Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
A federal judge denied the Obama administration’s request to pause a risk-corridor case brought by Portland, Ore.-based insurer Moda Health until courts rule on similar lawsuits.
Moda Health sued the government in June for $191 million in payments owed under the Affordable Care Act’s risk-corridor program for 2014 and 2015. The CMS has paid just $11.3 million so far, and recent data from the CMS further shows that Moda is set to receive only $2.9 million on top of that from the funds collected under the program for 2015.
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New York may have misallocated roughly $150 million in Obamacare grants, the Department of Health and Human Services Office of the Inspector General said Tuesday. The watchdog office says the state should refund any misspent money to the federal government.
HHS OIG found the state did not have internal procedures necessary to ensure federal funding was allocated properly to set up the state’s Affordable Care Act insurance exchange.
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A new study by Jonathan Gruber, one of the ACA’s chief architects, suggests that roughly two-thirds of new Medicaid enrollees in 2014 were eligible for the program under previous state eligibility criteria—meaning that they were not made eligible by the ACA. Gruber’s results, combined with much higher than expected Medicaid enrollment and spending over the past three years, has profound implications for the distribution of program costs and the effect of a repeal of the ACA. This means that the federal government has likely paid billions more each year than the law allows for the expansion population while states have spent billions less. Additionally, Gruber’s results suggest that if the ACA were repealed, a lot fewer people would likely lose coverage than previously thought.
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The House of Representatives has asked the Federal Court of Appeals for the D.C. Circuit to temporarily pause the House lawsuit challenging an ACA subsidy program, a move that could allow the incoming Trump administration to swiftly unwind the ACA exchanges. The House argues that the ACA did not fund payments to health insurance companies to help low-income people pay for their out-of-pocket health care costs, which the Obama administration has been paying anyway. If the court approves the request, it would allow Trump’s new administration time to decide whether it wants to keep defending a pivotal part of the health care law as it plots out a strategy to repeal the ACA. If Trump’s Justice Department doesn’t continue to defend the ACA, the subsidies could be eliminated immediately (unless Congress makes a deliberate decision to legally fund them).
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The Department of Health and Human Services finally released the 2015 Affordable Care Act risk corridor data. The data show the rapid deterioration of the ACA exchanges from 2014 to 2015.
The ACA’s risk corridor program was intended to transfer funds from profitable insurers to unprofitable ones for the first three years of the exchanges (2014 to 2016). The program ran a $2.5 billion deficit for the 2014 plan year as far more insurers incurred losses than made profits. In 2015, the deficit increased to more than $5.8 billion—a 132% increase.
If taxpayers are forced to bail out insurers for these losses, the total tab for 2014 and 2015 now exceeds $8.3 billion. If insurers’ experience in 2016 tracks what happened in 2015, the total 3-year risk corridor deficit will exceed $14 billion. The Obama administration has given mixed signals about whether it will tap taxpayer funds to bail out insurers for these losses. We now know just how much money is at stake.
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President-elect Donald Trump says he wants to preserve health insurance coverage even as he pursues repeal of the Obama-era overhaul that provided it to millions of uninsured people.
How his administration handles a pending lawsuit over billions of dollars in insurance subsidies will reveal whether Trump wants an orderly transition to a Republican-designed system or if he’d push “Obamacare” over a cliff. Stripping away the subsidies at issue in the case would put the program into a free-fall.
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House Democrats argue in an amicus brief filed Monday that a lawsuit brought by House Republicans against the Obama administration over the Affordable Care Act should not have standing in court.
Led by House Minority Leader Nancy Pelosi, 11 top Democrats filed the brief arguing the dispute should not be settled in court, but that even if the case has standing, the Obama administration acted lawfully by reimbursing insurers for cost-sharing reductions under the Affordable Care Act.
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House lawmakers are angry that one of the last taxpayer-funded Obamacare plans wants to move to for-profit status, saying that the millions of dollars provided in startup loans were meant to go to nonprofits.
Republican leaders of the House Ways and Means Committee wrote to the Obama administration and the Maryland consumer-oriented and operated plan Evergreen Health, which wants to become a for-profit health insurer.
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WikiLeaks published a memo dated November 23, 2015 about serious problems with the Affordable Care Act from Chris Jennings, the former Deputy Assistant to President Obama for Health Policy, to presidential candidate Hillary Clinton and John Podesta, the chairman of her campaign. Team Clinton’s private assessment of the problems bedeviling the ACA—that enrollment has fallen short of expectations, that the participant pool is much sicker than expected, and that the ACA’s risk corridor program lacks sufficient funds and authority to bail out participating insurers—markedly resembles that of skeptical outside analysts.
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House Republicans are wading into the heated legal battle between the White House and several insurers that claim they are owed money under ObamaCare.
The House GOP announced Friday it has filed a brief in a major ObamaCare lawsuit that involves a multibillion-dollar shortfall in a fund intended to cushion health insurers from financial losses under the law.
The $5 billion class-action lawsuit was filed by the now-shuttered insurance company called Health Republic of Oregon. It is one of about a dozen companies that have sued over the still-delayed payments, which they say crippled their businesses.
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