A three-member appellate court on June 29, 2011 upheld a key provision of the Patient Protection and Affordable Care Act of 2010, giving a significant victory to the Obama administration. The provision, challanged by the conservative Thomas More Law Center, includes the mandatory individual insurance requirement and has drawn ire from the conservatives. The 6th U.S. Circuit Court of Appeals in Cincinnati ruled in a 2-1 vote: We find that the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause. The majority included Judge James Graham, appointed by President Ronald Reagan, and Judge Boyce F. Martin, appointed by President Jimmy Carter.
However, in August 2011, the 11th U.S. Circuit Court of Appeals in Atlanta ruled against the mandatory coverage portion of the law. The ruling was 2 to 1, with the chief judge Joel Dubina and Judge Frank Hull ruling: "We have not found any generally applicable, judicially enforceable limiting principle that would permit us to uphold mandate without obliterating the boundaries inherent in the system of enumerated congressional powers". The mandate referred to in the ruling is the individual mandate to buy health insurance coverage.
On September 8, 2011, the 4th U.S. Circuit Court of Appeals in Richmond, Va., rejected the challenges to the constitutionality of the law. However, it said that threshold legal issues barred an immediate ruling.
The Obama administration on September 28, 2011 asked the Supreme Court to hear the case related to the Affordable Care Act. The administration notched up the fight by foregoing to the full 11th U.S. Circuit Court of Appeals and, instead, going straight to the Supreme Court to contest against the August ruling of the 3-member bench of the appeals court that ruled against the mandatory coverage option. So far three appeals courts--Sixth, Eleventh and Fourth--issued some sort of decisions on the Affordable Care Act, while a fourth hearing was held in the prior week by the U.S. Court of Appeals for the District of Columbia. The U.S. Solicitor General Donald Verrilli said in the September 28, 2011, filing that the individual mandate requires most people to buy insurance "rather than rely on a combination of attempted self-insurance and the backstop of care paid for by other market participants". The individual mandate thus "regulates economic conduct that substantially affects interstate commerce". Also pending before the apex court are several suits from individuals and a petition from Thomas More Law Center appealing the ruling of the Sixth U.S. Circuit Court of Appeals.
*** Long-Term Care Plan Abandoned ***
A key program in the Patient Protection and Affordable Care Act of 2010 was abandoned by the Obama administration on October 14, 2011 as HHS Secretary Kathleen Sebelius failed to certify twin requirements of the financial solvency of CLASS (Community Living Assistance Services and Support) for the next 75 years and affordable coverage easily accessible to all working adults, irrespective of health as needed by the law. The goal of the CLASS was very simple: Workers would pay an affordable premium during their careers, and could collect a modest daily amount, say $50, after they become disabled later in the life. They can either pay to a service provider for staying at home or nursing home costs. The program, championed by the late Sen. Teddy Kennedy, was scheduled to take off in 2013. The need for long-term care often comes unexpectedly: an old person takes a fall, a teen is badly injured in a car crash or a middle-aged worker suffers a devastating stroke. Medicare does not cover long-term care, and only about 3% adults have a private policy. Medicaid, federal-state program for the poors, covers the long-term care. Often middle-class family exhaust their saving before they become eligible for Medicaid.
*** Long-Term Care Plan Abandoned ***
On November 8, 2011, The U.S. Court of Appeals for the District of Columbia issued a split verdict upholding a lower court ruling that Congress had not overstepped its authority by passing President Obama's health care overhaul measure that required individuals to buy insurance or pay a penalty on their taxes, beginning in 2014. The 2-1 verdict included Judge Laurence Silberman, an appointee of President Ronald Reagan, and Judge Harry Edwards, an appointee of President Jimmy Carter in favor, while the dissenting voice was lent from the bench by Judge Brett Kavanaugh, a former aide to President George W. Bush who had appointed him to the court. The appeal was filed by the American Center for Law and Justice, a legal group founded by tele-evangelist Pat Robertson.
On November 14, 2011, the US Supreme Court agreed to hear the Obama administration's appeal, filed on September 28, 2011, to the ruling issued by the 11th Circuit Court of Appeals. The apex court will probably rule in the summer of 2012.
