Category: Implementation

Looking closer, the 6.3 million-person enrollment drop in fully insured employee plans represents a sudden 10 percent decline in a market that previously had been eroding by about 1 percent to 3 percent a year. In contrast, the 1.4 million more individuals in self-insured plans equates to enrollment growth of about 1.5 percent in a market that, prior to Obamacare, was growing at about 1 to 3 percent a year—putting that uptick solidly within the pre-Affordable Care Act trend range.

Thus, the data indicates Obamacare likely was responsible for a significant additional decline in fully insured employer group coverage. But, with respect to another anticipated effect—the expectation that more employers will shift to self-insured plans to escape Obamacare’s costly benefit mandates—the data does not indicate that is yet occurring to any noticeable extent. The modest enrollment increase in self-insured employer plans could well be the result of other factors, the most likely being increased job creation as the economy continues to recover from the last recession.

Taken together, the administrative data tell us that the number of Americans with health insurance coverage increased by around 9.7 million individuals during 2014—not the 14.1 million estimated by Health and Human Services.

The Congressional Budget Office’s new report shows updated cost projections for the insurance coverage expansion in the Affordable Care Act. With the debate over the ACA remaining so intensely polarized, advocates moved aggressively to spin this routine update as reflecting favorably on the law. A front-page article in the Washington Post referred to the new findings as showing “savings,” quoting a supporter as saying, “I can’t see how people can continue to say . . . that Obamacare had no cost containment in it.” Such comments in the wake of CBO’s update are flawed interpretations of the new estimates and what they signify. The following explains what CBO has actually projected: basically that the ACA will do less to expand coverage than previously estimated.

Five years after President Obama signed the Affordable Care Act, the White House claims the law is working even better than imagined, but one of its leading critics says every major promise is now proven untrue and costs will keep going higher and higher unless we change course.

On March 23, 2010, President Obama signed the landmark Patient Protection and Affordable Care Act, also known as Obamacare, into law. It happened after a fierce debate on the House floor just a few days earlier and a controversial move by Senate Democratic leaders to pass changes by a simple majority since they did not have the votes to do it through regular order.

The law took full effect in 2014, following a disastrous roll-out of the federal health-care exchange website in October 2013. But for those who warned against the law before its passage, the contents of the law are far more troubling than the major technical problems that bogged down the exchange.

“People have learned on a very personal level how they were lied to in the passage of this law. They’ve lost their doctor. They’ve lost their health plan. Their costs are going up. Many people have lost jobs and certainly hours as a result of it. Small businesses have felt a huge impact, said Galen Institute President Grace-Marie Turner. “It’s been a tremendous drain on the economy, and very few if any of those original promises were met.”

Turner is a longtime veteran of Washington health-care policy debates. She was at the forefront of the effort to stop the Clinton administration’s attempt to overhaul the health-care system in 1993 and is still fighting to roll back Obamacare.

She was in the House chamber in March 2010 during the final, intense moments of the debate.

ObamaCare is celebrating its fifth anniversary, but few Americas are cheering.

The Real Clear Politics average of the latest major opinion polls about the health law shows that 52.5% oppose it and only 42% approve. The 10.5% spread is identical to the average of polls taken when the law was signed five years ago. Approval numbers never have topped disapproval numbers since the law was enacted. It is not getting more popular and it is not settled law, as President Obama claims.

President Obama is touting the increased number of people who have health insurance as a result of the law. According to Gallup, the uninsured rate among U.S. adults averaged 12.9% in the fourth quarter of last year. The uninsured rate was 14.4% the year before the health law passed, also according to Gallup.

So our health sector has been thrown into turmoil, millions of people have lost their private health plans, $1 trillion in new and higher taxes have been imposed on individuals and businesses – and the uninsured rate has dropped a net of 1.5%.

Complying with the health care law is costing small businesses thousands of dollars that they didn’t have to spend before the new regulations went into effect.

Brad Mete estimates his staffing company, Affinity Resources, will spend $100,000 this year on record-keeping and filing documents with the government. He’s hired two extra staffers and is spending more on services from its human resources provider.

The Affordable Care Act, which as of next Jan. 1 applies to all companies with 50 or more workers, requires owners to track staffers’ hours, absences and how much they spend on health insurance. Many small businesses don’t have the human resources departments or computer systems that large companies have, making it harder to handle the paperwork. On average, complying with the law costs small businesses more than $15,000 a year, according to a survey released a year ago by the National Small Business Association.

