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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Last week, the comptroller general — the government’s chief accountability officer — issued an official statement that the administration has been sending unlawful payments to insurance companies through the ACA’s reinsurance program. These payments have totaled $3 billion thus far and have forced taxpayers to finance a larger part of insurers’ most expensive enrollees’ claims.
The U.S. House of Representatives filed suit against the administration for unlawful payments through another ACA program. These payments are to insurers for them to make plans more attractive by reducing enrollees’ deductibles and cost-sharing amounts. Congress never appropriated funds, yet the administration has paid insurers at least $10 billion through this program thus far.
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Republicans in Congress are plotting ways to block the Obama administration from paying insurance companies hundreds of millions of dollars as part of an ObamaCare program.
GOP lawmakers say they are looking at “a dozen” options — including a possible provision in the year-end spending bill — to prevent the administration from using an obscure fund within the Treasury Department to pay out massive settlements to insurers.
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The Obama administration is seeking to toss out a pair of high-profile healthcare lawsuits in which insurers claim they are owed millions of dollars under the Affordable Care Act.
The two insurers, Moda Healthcare and BlueCross BlueShield of North Carolina, have sued the federal government over a combined $338 million in ObamaCare payments they argue are overdue.
The Justice Department filed motions to dismiss both lawsuits on Friday, arguing that the federal government isn’t responsible for those payments at all.
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Congressional Republicans are warning the Obama administration not to settle with insurers that have sued the government over an Affordable Care Act program to compensate them for losses under the law, saying such a move would bypass spending limits set by Congress.
Forty-six House Republicans signed a letter sent Thursday to Health and Human Services Secretary Sylvia Mathews Burwell saying they oppose any settlements and could sue the administration to block them.
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New York has revolted against a critical component of the Affordable Care Act: RiskAdjustment. If its revolt survives an almost certain legal challenge, a number of states are likely to double down on New York’s actions and remove one of the few remaining fingers holding Obamacare on to a cliff.
Acting under direction of its new Superintendant of Financial Services, Maria Vullo, New York has joined the chorus of those familiar with the program in contending that the federal Risk Adjustment program is backfiring. Critics say the program transfers too much money amongst insurers and is actually destabilizing the market. New York is the first state, however, to put money behind the critique.
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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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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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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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The implementation of major legislation such as the Affordable Care Act (ACA) often results in fiscal outcomes that differ significantly from prior projections. Whenever this happens it leads to many questions, much confusion, and several claims and counter-claims. Rarely is it immediately clear whether the law is working differently than envisioned, or whether the unexpected outcomes are due to inevitable projection errors having nothing to do with the law.
On rare occasion, however, a prior projection proves so far off that its significance must be noted. Two weeks ago my colleague Brian Blase uncovered such a development with respect to the ACA’s Medicaid expansion. Recall that the ACA considerably expanded Medicaid eligibility – an expansion made optional for the states in a later Supreme Court ruling. It turns out that the 2015 per-capita cost of this Medicaid expansion is a whopping 49% higher than projections made just one year before.
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