Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
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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Former Obama administration official Donald Berwick once called the Center for Medicare and Medicaid Innovation (CMMI) “the jewel in the crown of health-care reform.” The metaphor is apt: CMMI, more than any other aspect of Obamacare, is an imperial enterprise.
Congress established CMMI in the Obamacare statute with the goal of finding ways to reduce federal spending on medical care without diminishing its quality. That, of course, is the responsibility of Congress, which created the Medicare program and which alone bears responsibility for making legislative changes to it.
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Our constitutional system was carefully designed to prevent any one branch from seizing too much control over the entire government. Only Congress can write legislation; only the President can execute the laws; only the courts can judge whether the laws are constitutional.
This balance of powers, however, does not maintain itself. It is a dynamic equilibrium requiring each branch of government to protect and fully exercise its rightful authorities. When one branch encroaches on another, that balance is endangered — and so are the freedoms the separation of powers were intended to protect.
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The Obama administration proposed this week new rules for its Risk Adjustment program, a critical component of the Affordable Care Act. There are actually some better-late-than-never parts of the proposal. Most notably the new rules will try to compensate for the extra expense insurers incur when people exploit ACA regulatory and enforcement weaknesses to time their insurance purchases to cover only expensive medical emergencies.
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When is a government program not a government program?
When the insurance industry says it isn’t.
In its effort to keep billions in unlawful ObamaCare corporate subsidies flowing, the industry is trying to persuade Congress that it receives no federal funds through the federal “reinsurance” program. Good luck with that.
The ObamaCare statute established the temporary, three-year (from 2014 to 2016) reinsurance program for two purposes: 1) to provide $5 billion to the Treasury; and 2) to provide $20 billion to issuers of individual ObamaCare policies.
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Most health policy experts knew, and many warned, that the Affordable Care Act would lead to massive consolidation in the health care industry, including hospitals, physicians’ practices, and especially health insurers. Now the Justice Department is pushing back by opposing the mergers of four large health insurers—Aetna with Humana and Anthem with Cigna—as they try to survive the Obamacare wasteland.
The Obama administration defended its opposition by claiming the mergers would reduce competition.Attorney General Loretta Lynch explained, “If allowed to proceed, these mergers would fundamentally reshape the health insurance industry.” That’s rich, since nothing has reshaped the health insurance industry more than Obamacare—and by design.
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A company that offers health insurance plans in New Hampshire under the Affordable Care Act is suing the federal government over a part of the health care law.
The lawsuit from Minuteman Health aims to block the current form of the federal Risk Adjustment program, which aims to stabilize the health care market by spreading the costs that come from covering sicker people among insurers with healthier clients.
CEO Tom Policelli says what’s actually happened is that health care co-ops like Minuteman pay millions to their larger competitors that offer more expensive plans.
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Two more health cooperatives have filed lawsuits against the Obama administration over a program in which insurers compensate each other for taking on sicker customers under the Affordable Care Act, following a similar lawsuit in June from another startup company.
New Mexico Health Connections and Minuteman Health of Massachusetts filed their cases on Friday afternoon, arguing the Obama administration mismanaged the program known as “risk adjustment” by creating an inaccurate formula that overly rewarded big insurers.
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Things have gone from bad to worse for the Affordable Care Act’s health-care co-op experiment.
Maryland’s co-op, Evergreen Health, filed a first-of-its-kind lawsuit in June against the federal government claiming that private insurers have gamed the system to avoid making “risk adjustment payments.” Under the ACA, insurers with healthier members must make these payments to insurers with unhealthier members. But Evergreen CEO Peter Beilenson argues that his co-op was unfairly labeled as healthier because private insurers encouraged their less healthy members to go to the doctor so their patient pools would appear less healthy. Evergreen is now expected to owe between $18 million and $22 million in risk adjustment payments.
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Senior Obama administration officials took a series of decisions beginning in late 2013 that ranged from the reckless to the illegal in an effort to keep insurers participating in health insurance exchanges.
The program — known as cost-sharing reduction (CSR) — requires insurers to reduce deductibles and other out-of-pocket spending for certain low-income people who signed up for coverage through health insurance exchanges. In turn, the statute authorized the administration to seek an appropriation from Congress to reimburse insurers for the cost of providing these coverage enhancements.
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