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

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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The Oklahoma Health Care Authority (OHCA) has proposed a plan to “rebalance” Medicaid eligibility in the Sooner State. Although OHCA’s “plan” so far consists of only a single page of bullet points, what little that is already known makes clear that the plan would gut the existing Insure Oklahoma program and replace it with Obamacare’s Medicaid expansion by another name. Oklahoma policymakers should quickly reject OHCA’s latest proposal to expand Obamacare and refocus their efforts on improving the program for the most vulnerable.

Thousands of kids and adults with intellectual and developmental disabilities in Oklahoma are already sitting on Medicaid waiting lists to get the home and community-based services that they desperately need.

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Obamacare is entering a new stage. The recent announcement by United Health Care that it will stop selling insurance to individuals and families through most health insurance exchanges marks the transition. In the next stage, federal and state policy makers must decide how to use broad regulatory powers they have under the Affordable Care Act to stabilize, expand, and diversify risk pools, improve local market competition, encourage insurers to compete on product quality rather than premium alone, and promote effective risk management. In addition, insurance companies must master rate setting, plan design, and network management and effectively manage the health risk of their enrollees in order to stay profitable, and consumers must learn how to choose and use the best plan for their circumstances.

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The uninsurance rate for nonelderly adults increased in the decade before the passage of the Affordable Care Act (ACA), driven by declining rates of employer-based coverage, especially during the recession at the end of the decade. The ACA was intended to decrease the percentage of the population without health insurance and to provide “quality, affordable health care for all.” The purpose of this brief is to consider how uninsurance rates are changing under the ACA.

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Two GOP lawmakers have introduced a bill that deviates from years of Republican health care orthodoxy by not attempting to repeal the Affordable Care Act.

Sen. Bill Cassidy (R-La.) and Rep. Pete Sessions (R-Texas) on Monday formally announced a bill that they say would cover more people than the Affordable Care Act does now. While the bill does not repeal the 2010 health care law, it would repeal both the individual and employer mandates and limits the “non-essential” products that plans would have to cover.

They aren’t being shy about how great they think their proposal is. They are calling it the “World’s Greatest Healthcare Plan.”

Although she promises to tinker with the Affordable Care Act (see below) Clinton is not proposing to fix any of its largest problems.

So what does Hillary Clinton propose to do about Obamacare? Spend more money. She proposes (1) to limit out of pocket costs to 5% of family income by offering a tax credit of up to $5,000 for spending above that amount, (2) to limit premium expenses to 8.5% of income, (3) to fix the family glitch, whereby dependents who are offered unaffordable coverage at work are barred from the exchange and (4) to spend more money to enroll people in Medicaid.

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Earlier this week, as was widely reported, Judge Rosemary Collyer of the District of Columbia District Court prohibited the Obama administration from continuing to divert money Congress had appropriated for federal tax refunds to instead pay insurance companies billions of dollars in “cost sharing reductions,” part of the Affordable Care Act.

The decision affects more than just the cost sharing reduction program. Just as a teaser, if upheld on appeal – and expect this case to get to the United States Supreme Court – the decision means that some high level Obama administration officials run a serious risk of criminal charges being brought against them should a subsequent President and Attorney General be motivated to pursue them.

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Let’s face it: When it comes to products most of us buy, health insurance is one of the least popular. And new survey results from the Kaiser Family Foundation out Friday morning find that sentiment reaching new lows.

Kaiser’s Larry Levitt said it makes perfect sense why consumers are feeling cranky about their coverage. “People are paying more, and in many cases getting less,” he said. The most obvious reason people aren’t psyched, Levitt said, is due to the explosion in health plans with high deductibles.

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