The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

It’s been six years since the passage of the Affordable Care Act and it’s still unpopular with the voters. Hardly a week goes by without the discovery of new problems and new victims.

Paul Ryan says he wants an alternative. Donald Trump does too. Republicans in the House are actually trying to come up with something. But if past Republican proposals are a guide, there is a danger they will propose something most people see as Obamacare lite. There is even a chance they could propose something that is more unpopular than Obamacare itself.

John C. Goodman lists eight ideas Republican health reformers should avoid if they want to be successful in the November elections.

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Last Thursday, the Obama administration suffered a legal setback, when a federal judge in Washington ruled that the administration exceeded its authority by paying out cost-sharing subsidies to health insurers under the Affordable Care Act.

The administration will doubtless appeal the case, which was brought by the Republican-led House of Representatives, but whether those appeals succeed may well depend on whether courts view the case as one of statutory interpretation, or one with constitutional implications.

In its briefs in the case, the administration tried to portray House v. Burwell as a successor case to King v. Burwell, another lawsuit surrounding Obamacare subsidy payments, which the Supreme Court decided in June 2015.

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Major insurer Highmark Inc. is suing the federal government, saying the feds failed to live up to obligations to pay the insurer nearly $223 million from an ObamaCare program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets.  The suit is likely to draw close attention because it comes from a company that continues to be a major player in the exchanges.

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The Supreme Court unanimously remanded a case challenging the ACA’s contraceptive mandate back to the United States Courts of Appeals for the Third, Fifth, Tenth and D.C. Circuits. The decision will give the parties an opportunity to reach a compromise that “accommodates petitioners’ religious exercise” while ensuring women covered by the petitioner’s health plans receive coverage that includes contraception.  The Beckett Fund for Religious Liberty, which brought the lawsuit one behalf of the Little Sisters of the Poor, called the ruling a win for the petitioners.

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Most big employers provide wellness programs now, and the Affordable Care Act gave the idea a boost in 2010 by letting companies offer employees financial incentives— such as lower health insurance premiums, gift cards or prizes—worth up to 30 percent of the cost of their health insurance.

But as the wellness industry has grown, questions have started to arise about just how effective these programs really are—and how fair. It’s not clear the programs financially benefit employers, and evidence is also mixed on whether they make employees healthier. And now, some employees have begun to bristle at the omnipresence of wellness in corporate culture and see the requirement to share personal health data with their employer as an intrusion on their privacy.

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The legal war over ObamaCare is back.

A federal judge gave House Republicans a significant victory on Thursday when she ruled that the administration is illegally making certain ObamaCare payments without a congressional appropriation.

Still, the case is far from over. Democrats are turning their attention to the appeal of the ruling, and experts say the case does not pose the same mortal threat to the healthcare law that previous challenges did.

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John Boehner isn’t popular with conservatives these days, but the former House Speaker deserves an apology from those who derided his lawsuit challenging President Obama’s usurpation of legislative power. Mr. Boehner went ahead despite skeptics from the left and right, and on Thursday the House won a landmark victory on behalf of Congress’s power of the purse.

Federal Judge Rosemary Collyer handed down summary judgment for the House, ruling that the executive branch had unlawfully spent money on ObamaCare without congressional assent. Judge Collyer noted that Congress had expressly not appropriated money to reimburse health insurers under Section 1402 of the Affordable Care Act. The Administration spent money on those reimbursements anyway.

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Health plans would likely feel the financial hit if the courts ultimately strike down Obamacare’s cost-sharing subsidies. That’s because those payments go directly to insurers to make up for lower payments from their poorest customers.

A federal court ruled today that the Obama administration has been improperly funding the cost-sharing subsidies. The ruling is stayed pending appeal, so there will be no immediate fallout for health plans.

But at stake is approximately $175 billion over a decade that insurers would receive to subsidize their Obamacare customers. Cost-sharing subsidies are available to enrollees with incomes below 250 percent of the federal poverty level who enroll in silver plans. They’re designed to reduce out-of-pocket costs when those individuals access medical care.

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The leaders of the House GOP effort to replace the Affordable Care Act (ACA) will brief lawmakers at a closed-door meeting Thursday before publicly releasing their plan in June.

The meeting, which will be attended by Speaker Paul Ryan (R-Wis.), marks the first time the task force will lay out a draft of its plan after months of conversations with members, according to a House GOP aide.

The plan is expected to include numerous standard Republican health policy ideas — including a controversial proposal to cap the employer tax exclusion for health insurance, according to two Republican lobbyists.

Democrats have long attacked Republicans for failing to come up with an alternative healthcare plan, but leaders, including Ryan, have promised to produce one that could be taken up by a GOP president next year.

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House GOP leaders announced Wednesday at a weekly closed-door conference meeting that they will present members with an update on the Republican Obamacare replacement plan on Thursday afternoon, according to a senior GOP aide.

The same day, Democrats and Republicans in a key committee had a civil conversation about health care policy, indicating where that debate may be heading.

The Obamacare replacement plan is part of House Speaker Paul Ryan’s (R-Wis.) promise to put together a conservative agenda ahead of the Republican convention this summer.

While the plan is not yet finalized, a hearing in Energy and Commerce Committee’s health subcommittee on Wednesday offered hints of what the replacement plan might contain. Committee members are mulling various ways to handle pre-existing conditions, quality of coverage, affordability and insurance regulation.

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