The American people have become familiar with ObamaCare’s failings: higher premiums, fewer choices and a more powerful federal health bureaucracy. Yet another important piece of health-care legislation, signed into law last year, has gone almost unnoticed.
The Medicare Access and CHIP Reauthorization Act, known simply as Macra, was enacted to replace the outdated and dysfunctional system for paying doctors under Medicare. The old system, based on the universally despised sustainable-growth rate formula, perennially threatened to impose unsustainable cuts in physicians’ fees.
. . .
ObamaCare is bringing out corporate America’s worst crony-capitalist impulses. The health-insurance lobby has teamed up with trial lawyers to sue the federal government—through individual lawsuits and a $5 billion class action—for not following through on a bailout deal buried in the law. This provision, the risk corridor program, would have required taxpayers to bail out insurers for losing money on the health-care exchanges. In late 2013, Sen. Marco Rubio introduced legislation to repeal the provision entirely and later another bill to make the program budget neutral. When it came time to pass a spending bill at the end of 2014, Congress succeeded in making it the law of the land that the bailout program could not cost taxpayers a single cent—which ended up saving taxpayers $2.5 billion. In December of last year, they repeated the feat. Now, Rubio is urging leaders in both the House and Senate to make this a priority and stop the bailout a third time.
. . .
As candidates in both parties focus on the general election campaign, some Republicans wonder if large premium increases related to the Affordable Care Act could be an “October surprise” that helps propel them to victory in November. The causes of the approaching premium increases vary, but some are rooted in a 2013 Obama administration proposal.
In reporting on premium increases by one Iowa insurer, the Des Moines Register noted that individuals who bought new plans that complied with Affordable Care Act regulations could face premium increases of 38% to 43% next year.
For every action, there is an equal and opposite reaction. Political solutions from years past may materialize in the form of rate hikes this fall–and could generate a distinct reaction among voters on Election Day.
A plan the Clinton campaign unveiled in September would create a refundable tax credit worth as much as $2,500 per individual and $5,000 per family to cover out-of-pocket health-care expenses. Knowing there is a federal credit might give employees incentive to incur additional expenses to exceed the subsidy threshold. That would mean a credit aimed at mitigating the effects of rising health costs for some families could end up exacerbating the problem on a broader scale.
. . .
Though it was more a TKO than a straight-up ruling, the Little Sisters of the Poor prevailed at the Supreme Court on Monday in their fight against the ObamaCare contraceptive mandate.
True, the justices made clear that they were not ruling on the merits, which is why so many headlines speak of the court’s having “punted” on the case. Even so, in a unanimous decision they made the path forward much easier for the sisters and much more difficult for the Obama administration.
To begin with, the justices vacated the lower-court rulings the sisters were fighting. The parties, the court said, should have another opportunity to work out a way to deliver contraceptives that doesn’t violate the religious objections of the Little Sisters and their co-plaintiffs.
. . .
Last Thursday, the Obama administration suffered a legal setback, when a federal judge in Washington ruled that the administration exceeded its authority by paying out cost-sharing subsidies to health insurers under the Affordable Care Act.
The administration will doubtless appeal the case, which was brought by the Republican-led House of Representatives, but whether those appeals succeed may well depend on whether courts view the case as one of statutory interpretation, or one with constitutional implications.
In its briefs in the case, the administration tried to portray House v. Burwell as a successor case to King v. Burwell, another lawsuit surrounding Obamacare subsidy payments, which the Supreme Court decided in June 2015.
. . .
Major insurer Highmark Inc. is suing the federal government, saying the feds failed to live up to obligations to pay the insurer nearly $223 million from an ObamaCare program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets. The suit is likely to draw close attention because it comes from a company that continues to be a major player in the exchanges.
. . .
Health insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the ObamaCare exchanges next year as some companies pull out of unprofitable markets. The entire states of Alaska and Alabama are expected to have only one insurer on the health law’s signature online marketplaces next year, according to state regulators. The same is expected to be true in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, state regulators said.
. . .
John Boehner isn’t popular with conservatives these days, but the former House Speaker deserves an apology from those who derided his lawsuit challenging President Obama’s usurpation of legislative power. Mr. Boehner went ahead despite skeptics from the left and right, and on Thursday the House won a landmark victory on behalf of Congress’s power of the purse.
Federal Judge Rosemary Collyer handed down summary judgment for the House, ruling that the executive branch had unlawfully spent money on ObamaCare without congressional assent. Judge Collyer noted that Congress had expressly not appropriated money to reimburse health insurers under Section 1402 of the Affordable Care Act. The Administration spent money on those reimbursements anyway.
. . .
Humana’s announcement Wednesday that it is considering raising premiums and changing or eliminating plans makes it only the latest insurer to say it might scale back involvement on the Affordable Care Act exchanges next year. Here’s the $9 billion question those insurers that remain on the ACA marketplaces ought to consider: What happens if Donald Trump is elected–and cuts off their access to ObamaCare cost-sharing subsidies?
Subsidies related to the 2010 health-care law aim to help reduce co-payments and deductibles for low-income individuals who meet certain criteria. House Republicans challenged the subsidies in court in late 2014, arguing that because the text of the Affordable Care Act does not include a specific appropriation for the subsidies, the executive branch cannot spend money Congress never disbursed.