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

Health insurers in New Mexico and other states are gearing up for a legal fight with the Obama administration over millions of dollars the insurers both owe and are owed under separate provisions of the Affordable Care Act (ACA).

New Mexico Health Connections, the state’s Consumer Operated and Oriented Plan, or CO-OP, confirmed to The Hill that it is working with lawyers to frame lawsuits on both ObamaCare’s risk-adjustment and risk-corridor provisions, which make up two of the so-called three Rs of the ACA’s premium stabilization program.

. . .

Today, the Department of Health and Human Services (HHS) issued an analysis of Affordable Care Act (ACA) exchange plan deductibles. Because the analysis presents data in a misleading way, it draws inaccurate conclusions about the current status of the ACA. This short post provides readers with key missing pieces.

Although it is more common to present the average than the median in statistical analysis, showing both is often done to describe the data being presented. HHS’ analysis relied exclusively on the median plan deductible ($850) and did not include the weighted average plan deductible.

. . .

The battle between congressional Republicans and the White House over the Affordable Care Act is again escalating—in court and on Capitol Hill.

The administration on Wednesday appealed a federal trial judge’s ruling that the government is improperly reimbursing insurers under a program to cover discounts for low-income consumers.

And House Republicans on Thursday began two days of hearings to hammer away at the issue. They released a report that said the administration distributed the funds even though it was aware it needed Congress’s approval.

. . .

An investigation by House Republicans argues that the Obama administration is illegally making certain payments under ObamaCare and that officials initially recognized they did not have authority to do so before reversing course.

House Republicans argue that the administration is unconstitutionally making ObamaCare’s “cost sharing reduction” payments to insurers — which help lower out-of-pocket healthcare costs for low-income ObamaCare enrollees — without a congressional appropriation.

. . .

House Republicans on Thursday released an investigative report and held the first of two hearings questioning the legality of Obamacare’s cost-sharing reduction program. That program is also the subject of a House lawsuit against the administration.

At issue is whether the cost-sharing program is legally funded. House Republicans, through an investigation conducted by the Ways and Means and Energy and Commerce committees, concluded that the health care law does not provide funding for the cost-sharing program.

. . .

Republicans and Democrats continued to talk at each other Friday about Obamacare’s cost-sharing reduction program in an Energy and Commerce oversight subcommittee hearing.

The hearing was the second in two days following the release of a GOP report claiming that payments to the administration’s program were made illegally.

Republicans suggested that the way the payments have been handled sets a dangerous precedent for the future and nullifies Congress’s power of the purse. Democrats chalked the investigation up as yet another GOP attempt to sabotage the Affordable Care Act. They also said since there is already a court case on the matter, Congress doesn’t need to do its own investigation.

. . .

The Obama administration knowingly spent billions in health care dollars without proper congressional authority and went to “great lengths” to impede congressional scrutiny of the money, Republicans on two major House committees said in a report that will be made public on Thursday.

An extensive investigation by the Ways and Means and the Energy and Commerce Committees concluded that the administration plowed ahead with funding for a consumer cost-reduction program that was central to the new health insurance law even though Congress did not provide money for it.

. . .

The Obama administration has been illegally funding Obamacare “Cost Sharing Reduction” (CSR) payments for years over the objections of IRS officials, according to a report released today by the House Ways and Means Committee and the House Energy and Commerce Committee.
Key findings:

-The administration initially submitted a CSR appropriations request for Fiscal Year 2014, but later withdrew it and began making payments illegally.

-CSR payments were created as one way to artificially hide the true costs of Obamacare through a web of government spending programs.

-After officials from the Obama Department of Health and Human Services (HHS) withdrew the CSR appropriations request, the administration begun illegally shifting funds from a separate appropriation.

-IRS officials expressed concern that this method of funding CSR payments was illegal so were briefed on the memorandum.

-Following this meeting, IRS officials continued to have concerns that the CSR payments violated federal law and raised concerns with IRS Chief John Koskinen.

-Shortly thereafter, DoJ and Treasury officials officially approved the decision to use an unrelated appropriation to make CSR payments.

 

With insurers struggling to make money and access to plans severely limited, top South Carolina health officials warn the Obamacare health insurance marketplace is on the verge of collapse.

Obamacare was supposed to create a competitive platform for customers to shop for coverage. But in most South Carolina counties, HealthCare.gov more closely resembles a monopoly dominated by the largest private health insurance company in the state — BlueCross BlueShield.

Next year, access to Obamacare in South Carolina will likely become even more limited. United Healthcare, which sells Affordable Care Act plans in five counties and in several other states, has announced it will leave most markets in 2017. The company estimates it lost $475 million on Obamacare customers across the country last year.

. . .

Insurers from Oregon to Pennsylvania, including a failed health-care co-operative and two long-established Blues plans have lost billions of dollars selling Obamacare policies. Now they are suing the federal government to recoup their losses. In a testament to industry desperation, insurers are asking federal judges to simply ignore a congressional ban on the payment of these corporate subsidies.

The regulatory atrocity that is Obamacare inspired this race to the courthouse. Despite billions in subsidies — to both low-income individuals and well-capitalized insurance companies — the industry has incurred big losses in the individual market.

In a paper published June 28 by the Mercatus Center, Brian Blase (Mercatus), Ed Haislmaier (Heritage Foundation), Seth Chandler (University of Houston), and Doug Badger (Galen Institute) used data derived from insurance-company regulatory filings to determine the extent and source of those losses. The study examined the performance of 174 insurers that sold qualified health plans (QHPs) in 2014 to both individuals and small groups (generally companies with 50 or fewer workers).

. . .