“The Obama administration is relying heavily on outside contractors to implement a core component of healthcare reform as it races to set up a federal health insurance marketplace before 2014. The fast-approaching deadline gives the administration little time to scrutinize private-sector partners for conflicts of interest. The purchase of one of these contractors, Quality Software Services, Inc. (QSSI), by UnitedHealth Group, a major healthcare conglomerate, has sparked concerns about a potentially uneven playing field.”

“As the federal government tries to leave the states with the freedom to set up individualized local health exchanges, state officials say they’ve received so little guidance that they’re afraid they’ll have to make changes as more regulations come out after the presidential election.”

“The ACA health insurance subsidies are the most significant expansion of entitlements since the 1960s. In light of the precarious fiscal outlook for the federal government, its cost is a central concern to policymakers and taxpayers alike. When the ACA passed in June 2010, the Congressional Budget Office projected the budget cost between fiscal 2012 and fiscal 2019 to be $462 billion. By June 2012, the cost for these same years had jumped to $574 billion, an increase of nearly 25 percent.”

“Republicans on the Oversight and Government Reform Committee threatened to issue subpoenas if the IRS doesn’t turn over more records about how it’s implementing the law’s insurance subsidies. Republicans believe the IRS is planning to hand out billions of dollars in subsidies that aren’t authorized by the healthcare law.”

“November 16th is the deadline for states to submit a blueprint to the federal government for Obamacare’s insurance exchanges — a key component of the new healthcare law. Already, the exchange system is proving to be an unmitigated disaster.”

“The District’s small businesses may have to buy their employee health insurance through a city-run exchange come 2014, following a controversial vote by a city board. The D.C. Health Benefit Exchange Authority, charged with implementing the federal health-care overhaul law, voted Wednesday to accept a recommendation that all health-insurance plans sold in the city for 50 members or fewer must be purchased through the exchange.”

“The experts believed states would want to tailor the exchanges to their own populations. But the task has proved exceedingly complicated. Participating states must set up a call center as well as a Web site that allows people to easily find and understand health plans, in much the way that Orbitz and Travelocity help people find airline flights.”

“A D.C. board has voted to require individuals and small-business owners in the District to purchase their health insurance through the newly minted health exchange it oversees. The D.C. Health Benefit Exchange board approved the regulations late Wednesday, with just one modification to shrink the size of businesses that would come under the regulation.”

“Obama’s plan makes tax credits available to people who get health insurance from exchanges set up by state governments. If states don’t establish those exchanges, the federal government will do so for them. The federal exchanges, however, don’t come with tax credits: The law authorizes credits only for people who get insurance from state-established exchanges. And that creates some problems the administration didn’t foresee, and now hopes to wish away.”

“The concerns are also damning in the context of the the normal tug of war between the states and Washington DC. That’s because in his testimony, Mr. Consedine states he wrote to HHS weeks ago and has not received a reply. While its’ not unusual for the Feds to stiff politically inconvenient inquiries, I am fearful that the reason why HHS seems unwilling to provide a timely reply is because it doesn’t know the answers.”