Category: Implementation

Insurers and hospitals can’t discriminate against patients because of their gender identity under the Affordable Care Act, federal officials said Friday, but patient groups complained the rule doesn’t go far enough.

The Department of Health and Human Servicesfinalized a rule that prohibited discrimination in health care based on a long list of characteristics ranging from race to pregnancy, gender identity and “sex stereotyping.”

It doesn’t mean insurers have to cover all treatments associated with gender transitioning but they just can’t outright deny them either. But the rule doesn’t go far enough in clarifying what is discrimination, some say.

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The Obama administration’s continuing efforts to rewrite and re-interpret the legal requirements of the Affordable Care Act (ACA) hit a new roadblock in federal district court yesterday. Judge Rosemary M. Collyer ruled that advance payments to insurers of cost-sharing reduction (CSR) subsidies for certain lower-income enrollees in Obamacare’s health insurance exchanges were never appropriated by Congress. Oops. She therefore enjoined any further reimbursements until a valid appropriation is in place, but the judge also issued a stay of that injunction pending any appeal by the parties.

The decision in United States House of Representatives v. Sylvia Matthews Burwell, et al. is a big win for House Republicans, other Obamacare opponents, and the rule of law. It also signals at least the outer limits of the Obama administration’s repeated efforts to stretch implementation of the 2010 law far beyond legal norms and the plain meaning of the ACA’s statutory text.

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The Department of Justice will appeal a federal judge’s ruling in a lawsuit from House Republicans against the Obama administration.

A spokesperson did not respond to an inquiry asking when the department would file an appeal. A district judge for the District of Columbia ruled yesterday that the administration was improperly funding cost-sharing subsidies under the Affordable Care Act.

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A federal judge’s decision Thursday that the Obama administration unconstitutionally spent money to pay for part of the Affordable Care Act may not disrupt health plans or beneficiaries right away. But the fresh uncertainty immediately delivered a blow to the share prices of hospitals and health insurers.

House Republicans alleged in a lawsuit that the administration illegally spent money that Congress never appropriated for the ACA’s cost-sharing provisions. Those provisions include reduced deductibles, copayments and coinsurance many Americans receive, depending on income, for plans purchased through the ACA’s insurance exchanges.

U.S. District Court Judge Rosemary Collyer agreed with House Republicans on Thursday, writing that appropriating the money without congressional approval violates the U.S. Constitution.

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Today, a federal judge sided with the House of Representatives in a major lawsuit challenging executive branch overreach,ruling that the Obama administration has been making illegal payments to health insurance companies participating in the Affordable Care Act (ACA) exchanges. U.S. District Court Judge Rosemary Collyer found that Congress never appropriated the billions of taxpayer dollars that the administration has delivered to insurers through the ACA’s cost sharing reduction (CSR) program. Today’s decision is a victory for the rule of law. It may also give insurers pause about their future participation in the exchanges.

The issue raised by the House of Representatives lawsuit is that the executive branch cannot spend money without a congressional appropriation since Article I of the Constitution gives Congress the power of the purse. Today, Judge Collyer agreed, writing “Paying out [cost-sharing subsidies] without an appropriation violates the Constitution. Congress is the only source for such an appropriation, and no public money can be spent without one.”

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A federal judge on Thursday ruled the Obama administration has been improperly funding an Obamacare subsidy program, a huge win for the House of Representatives’ lawsuit against the White House.

The judge said that the program can continue, pending appeal. The ruling, if it stands, could be a significant financial setback for the millions of low-income Americans who benefit from the cost-sharing subsidies, which help people pay for out-of-pocket costs like co-pays at the doctor’s office.

Congress authorized the program but never actually provided the money for it, wrote U.S. District Court Judge Rosemary M. Collyer, a George W. Bush appointee.
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Rising healthcare costs are Americans’ primary financial concern. In fact, a recent survey found that 76% of Americans are concerned about increasing health insurance costs with nearly two-thirds more concerned this year than they were last year. As is now clear, the Affordable Care Act is making the problem worse. A recent S&P Global Institute report (not publicly available) showed that healthcare spending per individual market enrollee increased by nearly 70% in the first two years after the key provisions of the ACA took effect.

A recent Mercatus working paper, authored by Brian Blase, along with Doug Badger of the Galen Institute and Ed Haislmaier of the Heritage Foundation, found that insurers made risk corridor claims of $273 per enrollee on individual market qualified health plans—plans that comply with the ACA and are certified to be sold on exchanges—in 2014. Risk corridors were designed to transfer money from insurers that made profits selling QHPs to insurers that incurred losses on QHPs. Assuming that a fully-funded risk corridor program would have subsidized about two-thirds of insurer losses, insurers likely lost around $400 per enrollee in 2014. Since insurers enrolled about 8 million people in 2014, they likely lost about $3.2 billion overall selling individual QHPs.

The House Energy and Commerce Committee Republicans can’t find most of the $200 million that the Obama administration claims it recouped from state-based health care exchanges as part of a federal grant program to help them set up shop, according to a new report obtained by Morning Consult.

Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt told the committee in December that “over $200 million” had been returned to federal coffers from the state exchanges since the grant program went into effect.

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The Obama administration could give states more power to manage the Affordable Care Act’s risk adjustment program, in a concession to critics who complained that the program unfairly penalized certain companies and threatened to destabilize the exchange system.

The new policy, which was issued late on May 6, encourages state insurance commissioners to seek “local approaches” to easing the impact of the risk adjustment process on small and high-growth health plans. That language appears to open the door to allowing states to artificially limit the amounts that companies might have to pay into the program each year.

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