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

The top Justice Department official who defended the president’s health care law at the Supreme Court is leaving his job.

Solicitor General Donald Verrilli Jr. is ending his five-year tenure as the administration’s chief lawyer at the high court, President Barack Obama said in a statement Thursday.

Verrilli, 58, made the principal argument in defense of the health law against a major challenge in 2012 and an attack on subsidies for low-income Americans last year. The 2012 case took place in the midst of Obama’s re-election campaign, with the signature domestic achievement of his first term essentially on trial at the Supreme Court.

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The Senate will begin work thisweek on its health-related appropriations bill, which it hopes will make it to a floor vote this year.

The health panel of the Senate Appropriations Committee, led by Sen. Roy Blunt (R-Mo.), will meet Tuesday to mark up its spending bill. That bill, which includes funding for the Departments of Labor and Health and Human Services, passed out of committee last year, but ultimately did not make it for a full floor vote.

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The implementation of ObamaCare has caused private health insurance to increase premiums and deductibles to meet both shifting market demand and regulatory compliance, largely passing on these added costs to the American people. Continuing to expand the program, as Hillary Clinton suggests, will most certainly force greater government control into our health care system. With this we will not only see a serious reduction in private sector insurer options, but also the introduction of longer wait times, wait lists, and limits on pharmaceutical innovation as evidenced in closed, government-run health care systems around the globe.

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Republican lawmakers crafting alternatives to Obamacare face a fundamental decision: whether to focus on expanding coverage or containing costs. Their choice may be driven, at least in part, by budget scorekeepers.

The Congressional Budget Office released a report in December 2008 on key issues in analyzing major health-care proposals. Included was a chart projecting individuals’ willingness to enroll in health insurance at various levels of subsidy (in technical terms, an elasticity curve). That curve suggested that insurance enrollment would remain below 40% until subsidies reached 70% of cost and that even if costs were 100% subsidized, about a fifth of individuals would decline to enroll. (And that level of subsidy is probably much greater than many Republicans would be willing to offer.)

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Will ObamaCare be a top issue in this fall’s presidential and congressional campaigns? Republicans better make it one if they want to prevail.

The continuing unpopularity of President Obama’s signature domestic achievement gives Republicans an enormous opportunity. Only 39.2% of Americans favor ObamaCare in the Real Clear Politics average of recent polls; nearly half, 48.8%, oppose it. There’s also a sharp partisan divide that benefits the GOP: While 78% of Democrats approve of ObamaCare, according to an April survey from the Pew Research Center, 58% of independents and 89% of Republicans disapprove of it.

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A federal district judge ruled this month, in a lawsuit brought by House Republicans, that the Obama administration lacks the authority to pay cost-sharing subsidies to health insurers if Congress has not appropriated the funds. Some civil servants in the administration may agree.

The House Ways and Means Committee released a deposition Tuesday of David Fisher, former chief risk officer for the Internal Revenue Service. In it, Mr. Fisher recounts a series of events in late 2013 and early 2014 regarding the source and legality of Obamacare cost-sharing subsidies to insurers.

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On Jan. 13, 2014, a team of Internal Revenue Service financial managers piled into government vans and headed to the Old Executive Office Building for what would turn out to be a very unusual meeting.

 

The clandestine nature of the session underscores the intense conflict over Obamacare spending, which is the subject of a federal lawsuit in which House Republicans have so far prevailed, as well as a continuing investigation by the Ways and Means and the Energy and Commerce Committees. It also shows that more than six years after President Obama signed the Affordable Care Act into law, Republican opposition has not waned.

After failing to win congressional approval for the funds, the Obama administration spent the money anyway and has now distributed about $7 billion to insurance companies to offset out-of-pocket costs for eligible consumers. The administration asserts that the health care legislation provided permanent, continuing authority to do so, and that no further appropriation was necessary.

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In state capitols across the country, health care lobbyists and consultants are pushing a relatively unknown provision of the Affordable Care Act: Section 1332. According to some proponents, these waivers will “turbocharge state innovation” and will provide states with an “exit strategy” from the ACA. But is the hype true? Will Section 1332 waivers be as truly transformative to our health care system as suggested?

As policy practitioners who work daily with state policymakers around the country, we have seen proponents be overly dismissive—or perhaps even unaware—of the large practical and political challenges surrounding the implementation of these waivers. A serious, objective examination of the new Section 1332 federal guidance sparks far more questions than answers for policymakers.

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ObamaCare is bringing out corporate America’s worst crony-capitalist impulses. The health-insurance lobby has teamed up with trial lawyers to sue the federal government—through individual lawsuits and a $5 billion class action—for not following through on a bailout deal buried in the law. This provision, the risk corridor program, would have required taxpayers to bail out insurers for losing money on the health-care exchanges. In late 2013, Sen. Marco Rubio introduced legislation to repeal the provision entirely and later another bill to make the program budget neutral. When it came time to pass a spending bill at the end of 2014, Congress succeeded in making it the law of the land that the bailout program could not cost taxpayers a single cent—which ended up saving taxpayers $2.5 billion. In December of last year, they repeated the feat. Now, Rubio is urging leaders in both the House and Senate to make this a priority and stop the bailout a third time.

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