One of the biggest windfalls for seniors from the Affordable Care Act, signed by President Obama on March 23, 2010, is the narrowing of coverage gap, also known as doughnut hole, because of the Obama administration's aggressive bargaining, as part of the law, with the pharmaceutical companies to get discounts as deep as 50 percent for brand name drugs. The research results were published in The Dallas Morning News in its November 28, 2011, edition. As a result, the average savings to Medicare beneficiaries arising from the brand name drugs in 2011 are estimated to be around $581 from the brand name drugs alone with an additional $22. More than 2 million Americans already got some help, discounts mostly have gone to middle-class seniors as poors are automatically covered in the coverage gap at the expense of taxpayers. Medicare covers about 47 million older or disabled people, and about 9 out of 10 have some kind of prescription plan. Most rely on the drug benefit, also known as Part D, which is delivered through private insurance plans. The coverage gap starts after an individual reaches $2,840 threshold, and then for the next $3,600, is on the hook. After the individual exceeds $6,440, the catastrophic coverage kicks in, with the beneficiary paying a token amount.
On February 2, 2012, the Obama administration made public the first full-year of benefit of the healthcare overhaul law in closing the gap of doughnut hole. Approximately 3.6 million Americans saved $2.1 billion in 2011 because of the deep discount provided by the drug makers to help Medicare beneficiaries in the doughnut hole gap. The gap, created in the Medicare Part D program during the George W. Bush administration, was partly covered by $250 rebate in 2010 as part of the Affordable Care Act signed in March 2010. In 2011, the law provided beneficiaries a 50% discount on covered brand-name drugs and 7 percent coverage on generics when they hit the so-called doughnut hole. That came out to be $604 per Medicare beneficiary. Those benefits are slated to rise to 75 percent for brand name and generic drugs by 2020, when the coverage gap will be eliminated altogether.
In a landmark ruling, the US Supreme Court on June 28, 2012 upheld most of the provisions of Affordable Care Act, including two controversial ones: (A) Individual requirement for every American to have health insurance (by 5-4 votes), and (B) Expansion of Medicaid to cover an additional 17 million Americans (by 5-4 votes). On both occasions, Chief Justice John Roberts voted with the liberal bloc of the court: Justice Ruth Bader Ginsburg, Justice Stephen Breyer, Justice Sonya Sotomayor, and Justice Elena Kagan. Writing for the majority, Chief Justice Roberts struggled to explain his rationale to uphold the law. On "individual requirement" provision, a "mandate" for all Americans to carry insurance coverage is illegal, but if it is deemed as a tax, it is perfectly legal. On Medicaid expansion provision, the court found problems, but still stated that Congress had authority to expand Medicaid. However, court asked federal government not to punish any state if it didn't participate in the Medicaid expansion. The dissenting judges are Justice Anthony Kennedy, Justice Antonin Scalia, Justice Samuel Alito and Justice Clarence Thomas.
Key Provisions of Affordable Care Act Phase-In Timeline
2010
** High-risk health insurance pool set up to provide affordable coverage for uninsured people with medical problems.
** Lifetime dollar limits on insurance coverage barred.
** Tax credits given to small businesses (up to 25 employees) provide workers with insurance.
** Health Insurance plans required to maintain dependent coverage until age 26.
** Insurers prohibited to exclude children from coverage because of pre-existing conditions.
2012
** Prescription drug coverage for the Medicare gap, also called as doughnut hole, to be carried out by discounts.
2013
** Medical expense contributions to tax-sheltered flexible spending accounts to be limited to $2,500 a year, with annual increases based on COLA.
** Medicare payroll tax to be increased on couples making more than $250,000 a year and individuals making more than $200,000 a year.
** A new tax of 3.8 percent on investment income to be slapped.
** Program to create non-profit insurance co-ops to be set up.
2014
** States will create Health Insurance Exchanges--supermarkets for individuals and small businesses to buy coverage.
** Insurers will be prohibited from denying or limiting coverage based on pre-existing conditions.
** Income-based tax credits to be provided for most consumers in HIEs.
** Medicaid expansion to cover low-income people up to 133-percent of poverty level.
** Citizens and legal residents to be required to have health insurance, with exceptions, or pay fine.
** Employers with more than 50 workers to be penalized if insurance is not offered, and if their workers get coverage through HIE and receive tax credit.
2018
** A tax will be imposed on so-called cadillac health plans, employer-sponsored health insurance worth more than $10,200 for individual coverage or $27,500 for a family plan.
