenty of aliases, multiple personalities or you tend to keep old college ID cards and driver’s licenses, you may catch a break. Otherwise, it appears to be an April Fool’s joke gone bad.

May – April showers bring….You know…May flowers.  So, to commemorate the upcoming warmer weather, each insurer has assigned itself to a specific flower, and all corporate and local offices must reflect that motif.

Some of the selections made by the carriers are listed below:

Aetna – Carnation

Humana – Snapdragon

Medical Mutual – Rose

Premier – Marigold

Anthem Blue Cross – Daffodil

Ambetter – Geranium

UnitedHealthcare – Hydrangea

SummaCare – Daffodil

NOTE: Anthem and SummaCare both selected the same flower and subsequently sued each other to determine who has the exclusive flower rights.

June – Ohio’s newest health insurance company is under investigation for allegedly not paying a single claim during the first five months of the year. “No Pain No Claim” is the name of the carrier that started to offer policies in 2016. Approved by regulators, they offer coverage in 12 Counties located near the Indiana border.

When asked to provide claim records and payout information, an official of the company said, “We don’t have any documentation regarding claims. Our operational expenses were too high this year although by 2020 we hope to start reimbursing a few policyholders.”

July – An enormous data breach hits the Midwestern states as a rogue hacker believed to be living in Cincinnati infiltrates many large financial institutions. Oddly, no personal or sensitive information is taken. But every policyholder receives new ID cards with their first-grade teacher’s name on it. Very strange.

Funny LeBron Stories

LeBron’s Marketplace!

August – In an effort to increase market share, surprisingly, Medical Mutual and Humana decide to change their corporate names and logos. The move is effective on October 1, and all stationery and business cards will also be changed.

Medical Mutual will become “LeBron’s Marketplace” and Humana will become “Buckeye Nuts And Guts.” Both companies are obviously attempting to capitalize on  the Ohio theme. Of course, it may not be so popular in other states.

September – A special Open Enrollment period has been approved for the entire month by the Department of Health and Human Services (HHS). To qualify, you must file your 2016 and 2017 federal tax returns before the end of 2015 and agree to pay applicable back-taxes of all immediate family members. Although it is not anticipated that any person will take advantage of this newly-created SEP, many Department employees are praising this idea as an “act of kindness.”

October – Halloween tricks and treats from the healthcare industry. In an effort to promote responsible eating, employees are encouraged to give out raspberries, beet juice, or broccoli spears to children, and forgo the traditional candy items. However, the city of Cleveland quickly responds to the idea, by extending Beggars Night to the entire month of October and requiring all treats consist of a minimum of one pound of chocolate, and two dozen Rice Krispies treats..

November – Open Enrollment officially begins with a massive advertising campaign designed to increase the number of Americans that sign up by 40%. As a special inducement, if you enroll in a plan during the first 15 days of November, a frozen turkey will be sent in time to enjoy before next July 4th.

However, for individuals or families that enroll AND refer a friend, a small mobile home that is completely furnished, will be sent. The value of this inducement is $11,500 and is unfortunately, taxable.

December – Keeping with the “Holiday Spirit,” during this month, insurers are offering potato latkes and pumpkin pie to all policyholders that schedule a preventative colonoscopy. Of course, the food is served after the procedure has completed. The evening before the colonoscopy, a tasty concoction of bowel-cleansing Miralax is provided.

If You Missed Ohio Open Enrollment – 10 Things You Need To Know

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Open Enrollment to purchase subsidized health insurance in Ohio typically occurs between November and February each year. During that time, no medical questions are asked, and single and family plan rates are  reduced by the federal government by using a subsidy in the form of an instant tax-credit. On and off Marketplace coverage is available, so if your income is high, you can still enroll in an affordable plan.

However, if you didn’t watch the news or read a newspaper, procrastinated too long, or simply didn’t have money set aside to buy a policy, you probably missed the OE period. But you can still obtain affordable healthcare benefits. Here are 10 items that will help you secure coverage now, and ensure you won’t miss Open Enrollment next year!

1. Don’t miss Open Enrollment this year! There’s always plenty of advertising in both the print and online media. Generally, if you want your policy to be effective January 1, the deadline is December 15th, so don’t wait after the Holidays to do your healthcare shopping. November 1st is the first day, and it runs through January 31st. If you miss the cutoff, you will probably need an “SEP” (discussed later) to receive favorable treatment.

2. Consider purchasing a temporary Ohio health insurance plan. No, it won’t match the office visit and prescription copays that an Exchange policy offers, but it will provide a very inexpensive stopgap option that is easy on your pocketbook and can be placed in-force within 24-36 hours. UnitedHealthcare is one of many companies that offers low rates. Medical Mutual also offers competitive pricing.

