With almost half of the U.S. population using prescription medications, expensive sticker prices on certain medications have led policymakers to address drug prices through proposed legislation and regulation. This paper examines the various factors that influence how drugs are priced–including regulatory burdens and health care payment models–in order to provide an understanding of these prices in the larger picture of American health care.

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The implementation of ObamaCare has caused private health insurance to increase premiums and deductibles to meet both shifting market demand and regulatory compliance, largely passing on these added costs to the American people. Continuing to expand the program, as Hillary Clinton suggests, will most certainly force greater government control into our health care system. With this we will not only see a serious reduction in private sector insurer options, but also the introduction of longer wait times, wait lists, and limits on pharmaceutical innovation as evidenced in closed, government-run health care systems around the globe.

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A few weeks back, I noted that a judge had ruled against the Obama administration in a dispute over health-insurance subsidies. Some background: Obamacare makes insurers reduce out of pocket costs, like deductibles, to low-income people who purchase qualifying plans; the government is supposed to reimburse the companies directly. However, Congress didn’t appropriate any money to pay for these subsidies. When the administration went ahead and paid the insurers anyway — distributing about $7 billion without congressional approval — House lawmakers sued.

Now it appears that House Republicans, and Judge Rosemary Collyer, aren’t the only folks who thought the administration’s actions were questionable. A report in the New York Times this weekend says that IRS officials raised concerns that the administration had no legal authority to spend the money.

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California is moving to become the first state to allow unauthorized immigrants to purchase insurance through the state exchange. The state Assembly voted Tuesday to open up Covered California to immigrants living in the U.S. illegally who want to purchase a health plan with their own funds.

SB 10, sponsored by Democratic state Sen. Ricardo Lara from southeast Los Angeles County, would authorize the state to apply for a federal waiver to make the change. The state Senate voted to pass the measure last June and an April staff report from Covered California also expressed support for the move.

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UnitedHealthcare will stop offering Affordable Care Act plans in Illinois in 2017, the Tribune confirmed Tuesday.

The departure of the insurance company will reduce the number of coverage options for consumers in 27 counties.

UnitedHealthcare announced in April that it would pull out of nearly all of the ACA exchanges because of heavier-than-expected losses from covering a population that turned out to be sicker than it expected. The ACA plans, which the company offered in 34 states this year, are a small share of UnitedHealthcare’s total business.

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House Republicans and the Obama administration are clashing over subpoenas for ObamaCare documents. Republicans are upping the pressure on the administration, saying officials are withholding documents that Congress has every right to see.

At issue are two separate portions of ObamaCare. One is the Basic Health Program, which states can choose to implement and is aimed at providing choices for low-income people with slightly too much income to qualify for Medicaid. The other is the law’s “cost-sharing reductions” which are payments that help lower out-of pocket-costs for low-income ObamaCare enrollees.

“Your refusal to provide the requested documents and information raises serious concerns about the Department’s willingness to be accountable for the lawful execution of laws passed by Congress,” Energy and Commerce Chairman Fred Upton and House Ways and Means Chairman Kevin Brady wrote to Health and Human Services Secretary Sylvia Mathews Burwell on Tuesday.

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Yesterday, the New York Times detailed the highly irregular manner preceding the administration’s decision to make the CSR payments once Congress refused to grant the White House’s request for an appropriation. Despite strong disagreements over the legality of these payments among IRS employees, top political appointees with the administration, including then-Attorney General Eric Holder and Treasury Secretary Jack Lew, signed off.

At a congressional deposition, David Fisher, an IRS financial risk officer at the time, testified that the process behind the authorization of the CSR payments was unusual. Moreover, he testified that the “cost-sharing reduction payments are not linked to the Internal Revenue Code, as far as I could tell, directly anywhere. There is no linkage to the permanent appropriation, nor is there any link to any other appropriation that was indicating what account these funds should be paid from.”

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The not-for-profit insurers that are planned to form the backbone of the Obamacare exchanges, including the Blues health plans, reported yesterday that they lost a lot of money in the first quarter of 2016. It was the same day that United Healthcare announced that it was pulling out entirely from the California exchanges–a state that many Obamacare acolytes held up as a model for the law’s successful execution.

In statutory filings that they posted this month, the not-for-profit health plans showed an average negative net margin of -2.5% during the first quarter of 2016. AIS Health Plan Week revealed the data on 41 not-for-profit plans. Credit Suisse reported on those results in a report issued yesterday. The total net losses among the 41 health plans approached a whopping $1.5 billion for the quarter.

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UnitedHealth Group Inc. is leaving California’s insurance exchange at the end of this year, state officials confirmed Tuesday.

The nation’s largest health insurer announced in April it was dropping out of all but a handful of 34 health insurance marketplaces it participated in. But the company had not discussed its plans in California.

UnitedHealth’s pullout also affects individual policies sold outside the Covered California exchange, which will remain in effect until the end of December.

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On Jan. 13, 2014, a team of Internal Revenue Service financial managers piled into government vans and headed to the Old Executive Office Building for what would turn out to be a very unusual meeting.

 

The clandestine nature of the session underscores the intense conflict over Obamacare spending, which is the subject of a federal lawsuit in which House Republicans have so far prevailed, as well as a continuing investigation by the Ways and Means and the Energy and Commerce Committees. It also shows that more than six years after President Obama signed the Affordable Care Act into law, Republican opposition has not waned.

After failing to win congressional approval for the funds, the Obama administration spent the money anyway and has now distributed about $7 billion to insurance companies to offset out-of-pocket costs for eligible consumers. The administration asserts that the health care legislation provided permanent, continuing authority to do so, and that no further appropriation was necessary.

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