Articles on the implementation of ObamaCare.

In February of 2015, IRS issued Notice 2015-16 which was intended to discuss a number of potential approaches to the implementation of pieces of the tax. At the time, IRS requested comment on a number of issues including the definition of applicable coverage, how to figure the cost of that coverage, and the caps used to calculate the tax.

In July of 2015, IRS issued Notice 2015-52 (downloads as a pdf) to address even more concerns, including who may be liable for the tax, employer aggregation, allocation of tax and payment of the tax. Here are some of the highlights with a little bit of commentary:

One of the last remaining features of the Affordable Care Act (ACA) that has yet to be implemented is the so-called “Cadillac tax,” which takes effect in 2018. Section 4980I will impose a 40 percent excise tax on employee benefits the cost of which exceeds certain statutory limits. The Cadillac tax is intended to limit the generosity of employer coverage on the theory that excess coverage encourages excess health care expenditures and thus drives up the total cost of health care. The tax is also, however, one of the major anticipated sources of revenue under the ACA, expected to raise $87 billion over the next 10 years.

Fed up with the insurance industry, Democrats used the health care overhaul to create nonprofit co-ops that would compete with the corporations. Now a government audit finds co-ops are awash in red ink.

Only one out of 23 — the co-op in Maine — made money last year, said Thursday’s report from the Health and Human Services inspector general’s office. Thirteen lagged far behind their sign-up goals for 2014.

As Medicare and Medicaid reach their 50th anniversary on Thursday, the two vast government programs that insure more than one-third of Americans are undergoing a transformation that none of their original architects foresaw: Private health insurance companies are playing a rapidly growing role in both.

This Viewpoint discusses 4 key changes that could improve the Affordable Care Act and create broad support across the states.

The Affordable Care Act (ACA) is best seen as transitional legislation on the road to long-term structural reform of the US health care system. This is not so much because the ACA is politically controversial and there is bound to be pressure for changes, despite the US Supreme Court’s King v Burwell decision,1 but rather it is because the ACA’s design still lacks the consistent, strategic building blocks needed for a stable, long-term system redesign.

Neither Republicans nor Democrats have spent much time, at least not in public, discussing changes to the Affordable Care Act (ACA) that could refine or improve the legislation. Republicans have mostly focused on strategies to repeal the ACA, which, even with their control of the House and Senate, appears highly unlikely because they could not muster the 67 votes needed to override a presidential veto. Democrats, while privately acknowledging there are changes that could improve the legislation, have publicly devoted most of their energies to defending the ACA.

Welfare: During the debates on ObamaCare, Medicaid got little attention. That was a mistake, since enrollment and the cost of treating all those jumping onto the program is surging beyond expectations.
At first, ObamaCare tried to force states to expand eligibility for Medicaid by including childless adults and people with incomes 38% above the poverty line. In 2012, the Supreme Court blocked this attempt, making expansion optional for states.

Last week, Alaska became the 30th state to expand Medicaid with federal funding from the Affordable Care Act. “Alaska and Alaskans cannot wait any longer,” said Gov. Bill Walker. “We‘re not going to step away from this opportunity to help fellow Alaskans, period.”

Across the country, governors and state lawmakers have circled “2017” on their calendars. This is the first year that the enhanced federal funding for Obamacare’s Medicaid expansion starts to fade away and states will have to scramble to find new funds to pick up their share of the expense. As it turns out, “free money” comes at a cost.