On the 9th floor of a glassy high rise in downtown Washington, partitions are coming down to make more room for workers handing out billions of dollars in Obamacare-funded research awards.

Business has been brisk at the Patient-Centered Outcomes Research Institute or, PCORI, as it is known. The institute was created by Congress under the Affordable Care Act to figure out what medical treatments work best — measures largely AWOL from the nation’s health care delivery system.

Much has been said about the formularies, cost-sharing, and patient burden required of enrollees on the ACA health insurance exchanges. Deductibles averaged nearly $3,000 for silver plans on the exchanges, and cost-sharing for specialty drugs can often reach 40 percent or higher. None of this is new, and this is a trend going on outside of the exchanges, in the employer-sponsored market as well. According to the Kaiser Family Foundation, employer plans now have deductibles averaging over $1,000 and a small, but growing share of plans use coinsurance rather than copays even for physician visits. Fundamentally, this means that patients are more involved in their health care decision-making.

As pressure mounts on state-run public health insurance exchanges to be financially self-sufficient in time for 2016, consumer operated and oriented plans created under the Affordable Care Act face the same challenge. And with two recent troubling developments in the CO-OP space, there are renewed questions about the long-term viability of these nonprofit entities that seek to compete with commercial carriers that offer plans on the public exchanges.

Three Republican senators have sent a letter to the Centers for Medicare and Medicaid Services expressing concern for the “lack of oversight for more than $1 billion in federal grants” given to state-based marketplaces.

In the letter to CMS Acting Administrator Andy Slavitt, the senators — Orrin Hatch of Utah, Chuck Grassley of Iowa, and John Barrasso of Wyoming — note a handful of state-based exchanges have switched to the federal marketplace, run by CMS, and inquire if the agency will seek reimbursement for funds the states received from CMS to set up a state-based marketplace.

In February of 2015, IRS issued Notice 2015-16 which was intended to discuss a number of potential approaches to the implementation of pieces of the tax. At the time, IRS requested comment on a number of issues including the definition of applicable coverage, how to figure the cost of that coverage, and the caps used to calculate the tax.

In July of 2015, IRS issued Notice 2015-52 (downloads as a pdf) to address even more concerns, including who may be liable for the tax, employer aggregation, allocation of tax and payment of the tax. Here are some of the highlights with a little bit of commentary:

One of the last remaining features of the Affordable Care Act (ACA) that has yet to be implemented is the so-called “Cadillac tax,” which takes effect in 2018. Section 4980I will impose a 40 percent excise tax on employee benefits the cost of which exceeds certain statutory limits. The Cadillac tax is intended to limit the generosity of employer coverage on the theory that excess coverage encourages excess health care expenditures and thus drives up the total cost of health care. The tax is also, however, one of the major anticipated sources of revenue under the ACA, expected to raise $87 billion over the next 10 years.

WASHINGTON — Hoping to avoid another political uproar over the Affordable Care Act, the Obama administration is trying to persuade states to cut back big rate increases requested by many health insurance companies for 2016.

Federal officials refuse to identify the troubled Obamacare health co-ops that the Centers for Medicare and Medicaid Services has placed in a special risk category requiring “enhanced oversight” due to low profitability or low enrollment.

Read more: http://dailycaller.com/2015/08/03/obama-administration-refuses-to-identify-troubled-healthcare-co-ops/#ixzz3hsEAlG77

The federal government could be out more than $140 million by the time a defunct Iowa health-insurance cooperative’s finances are settled, a new court filing suggests.

CoOportunity Health, which was created under the Affordable Care Act, went belly up last December after losing millions of dollars. Its financing included $147 million in loans from the federal government. That money was used to launch the company in 2012 and then to keep it afloat as it sold health-insurance policies to about 110,000 people in Iowa and Nebraska.