The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

A school district in Tennessee is shutting classroom doors because of the added costs of Obamacare. Jerry Strong, the Clay County Director of Schools, told the Associated Press, “the Affordable Care Act… has made it very difficult for us to have our employees properly covered and meet the mandates of the law.” The school district was already struggling with their budget, “struggling with budget concerns for three years.”

In a significant win for House Speaker John Boehner and congressional Republicans, a federal judge Monday denied a request by the Obama administration to immediately appeal whether the House of Representatives has the legal right to challenge a provision of the Affordable Care Act.

U.S. District Court Judge Rosemary Collyer ruled last month that one part of the challenge could go forward because the House had shown it had the standing necessary to bring the case. Lawyers for the Obama administration — concerned by what they called an unprecedented ruling on the threshold issue of standing — sought to appeal Collyer’s ruling before her court heard arguments on the underlying merits of the case.

Former Florida governor Jeb Bush released his 2016 health plan on Tuesday, including a 10-page background paper that fleshed out a shorter summary outline. The good news is that it’s more serious and detailed than the handful of plans offered by his rivals for the Republican presidential nomination. The better news is that it tries to suggest several steps beyond the standard “repeal and replace” orthodoxy regarding Obamacare.

Just about every presidential campaign’s policy plans leave a lot of blanks and rhetorical placeholders, to be filled in later. They also straddle conflicting pressure points and dodge inevitable tradeoffs. The preference is to point in a general, and seemingly more popular, direction, without offering too many instructions for how to traverse the complicated path from here to there. On top of that, the limited attention spans of most voters, let alone candidates, cannot be taxed too much (unlike their incomes).

No good deeds go unpunished in national politics, so let’s look a little closer under the hood of the Jeb Bush health plan unveiled earlier this week.

Attracting the most rubbernecking attention is the former Florida governor’s endorsement of a cap on the tax exclusion for employer-sponsored health insurance, as an alternative to Obamacare’s Cadillac tax on high-cost employer plans.

Public opposition to ObamaCare has lasted far longer than its authors imagined. Unsubsidized consumers avoid ObamaCare coverage. Twenty states have rejected its Medicaid expansion. Congress wants to repeal it. President Obama and the Supreme Court have repeatedly amended and expanded it, transforming the statute Congress enacted into an illegitimate law that no Congress ever had the votes to pass, and making repeal not just an economic imperative but necessary to restore the Constitution’s system of checks and balances.

Risk corridor data released on October 1 by the administration shows that insurers lost a lot of money on Affordable Care Act (ACA) plans in 2014. The ACA established a three-year risk corridor program to transfer funds from insurers with lower-than-expected medical claims on ACA plans, i.e., profitable insurers, to insurers with higher-than-expected claims, i.e., insurers with losses. Despite administration claims that incoming payments from profitable insurers would cover losses from unprofitable ones, the risk corridor program shortfall exceeded $2.5 billion in 2014. Insurers with lower-than-anticipated claims owed about $360 million, and insurers with higher-than-anticipated claims requested about $2.9 billion from the program.

Beginning in FY 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state Fiscal Year (FY) 2015 and state Fiscal Year 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described below.

Those who reflexively assert that conservative critics of Obamacare don’t have an alternative can’t make that charge. They never could. The architecture of a replacement plan was always taking shape, led by groups like the 2017 Project and people like my AEI colleague Jim Capretta. Governor Bush has laid it out in detail. And the more thoughtful candidates this cycle are aiming to run on it.

While the House Speakership remains in limbo, plans to repeal Obamacare via reconciliation are still moving forward. Last week, the House Budget Committee advanced the bill, which would gut key Obamacare provisions, along with defunding Planned Parenthood for a year–to the House floor.