Category: Implementation

One reason why the anger over ObamaCare has subsided somewhat could be that more than 70 significant changes have been made to the law since it was enacted in 2010—delaying, weakening, and eliminating some of its more onerous and burdensome provisions. The law that is being implemented is not the one Congress passed.

By our updated count at the Galen Institute, at least 43 of the changes to the Affordable Care Act have been made unilaterally by the Obama administration, 24 have passed Congress and been signed into law by President Obama, and three were made by the Supreme Court, which had to rewrite the law to uphold it.

Yesterday, the nonpartisan Congressional Budget Office released its annual ten-year Budget and Economic Outlook. The document contains the CBO’s updated estimates for economic growth, employment, and the nation’s fiscal health. The most notable change was to enrollment in Obamacare’s health insurance exchanges. The CBO, bowing to reality, slashed their 2016 estimates of exchange enrollment from 21 million to 13 million. Furthermore, the CBO implied that it expects exchange enrollment to peak at 16 million: a far cry from the 24 million it predicted last March.

This is the second year that the Affordable Care Act and taxes will collide, and two changes this year could make the cumbersome tax filing process a bit more complicated.

Janna Herron of The Fiscal Times fills you in on what you should know this time around—the forms, the penalties, and the deadlines.

When the Affordable Care Act was drafted, the Congressional Budget Office expected people to sign up quickly for new health insurance.

Now, two years into the law, it’s clear that progress is going to be slower. The Obama administration acknowledged as much in late 2014, and again in October, when it presented its own modest predictions. Monday, the budget office also agreed, slashing its 2016 estimate by close to 40%.

The Obama administration’s top health insurance official told Congress Thursday he wants to “loosen up capital rules” to allow private investors to become part owners of the dozen surviving ObamaCare co-ops.

Andy Slavitt, the acting administrator for the Centers for Medicare and Medicaid Services which oversees the ObamaCare co-ops, told the Senate Finance Committee that his agency would also look approvingly on co-op mergers with existing insurance companies.

The new private investment policy represents a major reversal for the Obama administration, which has previously hailed the non-profit co-op health insurance model as a tool for providing competition to private, for-profit insurers.

In the wake of Louisiana governor John Bel Edwards’ announcement last week that his state would expand Medicaid under ObamaCare, the White House rolled out a new scheme to persuade the 19 states that are still holding out to fall into line and expand their programs: throw more money at them.

But these state officials should resist the temptation, for at least three reasons:

1. First and most obvious is that expansion states have all experienced the same thing: More people signed up than expected, and it blew a hole in the states’ budgets.
2. The second reason is that there’s no such thing as “free” federal dollars. The money comes with conditions, which effectively shifts policymaking from the receiving state’s legislature and governor to a distant federal bureaucracy (in this case, the Centers for Medicare & Medicaid Services), which dictates how states must spend federal Medicaid funds.
3. The third reason is less abstract: Medicaid will harm those it’s meant to help. Often lost in the expansion debate is that Medicaid is the worst form of health coverage in the country.

After the passage of the Affordable Care Act, the federal government gave Oregon $300 million to build an online health insurance exchange. The state then hired Oracle, the world’s second-largest software company, with profits of nearly $10 billion last year, to build the website.

The website never worked. In May 2014, then-Gov. John Kitzhaber, who was running for re-election and getting a lot of heat for Cover Oregon’s failure—asked Attorney General Ellen Rosenblum to sue Oracle.

For nearly two years, Oracle has been in a bruising, $5.5 billion legal battle with the state of Oregon over who is at fault for Cover Oregon, the failed $300 million health insurance website.

The U.S. government will limit a process that allowed people to sign up for health insurance under ObamaCare outside of the normal enrollment period. Typically, individuals have from about November to January to purchase insurance under ObamaCare. In some cases, though, they’re allowed to sign up outside that period, such as when they have a child.

The government is also tightening an exception that let people sign-up when they moved, by clarifying that people can’t get coverage based on a short-term or temporary relocation, the Centers for Medicare and Medicaid Services said in a blog post on Tuesday. It also plans to more tightly enforce other limits on enrollment by making sure people are qualified to sign-up in the remaining special circumstances.

In November, UnitedHealth abruptly reversed its previously sunny take on ObamaCare and said that the company would have to pull out of the government-run exchanges if market conditions didn’t improve.

UnitedHealth’s bombshell raised the specter, once thought safely in the grave, of the “adverse selection death spiral,” the phenomenon where sick people are more likely to buy insurance, which raises the average expenditure, which means higher premiums, which makes insurance a worse deal for the healthiest members of your insurance pool, which means they drop out, which means your pool is even sicker and average expenditure goes up even more … and there goes the insurance market.

President Obama is proposing to boost federal funding for states that choose to expand Medicaid under ObamaCare in a new effort to entice states to make the move.

Obama will propose in his 2017 budget to have the federal government pick up the entire cost of expansion for three years, no matter when a state decides to accept the expansion.

Under current law, states only got three years of full federal funding if they accepted the expansion in 2014. If nothing changes, states newly accepting the expansion would not get full federal funding after 2016 and instead would get payments that are somewhat less, eventually dialing back to 90% of costs.