The penalty for failing to have health insurance is going up next year, perhaps even higher than expected. Among uninsured individuals who are not exempt from the ObamaCare penalty, the average household fine for not having insurance in 2015 will be $661, rising to $969 per household in 2016, according to a Kaiser Family Foundation analysis.

 

Everyone knows ObamaCare subsidizes low-income individuals, but few are aware it also subsidizes big insurance companies. Corporate welfare payments to insurers under the risk corridor and reinsurance programs (both of which are slated to expire in 2017) amounted to $10.4 billion for the 2014 benefit year. In ObamaCare’s first year, “excess” losses outpaced “excess” gains by $2.5 billion. The White House wants taxpayers to make up the difference.

The ObamaCare program for small business in Illinois—known as SHOP—has been troubled from the start. Only two insurers sold health plans on the online marketplace to Chicago small businesses: startup Land of Lincoln Health and Blue Cross & Blue Shield of Illinois. Now there’s just one. Facing massive financial losses, Chicago-based Land of Lincoln has stopped signing up new small-business customers.

An increasing number of preferred provider plans (PPOs) offered under the health care law have no ceiling for out-of-network costs, leaving policyholders facing unlimited financial exposure. Forty-five percent of the silver level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders’ out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds.

To stay on the path of repeal and replace, ObamaCare opponents need to address three critical aspects of the effort. First is the question of risk-corridor payments under ObamaCare. These are the payments made to insurers with “excessive” losses from the plans they offer on the exchanges. A second important question is the “Cadillac” tax, which imposes a 40% excise tax on plans with premiums above certain dollar thresholds, and which would be fully repealed by the bill Congress will send the president. A third important question concerns another key feature of any credible replacement plan: tax credits.

The Justice Department last month asked the Supreme Court to review a preliminary injunction blocking the Obama administration from implementing the president’s immigration executive order, which would defer deportations for up to five million undocumented immigrants. Employers aren’t required to offer ObamaCare coverage or subsidies to these immigrants. The statutory language in the Affordable Care Act says that only “lawful residents” are eligible, and the government’s petition specifically notes that the immigration action does not “confer any form of legal status in this country.” In short, companies will be encouraged to hire these immigrants over U.S. citizens.

Democrats like to talk a lot about being the party of choice, but under Obamacare, individuals are finding their choices increasingly limited. At its core, Obamacare forces individuals to purchase government-approved insurance policies and precludes them from buying plans that might be more in line with their healthcare needs. Though Obamacare’s defenders argue that the requirements imposed on health insurance plans only serve to guarantee that individuals have better coverage, in reality, what’s happening is that the law is driving insurers to limit choices.

Cassandra Gekas, operations director for Vermont Health Connect, said staff members are working on a problem in which hundreds of people who paid their monthly premiums on time were canceled for nonpayment. Apparently, the cancellations were related to a five- to seven-day period it takes for the system to process end of the month payments. Vermont Health Connect was plagued with technical glitches and security problems after its launch Oct. 1, 2013.

While the average premium for the least expensive closed network silver plan — principally HMOs — rose from $274 to $299, a 9 percent increase, the average premium for the least expensive PPO or other silver-level open access plan grew from $291 to $339, an 17 percent jump. Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage.

Whether it is the Centers for Medicare and Medicaid Services (CMS) determining which treatments and technologies are worth covering and how much they are willing to reimburse for them; the Agency for Healthcare Research and Quality (AHRQ) mandating quality and safety standards; or the new Affordable Care Act exchanges setting the standard for benefit packages throughout the health insurance market, it is clear that government agencies and their mandates play a powerful role in guiding the provision of health benefits and the overall construct of the market.