Although temporary policies are ineligible for Obamacare subsidies, for most individuals and families, prices are still less than most Marketplace contracts. And, up to $1 million of coverage can be purchased  “per claim” or per “policy period.” You can terminate your benefits with a phone call and utilize a nationwide provider network.

Ohio Open Enrollment Missed

Having A Baby Qualifies For A Special Enrollment Period

3. Determine if you qualify for a “Special Enrollment Period.” Commonly referred to as an SEP, specific life events that cause a change in family status, allow you to take advantage of this special period of 60 days to secure either subsidized or unsubsidized Exchange coverage. It doesn’t matter if it occurs in January, July, September, or any other month.

Several of the most common “Life Events” include getting married or divorced, reaching age 26, losing existing employer-provided benefits, moving to a different residence, and becoming pregnant. However, in pregnancy situations, the newborn may enroll in a policy, but not either parent. Therefore, prenatal and delivery expenses will not be covered.

4. Be aware of changing OE dates. For example, for 2014 effective dates, the starting date was October 1 2013, and the ending date was March 31 2014. That was six full months for consumers to take about 25 minutes and purchase their coverage. For 2015 effective dates, the starting point was November 15th and it ended on February 15th. The application time plummeted to about 90 days from about 180 days.

And as previously mentioned, the OE period for 2016 is once again, only three months. Although extensions are possible because of occasional glitches and delays, January 31st is the expected last day to enroll. If you already have a policy, you can either keep your plan, or consider switching to a different option.

5. Don’t go without coverage. Just because you didn’t sign up in time doesn’t mean you have to remain uninsured. Although you won’t be able to duplicate Marketplace plan benefits and prices, you can still obtain a medical plan. Major medical expenses are the most important item to cover, and many available contracts will reduce your potential risk against these types of claims.

Short-term contracts won’t eliminate the special non-compliance tax. However, if you develop a serious illness, or have an accident that results in thousands (or hundreds of thousands) of medical bills, you’ll be able to easily cover the vast majority of expenses. And the cost of temporary plans is extremely cheap.

6. Find out in advance which companies accept your physicians and specialists. The most time-consuming and frustrating part of the process is finding a plan that meets your coverage and budget objectives, but doesn’t include your providers.

By contacting doctors and medical facilities in advance, you can ensure that the plan you purchase (even after the OE period) will provide in-network” benefits for routine and scheduled treatment. Since network provider lists change, it’s important to verify your doctor is not dropping the carrier you are using.

Health exchange Enrollment

If You Miss Open Enrollment, Eat Your Vegetables!

7. Stay healthy, and eat your vegetables, especially if you don’t plan to purchase any major medical or catastrophic coverage throughout the year. Don’t go outdoors, don’t answer the door, don’t eat raw meat, and don’t travel in any vehicle with the possible exception of a golf cart.

Of course, we’re being a bit satirical, but any major disease or accident could have a dramatic impact on your financial health. Postponing your medical coverage to January 1st may be too late to treat a serious ailment.

8. Negotiate lower medical bills with your physician, specialist, hospital, and any other facilities you receive treatment. Often, by paying directly in cash, you can reduce your expenses by as much as 50%. And why not? There’s no claim form, insurance company, or approval process that the healthcare provider has to pay for. So everyone is a winner.

Unless, of course, you incur a huge hospital bill you can’t pay. In those situations, you may be able to negotiate a favorable billing alternative that works within your budget. A $10,000 obligation could result in only monthly payments of $100 or less.

9. Do NOT buy a “Limited Benefit” plan. Generally, these are the policies that are underwritten by a company you may not be familiar with. Obtaining specific benefit details are almost impossible, and a mysterious “application” or “enrollment” fee  is included. Often, it can be as much as $150-$200. Preventative benefits are not covered at 100%, and a large claim could easily result in tens of thousands of dollars of out-of-pocket expenses.

These contracts are often peddled from boiler rooms that are located outside of Ohio. Your payment information (credit card or check) will be requested on the first contact. Obtaining a refund will be practically impossible, and speaking to a live person becomes much more difficult after they have processed your initial payment.

10. Watch for changes to the ACA legislation from the latest Supreme Court challenge such to Obamacare, such as King Vs. Burwell.The government sided with the original legislation in this decision, although future challenges may also reach the Supreme Court.

The King Vs. Burwell verdict ruled in favor of the legality of federal subsidies offered to residents of states that have not set up their own Exchange.  Ohio (and most other states) were at risk of losing these subsidies, which would have effectively doomed the future of Obamacare, unless drastic changes were made.