“It’s a horrible hassle,” says Mete, managing partner of the Miami-based company.

One of the most anticipated cases of the Supreme Court’s 2014-2015 term is King v. Burwell. In it, the Supreme Court is confronted with what should be a straightforward question of statutory interpretation about the scope of subsidies available under the Affordable Care Act (ACA). Section 1311 of the ACA states that “each state shall, not later than January 1, 2014, establish an American Health Benefit Exchange.” Another part of the law, section 1321, then qualifies that apparently absolute duty by providing that if the state does not “elect” to establish that exchange by January 1, 2014, or if it otherwise fails to meet the federal requirements for an exchange, “the Secretary [of HHS] shall . . . establish and operate such exchange within the state.”

The question of whether a state establishes this exchange determines far more than where individuals can buy their health care coverage. It also determines whether any purchaser of health insurance is entitled to a tax credit against his or her cost of coverage, as that subsidy is limited to taxpayers who are enrolled in a qualifying plan “through an Exchange established by the state” under Section 1311. Internal Revenue Service regulations interpreted the ACA requirement so that its tax subsidies were available to all individuals whether they enrolled in an exchange established by the state or by HHS when the state elected or failed to do so. The plaintiffs’ challenge to the regulation was in essence that the plain language of the ACA precluded the IRS from expanding the scope of the subsidy by this sleight of hand. King would have been an open-and-shut victory for the plaintiffs if the disputed interpretation had been some run-of-the-mill tax provision. But 36 states did not establish these exchanges because they wanted to guarantee their citizens the statutory tax breaks.

I haven’t commented much on the issues at play in the latest Obamacare case to reach the Supreme Court, mostly because there are so many lawyer-bloggers and health care pundits on the internet offering more informed takes than mine. But now duty calls, so here is my pundit’s view of things:

1) Having gone back and forth over the evidence presented, I’m not convinced by the plaintiffs’ argument that the people responsible for drafting for Obamacare consciously intended to limit subsidies in order to induce states to set up their own exchanges. The famous comments suggesting that they did, from Jonathan Gruber and others, make me suspect that this possibility floated somewhere in the Obamacare hive mind, and the much-discussed path that different versions of the bill took through the Senate allows room for the possibility that somebody involved with the process had that idea in mind, and that this person’s sense of how the law ought to work played some role in why the language that we have ended up in there. But the extent that we’re talking about the intent of the drafters as a collaborative group, my sense is that they’re telling the truth about having no such plan in mind, and thus that the text as we have it is the result of accident and oversight and blundering rather than design.

Chief Justice Roberts has said he likes mystery novels; once, as a lower-court judge, he invoked Sherlock Holmes’s “dog that didn’t bark.” But at the King v. Burwell arguments, Roberts himself was in effect the dog that didn’t bark, saying far less than expected and thus leaving reporters to puzzle over the mystery of how he might vote.

But the one question he did ask about statutory interpretation does merit particular notice, as the Washington Post’s Robert Barnes notes. It pertains to “Chevron deference” — the doctrine under which the Court generally should defer to an agency’s reasonable interpretation of an ambiguously worded statute.

The Supreme Court justices had a lively discussion yesterday during arguments in King v. Burwell about who Congress intended to get health insurance subsidies and under what conditions.

The central question is whether the Internal Revenue Service had the authority to write a rule authorizing subsidies to go to millions of people in the 37 states now operating under federal exchanges.

The plaintiffs say the language of the law is clear: Subsidies are allowed in “an Exchange established by the State under [section] 1311of the Patient Protection and Affordable Care Act.” It doesn’t just say this once, but nine times in various linguistic forms.

The government argues that it is just a typo in legislative drafting: Congress clearly wanted subsidies to be available to citizens of all of the states, and the IRS therefore had the authority to write its rule authorizing subsidies in both federal and state exchanges.

Today, the Supreme Court heard oral arguments in King v. Burwell, a case with significant implications for the future of Obamacare. Most of the justices’ questions proceeded along expected lines. Most notable was a series of questions by Associate Justice Anthony Kennedy, who questioned whether it would be constitutional for Obamacare to induce states to set up exchanges. If Kennedy’s fears are right—that federal subsidies for state-based exchanges are “coercive”—then he might side with the Obama administration in the case. But if you understand how Obamacare’s insurance markets work, it’s clear that Kennedy should side with Obama’s challengers.