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

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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For months during the Democratic presidential nominating contest, Hillary Clinton has resisted calls from Senator Bernie Sanders to back a single-payer health system, arguing that the fight for government-run health care was a wrenching legislative battle that had already been lost.

But as she tries to clinch the nomination, Mrs. Clinton is moving to the left on health care and this week took a significant step in her opponent’s direction, suggesting she would like to give people the option to buy into Medicare.

“I’m also in favor of what’s called the public option, so that people can buy into Medicare at a certain age,” Mrs. Clinton said on Monday at a campaign event in Virginia.

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Sen. Bernie Sanders has proposed paying for his policies that transform large sectors of the government and the economy mainly through increased taxes on wealthy Americans. A pair of new studies published Monday suggests Sanders would not come up with enough money using this approach, and that the poor and the middle class would have to pay more than Sanders has projected in order to fund his ideas.

The studies, published jointly by the nonpartisan Tax Policy Center and the Urban Institute in Washington, concludes that Sanders’s plans are short a total of more than $18 trillion over a decade. His programs would cost the federal government about $33 trillion over that period, almost all of which would go toward Sanders’s proposed system of national health insurance. Yet the Democratic presidential candidate has put forward just $15 trillion in new taxes, the authors concluded.

Using a combination of subsidized premiums for Marketplace coverage, an individual mandate, and expanded Medicaid eligibility, ObamaCare has increased insurance coverage rates. The authors of this study assess the relative contributions to insurance changes of these different provisions in the law’s first full year.

Their four key findings include:

  1. Insurance coverage was only moderately responsive to price subsidies, but the subsidies were still large enough to raise coverage by almost one percent of the population; the coverage gains were larger in states that operated their own health insurance exchanges (as opposed to using the federal exchange).
  2. The exemptions and tax penalty structure of the individual mandate had little impact on coverage decisions.
  3. The law increased Medicaid coverage both among newly eligible populations and those who were previously eligible for Medicaid (the “woodwork” effect), with the latter driven predominantly by states that expanded their programs prior to 2014.
  4. There was no “crowdout” effect of expanded Medicaid on private insurance. Overall, we conclude that exchange premium subsidies produced roughly 40% of the ACA’s 2014 coverage gains, and Medicaid the other 60%, of which 2/3 occurred among previously-eligible individuals.

More Democrats seem to be having doubts about the federal health care law, a contentious issue for most of President Barack Obama’s tenure and one of the defining elements of his legacy.

With the administration counting down its final year, Sen. Bernie Sanders’ call for “Medicare for all” appears to have rekindled aspirations for more ambitious changes beyond “Obamacare.”

That poses a challenge for Hillary Clinton, who has argued that the health care law is working and the nation should build on it, not start over.

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