Two years in, there’s a lot we still don’t know about Obamacare. How many people will it end up insuring? What will the premiums look like? How much will the program cost?

Some of these questions won’t be answered satisfactorily for a while, if ever. Even the most basic data point, on how many people have gained coverage, comes from Gallup polls and is a little murky. The percentage of people saying they don’t have health insurance has fallen from about 17 as enrollment kicked off to about 12 now. The easing of the recession has presumably helped that.

Other answers, however, will come into focus in the next year or so. The most important being: What will the market for individual insurance look like once Obamacare is in full effect?

Details

In 2011, analysts were speculating that Assurant Health might exit the insurance business, the Milwaukee Journal Sentinel reported last week. So the recent news that Assurant’s parent company was looking to “sell or shut down” the insurance carrier by year’s end was not a total surprise. The issue now is whether its demise holds larger lessons about Obamacare’s impact on insurance markets.

One analyst called Assurant, which reported operating losses of nearly $64 million in fiscal 2014 and $84 million in the first quarter of fiscal 2015, a “casualty” of the law. The Affordable Care Act “required health plans to cover a package of basic benefits and required health insurers to spend at least 80 cents of every premium dollar on medical care or quality initiatives,” the Journal-Sentinel reported.

Details

In its next Obamacare-related decision, the Supreme Court will decide whether employers in states that chose not to establish their own Obamacare exchanges can be forced to pay penalties for not offering insurance the government deems acceptable.

The case is somewhat complicated and based on textual questions and legislative history. But if the court rules that the phrase “established by the state” means what it looks like it means, this will bring a small dose of chaos to up to 37 states that now rely on the federal exchange — the infamous healthcare.gov.

A majority of those who bought insurance from the federal exchanges in those states would no longer be eligible for the subsidies that have made the high price of Obamacare insurance less unpalatable for Americans of modest means. And the employer fines that are currently triggered when employees who aren’t offered qualifying health insurance obtain subsidies to purchase it on the exchange would go away.

Details

If ObamaCare were working as well as supporters claim, would New York state have just decided to steer more than half of its subsidized exchange enrollees to a public managed-care plan? New York is the second state after Minnesota to adopt a Basic Health Program for households up to 200% of the poverty level. It’s a government-managed health care option included in the 2010 reform law.

Following Minnesota is a curious move. Minnesota has signed up just 22% of those eligible for exchange coverage, 48th among all states and barely half the U.S. average of 42%, according to the Kaiser Family Foundation.

The MNsure exchange also ranks near the bottom in its share of young-adult enrollees (24.2%) and near the top in its share of adults age 55 and up (33%).

To top it off, PreferredOne quit the Minnesota exchange despite being its dominant insurer in 2014, hardly a vote of confidence.

Details

Waste: After spending billions on state-run ObamaCare exchanges, the federal government is only now writing clear rules on how that money can be spent, while half of the exchanges head toward bankruptcy.

state-run exchanges were supposed to form the beating heart of ObamaCare. And the Obama administration dumped almost $5 billion in an effort to make it a reality.

The results have been a disaster.

Of the 37 states that received $2.1 billion in grants to establish an exchange, only 17 did so, and they got an additional $2.7 billion from the feds.

Of those 17, two went bankrupt in the first year. One of them, Oregon, had received a $60 million “early innovator grant.” Residents of those states now use the federal Healthcare.gov site.

A memo from Health and Human Services’ Inspector General Daniel Levinson warns that some of the remaining may be violating federal law in an effort to stay afloat.

Details

Almost two-thirds of enrollees receiving advance premium tax credit (APTC) in Marketplaces had to pay back an average of $729 of the tax credits they received in 2014, according to H&R Block, reducing these enrollees’ average tax refund by 33%. Approximately one in four enrollees with APTC received a refund, averaging $425, which represented an increase in their refunds of approximately 18%. A smaller percentage, almost 13%, of those with APTC had no repayment or refund due, meaning they estimated their 2014 income accurately. Finally, the average payment due for those who did not maintain coverage during all or a portion of the 2014 benefit year was approximately $178. A previous study by the Kaiser Family Foundation estimated, based on tracking income changes typical of the subsidy-eligible population, that taxpayers receiving APTC were about as likely to owe some repayment (50%) as receive a refund (45%), and found that the average repayment ($794) and refund ($773) were similar.

Details

The Affordable Care Act (ACA) changed the American health care system in myriad ways. The primary objectives of the ACA were to expand insurance coverage while reducing the cost of insurance, and to rein in the increasing cost of health care. Whether these goals are being achieved and at what cost to the budget and to the healthcare stakeholders are important considerations.

Details

Two Republican committee chairmen are pressing the Obama administration to improve its oversight of how state-run ObamaCare marketplaces use federal dollars, citing an inspector general report on potential violations of law.

Sens. Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa) wrote to the head of the Centers for Medicare and Medicaid Services (CMS) on Monday asking for the agency to issue clarifying guidance on how the federal dollars can be spent.

State-run ObamaCare marketplaces received federal funds to help set themselves up, but after Jan. 1 of this year, they marketplaces are supposed to be self-sustaining. They are now prohibited by law from using federal funds for “operating expenses.” They can only use the money for “design, development, and implementation.”

The problem is that the definition of these two categories can be unclear, as noted by an HHS Inspector General report late last month. The senators want clearer definitions from CMS.

Details

Three-quarters of emergency physicians say they’ve seen ER patient visits surge since Obamacare took effect — just the opposite of what many Americans expected would happen.

A poll released today by the American College of Emergency Physicians shows that 28% of 2,099 doctors surveyed nationally saw large increases in volume, while 47% saw slight increases. By contrast, fewer than half of doctors reported any increases last year in the early days of the Affordable Care Act.

Such hikes run counter to one of the goals of the health care overhaul, which is to reduce pressure on emergency rooms by getting more people insured through Medicaid or subsidized private coverage and providing better access to primary care.

A major reason that hasn’t happened is there simply aren’t enough primary care physicians to handle all the newly insured patients, says ACEP President Mike Gerardi, an emergency physician in New Jersey.

Details

In the 34 states that did not establish Obamacare exchanges, Governors nervously await a Supreme Court ruling that could throw their health insurance markets into chaos. Meanwhile, many of the Governors who did establish exchanges are regretting their decision.

More than five years after its enactment, Obamacare has proven a bitter brew for many states. Nowhere is this more evident than in health care exchanges.

Exchanges began as a figment of Washington’s imagination.

Details