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.
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. Five years after passage of the ACA, this report attempts to synthesize many of the studies and cost estimates which have been produced in order to answer these questions.
Key Take-Aways
The number of uninsured individuals has decreased, but not by as much as the Congressional Budget Office (CBO) originally predicted.[1]
· 15 million: fewer uninsured individuals since 2010
· 35 million: individuals still without insurance
· 12 million: more people enrolled in Medicaid since 2010
· 11 million: individuals have insurance through a state or federal exchange
· 7.7 million: individuals receiving subsidies for coverage through an exchange
The cost of expanded insurance coverage is being felt at the individual, state, and federal level.
· $300: average increase in annual deductibles for ESI from 2010-2014
· $5,730: average annual cap on out-of-pocket expenses for plans purchased through the exchange in 2014; $2,719 more than the average for ESI plans
· $43 billion: projected individual mandate penalties over the next 10 years
· $167 billion: mandate penalties paid by employers over the next 10 years
· $42.6 billion: cost of ACA regulations implemented thus far
· $1.2 trillion: federal cost for ACA coverage provisions over the next 10 years
The growth in total health expenditures has also returned to pre-recession rates, demonstrating no bend in the cost curve.[2]
· $3.15 trillion: national health care expenditures in 2014
· 17.9: percent of GDP spent on health care in 2014
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.
State-based marketplaces (SBMs) “cannot be allowed to use hard-earned taxpayer dollars for expenses that are statutorily prohibited,” the senators write.
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.
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. The fertile minds of health policy analysts had conjured a bewildering system of cross-subsidies that involved charging young people unfairly high premiums to reduce premiums for older workers, overcharging healthy people to subsidize unhealthy ones, taxing middle income people to subsidize lower-income people (what the President likes to call “middle class economics”), cutting Medicare to enlarge Medicaid, taxing the uninsured for being uninsured, taxing employer-sponsored health plans and taxing employers for not sponsoring health plans, all garnished with tens of billions in new taxes on medicines, medical “devices” (everything from tongue depressors to defibrillators) and, of course, on health insurance itself.
On March 4, 2015, the U.S. Supreme Court heard oral argument in King v. Burwell,[1] a tremendously important case involving the administration of the Patient Protection and Affordable Care Act, also known as Obamacare. King is important for a number of reasons. It’s important because a lot of money is at stake.[2] It’s important because it may require fundamental changes to be made to Obamacare.[3] And it’s important—indeed, perhaps it’s most important—because of its significant implications for the rule of law. In this Essay, I explain why the president’s actions in King were unlawful and why a ruling striking down the president’s actions is crucial to ensure the continued vitality of the rule of law.
From the early days of the Republic, a core component of our constitutional character has been the idea that our government is a government of laws and not of men.[4] This means that our leaders—elected and appointed—are constrained by the words in our statute books and in our Constitution.[5] Government officials must follow the law, even when their personal predilections would lead them in a different direction. This prevents arbitrary decision making and keeps executive discretion within proper bounds.
The Foundation for Government Accountability has just published a report on state enrollments under the Obamacare Medicaid expansion. Here’s what the authors say about Michigan:
When Republican Governor Rick Snyder lobbied the Michigan legislature to adopt his Obamacare Medicaid expansion plan, he too sold it on the promise of low and predictable enrollment. His office predicted no more than 477,000 able-bodied adults would ever sign up, with 323,000 signing up in the first year.
But more able-bodied adults enrolled in ObamaCare expansion in the first three months than the state thought would sign up during the entire year. Despite the fact that Michigan did not expand Medicaid eligibility until April, nearly 508,000 adults signed up by the end of 2014, far more than the state thought would ever enroll. Enrollment continues to climb, with nearly 582,000 able-bodied adults signing up by April 2015.
Two questions will dictate not only the future of healthcare, but also the balance of power between Washington, D.C., and the states, and the separation of powers between the federal branches. One concerns state sovereignty, the other the heckler’s veto.
When justices heard arguments regarding the Affordable Care Act (ACA, or Obamacare) in King v. Burwell on March 4, Justice Anthony Kennedy and Chief Justice John Roberts suggested ways they might vote to uphold an Internal Revenue Service rule granting taxpayer subsidies to Obamacare exchange policies in states that refused to join that part of the ACA.
The ACA’s Section 1401 provides that subsidies are granted for insurance policies purchased on exchanges “established by the State under (Section) 1311.” By contrast, the federal exchange is created by Section 1321. Challengers argue this was deliberate, pressuring states to create exchanges and join Obamacare, like the provision threatening states with canceling all Medicaid funds if they did not join the ACA’s expanded Medicaid. (The court struck down that part of the ACA in 2012 for coercing the states, violating the 10th Amendment.) The now-infamous videos of Dr. Jonathan Gruber corroborate this theory.
Americans’ tax burden is already $3 billion heavier because of Ohio Gov. John Kasich’s expansion of Medicaid under Obamacare.
By putting more able-bodied, working-age childless adults on Medicaid than Kasich projected, Obamacare expansion is reducing incentives to work and threatening traditional Medicaid recipients’ access to care faster and at greater cost than anticipated.
After Kasich expanded Medicaid unilaterally, a state panel approved $2.56 billion in Obamacare spending for the expansion’s first 18 months. The money was meant to last until July, but it ran out in February.
Kasich’s Obamacare expansion cost $323 million in March — 84 percent greater than estimates revised just six months earlier.
Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.
Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer-call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which is now working smoothly.