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

States increased their spending in fiscal year 2015 by the biggest margin in more than 20 years, but most of the increase was thanks to huge leaps in Medicaid spending under the first full year of the Affordable Care Act. Spending increased last fiscal year, which ended on June 30 for most states, by 7.8 percent, according to new estimates from the National Association of State Budget Officers (NASBO).

Tax-advantaged healthcare Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are at risk of being gutted because of ObamaCare’s Cadillac tax, warns the Employers Council On Flexible Compensation. The employers are asking employees to call on Congress to repeal the Affordable Care Act’s Cadillac tax on benefit-rich health plans, or at the very least to exempt employees’ contributions to these accounts from the Cadillac tax calculation.

Whether it is the Centers for Medicare and Medicaid Services (CMS) determining which treatments and technologies are worth covering and how much they are willing to reimburse for them; the Agency for Healthcare Research and Quality (AHRQ) mandating quality and safety standards; or the new Affordable Care Act exchanges setting the standard for benefit packages throughout the health insurance market, it is clear that government agencies and their mandates play a powerful role in guiding the provision of health benefits and the overall construct of the market.

The CEO of UnitedHealth, the nation’s largest health insurer, said on Tuesday he regretted the decision to enter the ObamaCare marketplace last year, which the company says has resulted in millions of dollars in losses. “It was for us a bad decision,” CEO Stephen Hemsley said at an investor’s meeting in New York, according to Bloomberg Business. UnitedHealth announced last month that it would no longer advertise its ObamaCare plans over the next year and may pull out of the exchanges completely in 2016.

Despite the individual mandate and massive new government subsidies delivered directly to insurers, many participating insurers, whose continued participation is essential to the the Affordable Care Act’s future, are losing substantial money. In order to assist those insurers, the administration is now seeking a taxpayer-financed bailout for them. Congress can block taxpayer funds from being used for this purpose by extending language contained in the 2015 government funding bill.

Over the last few years, Kentucky captured the nation’s attention by wholly embracing the health care law and expanding Medicaid under the Affordable Care Act. Now, with Governor-elect Matt Bevin promising to “repeal the expansion as it currently exists,” Kentucky may become a laboratory for the kind of rollback that the law’s opponents have so far only dreamed of.

The demise of Health Republic, the largest of the nonprofit cooperatives created under ObamaCare, left its more than 215,000 enrollees scrambling to find new insurance. But New York’s physicians and hospitals say the shutdown has left them, too, in a lurch. The Medical Society of the State of New York, a physician’s association, said of 800 doctors surveyed, 43% have claims unpaid by the insurer. Of these, 18% said they were owed $25,000 or more.

Tara O’Neill of the American Action Forum argues that the decision over how biosimilars should be reimbursed by the Centers for Medicare & Medicaid Services (CMS) should be determined by economic principles based on the value of the medication to patients and without putting patient safety and access to such products at risk. If the statutory text does not clearly provide for the favorable regulatory outcome of these factors, it should be amended.

Philip Dorsey, a retired lawyer and legal editor, recounts his experience with health insurance since the Affordable Care Act was enacted. Mr. Dorsey has been forced out of his plan each New Year’s Day since 2012.

“In the first year I got a glimpse of how reform reduced coverage for the many on the group health plans offered by large corporations to their employees. In the second year I saw how it had similar effects on the owners and employees in small businesses that obtain group plans through professional or trade associations. In the third year I would see how individuals who lost group insurance coverage were affected when forced into the individual market.”

The Affordable Care Act reordered the legal framework to let a president impose price restrictions unilaterally through the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. These executive-branch bodies were crafted to control what procedures doctors perform, but there is reason to believe they can also control drug prices.