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

Vermont’s top financial regulator has no regrets about being the nation’s only state insurance commissioner to refuse to license an Obamacare co-operative. Susan L. Donegan was commissioner for Vermont’s Division of Insurance in 2013 when she refused to issue a license to the proposed Vermont Health CO-OP, saying it failed to meet state standards. Her action barred the Obamacare non-profit from selling health insurance in the state.

In late September, the handful of CEOs leading Affordable Care Act-funded consumer operated and oriented plans traveled to Denver in search of answers. The past year had been a difficult one. Their companies were struggling, awash in red ink and facing a mounting list of operational challenges. A few co-ops had already shut down, and regulators were circling several more. The fledgling health insurers needed more support from the Centers for Medicare & Medicaid Services if they were going to survive. Most importantly, they needed a lot more money.

The Senate is going to have to re-write portions of the House-passed reconciliation bill after the parliamentarian said the legislation violated Senate rules. Senate parliamentarian Elizabeth MacDonough ruled Tuesday afternoon that sections repealing the ACA’s individual and employer mandates would not meet the Senate’s criteria for the expedited process, called reconciliation.

Until Carly Fiorina criticized Obamacare during Tuesday’s prime-time Republican debate, there hadn’t been much attention to health care in the GOP debates. During last week’s Democratic candidate forum in South Carolina, I didn’t detect a single question about health care or the Affordable Care Act. This is not a knock on hosts and moderators; debates and forums such as the Democratic meeting last week are not the best vehicles for drawing out presidential candidates on the intricacies of health policy. The result, however, is that the public is not learning much from these widely viewed events about what candidates would do regarding one of the country’s most divisive issues should he or she be elected president.

As gridlock persists in our nation’s capital and good legislation continues to die in the Senate, it is clear the next president will play a key role in determining the future of Obamacare. That means candidates’ positions on the issue will be among the most important when ballots are cast next year.

A total of $1.23 billion in federal taxpayer dollars has now been sunk in 12 of 23 co-ops created under Obamacare that have gone out of business, representing another Obamacare failure, lawmakers say. Co-ops in Arizona and Michigan went out of business last week, adding themselves to the 10 that have already failed in Utah, Kentucky, New York, Nevada, Louisiana, Oregon, Colorado, Tennessee, South Carolina, and a co-op that served both Iowa and Nebraska.

Asking whether the Obamacare Cadillac tax will increase worker wages might seem nonsensical on its face. But wait until you hear the answer: yes AND no. Don’t worry: Schrodinger’s cat hasn’t wandered into the thicket of health policy (nor am I channeling my inner two-handed economist). It’s a trick question: the answer depends on whether employers respond to the Cadillac tax by trimming health benefits to avoid the tax, or instead simply keep their health benefits as is and pass the tax onto their employees. For employers who trim health benefits I have a high degree of confidence that on average, worker wages will rise. For employers who absorb the Cadillac tax increase, average worker wages will fall.

The Supreme Court agreed Friday to settle a widespread dispute between the Obama administration and religious non-profits over insurance coverage for birth control, which is sure to elevate issues of religious freedom and reproductive rights in next year’s presidential campaign.

As Congress considers year-end legislative options, one small change in the Affordable Care Act could make a big difference in access to quality health care for millions of Americans: Lifting the ban on creation and expansion of physician-owned hospitals.

Health plans that offer coverage of doctors and hospitals outside the plan’s network are getting harder to find on the insurance marketplaces, according to two analyses published this week. Two-thirds of the 131 carriers that offered silver-level preferred provider organization plans in 2015 will either drop them entirely or offer fewer of them in January, an analysis by the Robert Wood Johnson Foundation found. Those cutbacks will affect customers in 37 states, according to the foundation.