Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.

The Department of Health and Human Services (HHS) administers the 3-year transitional reinsurance program established under section 1341 of the Patient Protection and Affordable Care Act. The program, which is financed by statutorily required contributions from participating health insurance issuers and group health plans, makes payments to eligible issuers, to stabilize health insurance premiums and encourage issuer participation in the health insurance markets. Section 1341 designates a specified amount of collections from issuers for reinsurance payments and also directs the deposit of a specified amount of collections in the general fund of the United States Treasury (Treasury). HHS asserts that when collections fall short of the amounts specified in statute the agency has authority to allocate all collections for reinsurance payments, making deposits in the Treasury only if collections reach the amounts specified for reinsurance payments in section 1341. HHS lacks authority to ignore the statute’s directive to deposit amounts from collections under the transitional reinsurance program in the Treasury and is required to collect and deposit amounts for the Treasury, regardless of whether its collections fall short of the amounts specified in statute for reinsurance payments. HHS may not use amounts collected for the Treasury to make reinsurance payments.

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The Obama administration failed to follow the president’s health care law in a $5 billion dispute over compensating insurers for high costs from seriously ill patients, Congress’ investigative arm said Thursday.

The opinion from the Government Accountability Office is a setback for the White House and bolsters Republican complaints that administration officials bent the law as problems arose carrying out its complex provisions. The finding may complicate efforts to stabilize premiums in the law’s insurance marketplaces, where about 11 million people get coverage.

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Vermont did not properly allocate millions of dollars in federal grants when establishing its marketplace created under the Affordable Care Act, a report released Tuesday by the Department of Health and Human Services Office of Inspector General said.

Vermont’s Agency of Human Services did not always follow federal requirements for allocating costs to establishment grants to establish its marketplace or for drawing down establishment grant funds, the report says.

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Medicaid expansion will not cure hospitals’ financial woes, according to a report released by the Congressional Budget Office. To put it bluntly, hospitals made a horrible deal by endorsing Obamacare in 2009. They agreed to annual reductions in their Medicare payments forever in exchange for a one-time increase in the number of insured patients. But Medicaid’s payment rates are below hospitals’ average costs, [and] the use of hospitals’ services among the newly insured will increase by about 40 percent as a result of having insurance.” If Medicaid pays hospitals less than their average costs, then inducing additional patient demand by expanding coverage could actually exacerbate hospitals’ shortfalls, not improve them.

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Legislative auditors said Wednesday they can’t confirm that the Medicaid application backlog numbers state officials have reported are correct.

Applications have been backlogged for about a year following the rocky rollout of a new computer system, an administrative decision that funneled all applications through a single state agency and a larger-than-expected influx of applications during the Affordable Care Act open enrollment period.

The auditors said the Kansas Department of Health and Environment gets the backlog number from Accenture, the contractor that built the new software platform known as the Kansas Eligibility Enforcement System, or KEES.
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A post-election fight about giving extra money to Obamacare insurance plans is brewing on Capitol Hill, following a summer of bad news for insurers. The conservative group Freedom Partners launched a campaign Thursday aimed at blocking an “insurer bailout,” which some fear is poised to occur in the final months of the Obama administration. The group is launching a website, BustTheBailouts.com, which it says will provide information to taxpayers and lawmakers about how insurers are lobbying for a bailout. They will also launch a series of videos and meet with lawmakers to advocate their cause.

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House Republicans on Wednesday jumped on rising premium rates and co-op closures to slam the Affordable Care Act, while Democrats lamented another hearing not focused on fixes to the Affordable Care Act.

At a joint Energy and Commerce subcommittee hearing, Republicans raised concerns about how rising premiums have affected their constituents, as well as the potential for fraud under the Obamacare exchanges. The subcommittee released a slate of reports earlier this week that slammed the future sustainability of the federal and state-based exchanges.

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The state-run insurance marketplaces created under the Affordable Care Act may not be sustainable, a GOP report released Tuesday by a House committee concludes.

The Energy and Commerce Committee report concludes that the $5 billion the federal government committed to building state-based exchanges has resulted in a failed experiment, and says that none of the exchanges are currently financially self-sustaining. The report comes ahead of a hearing Wednesday on the Affordable Care Act called by the committee’s health and oversight subcommittees.

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Five Senators are questioning Aetna’s decision to retreat from nearly a dozen Obamacare markets next year and how the decision is tied to the federal government’s attempt to block its proposed merger with Humana, which is being challenged by a Department of Justice antitrust lawsuit.

Sens. Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), Ed Markey (D-Mass.), Sherrod Brown (D-Ohio) and Bill Nelson (D-Fla.) sent a letter to Aetna CEO Mark Bertolini Thursday questioning the insurers’ change in perspective about its participation in the Obamacare exchanges this summer after the Department of Justice sued to block the proposed merger.

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Leading progressive senators are demanding an explanation from the insurance giant Aetna about its abrupt decision to pull out of most ObamaCare exchanges this year, which they said appeared to be politically motivated.

Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) announced Thursday they are launching a probe into Aetna, which bailed on ObamaCare just weeks after the Justice Department moved to block its multi-billion merger with another top-five insurer.

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