2020
** Doughnut hole coverage gap in Medicare prescription benefit will be phased out.
** Seniors will pay just 25 percent of the cost of brand-name and generic drugs.
The Supreme Court's decision to uphold the Affordable Care Act means an additional Medicare contributing tax of 3.8 percent to be imposed on wealthy come 2013. The tax will apply to non-business-related net income from interest, dividends, annuities, royalties and rents and capital gains, as well as income from a business that is considered a passive activity or a business that trades a financial instrument or commodity. The additional Medicare contributing tax of 3.8 percent will be applied to incomes over $200,000 threshold for single and $250,000 threshold for married couple, irrespective of actual income level. Let's take this example: an individual, who files tax return as a single, with $80,000 annual income has a net income of $400,000 from sale of a vacation home. The 3.8 percent additional Medicare contributing tax will be applied on the income of $280,000 (= $400,000 + $80,000 - $200,000). In this example, the additional 3.8 percent Medicare contributing tax will amount to $10,640.
According to Kaiser Family Foundation and the Urban Institute report issued on November 26, 2012, Medicaid expansion under the Obamacare may not be as burdensome on the states as many Republican governors are saying. States will receive more than $9 from the federal government for $1 they spend in expanding Medicaid to cover low-income Americans. According to the study, the expanding Medicaid will cost more than $1 trillion between 2013 and 2022, and will cover about 20 million more low-income people. Out of that, states will spend just $76 billion, while the federal government will spend the remaining $952 billion. Washington pays all of the cost for the first three years, gradually shifting to 90 percent.
Affordable Care Act presents a dilemma for Texans as the state has opted out from the expanded Medicaid option, which allows all U.S. citizens below 133 percent poverty level--or $25,390 for a family of three--to be covered by Medicaid. The U.S. Supreme Court last year (2012) ruled, while upholding the law, that states might reject the expanded Medicaid option offered by Affordable Care Act. However, the landmark healthcare overhaul bill allows legal immigrants with income less than the federal poverty limit, or $19,090 for a family of three, to receive federal subsidy to buy insurance from the private insurers in state health insurance market. By rejecting the expansion of Medicaid, the state of Texas will leave $101.1 billion (over the next 10 years) in federal Medicaid matching fund in lieu of raising $15.6 billion (over the next 10 years) in state money and set up a situation where some poor Texans are to be denied help in getting insurance coverage while the legal immigrants will receive federal subsidy.
Tennessee became the latest state on March 27, 2013 to reject Obama administration's Medicaid Expansion plan under the Affordable Care Act. Instead, Governor Bill Haslam wanted Medicaid expansion money to help individuals buy private health plan from insurance exchanges. So far, about 24 states, mostly led by Democratic governors, opted in for the Medicaid expansion plan, under which federal government will bear the full amount between 2014 and 2016, and after 2016, the federal share will go down gradually to 90 percent in 2020.
On April 1, 2013, Obama administration delayed the implementation of a key feature--geared towards catering the need of small businesses--of the Affordable Care Act. The landmark law signed in 2010 calls for a Small Business Health Options Program that each state exchange will offer, enroll, and help compare competing plans for employees of the small businesses. The coverage was originally thought to begin on January 1, 2014 with enrollment to start on October 1, 2013. However, the administration delayed the implementation as insurers needed "additional time to prepare for an employee choice model". Federal government will delay the program for the 33 states where it will run the exchanges to 2015, according to April 1, 2013 Obama administration announcement.
On July 2, 2013, the White House announced delay in implementation of a key component of Affordable Care Act by a year. Under the healthcare overhaul signed by President Obama in 2010, businesses with 50 or more employees are required to offer health insurance to its employees or pay a fine of $2,000 per employee beyond the first 30 employees. The provision, commonly known as employer mandate, will become effective on January 1, 2015 instead of January 1, 2014. Under the employer mandate, employers have to go through rigorous reporting requirement such as documenting how much they are paying their employees, how many hours a week the employees are working and how much employees are contributing to healthcare coverage. The mandate sets a threshold of 30 hours for full-time employees.
Another requirement that will test the Affordable Care Act is related to the so-called Cadillac tax that may hit hard municipal employees across America. Under the healthcare overhaul plan, beginning in 2018, a 40 percent tax will be slapped on the excess of the annual healthcare premium exceeding the threshold of $10, 200 for individuals and $27, 500 for families. The thresholds will rise with inflation after 2018.
Just like employer mandate provision, another key, but altogether different, provision was put on hold for an year. The out-of-pocket maximum provision supposed to take hold on January 1, 2014 will now be effective from 2015. Under this provision, the total out-of-pocket costs would cap $6,350 for individuals and $12,700 for families. The one-year extension was published in February 2013 on the Labor Department website under the maze of information. This grace period came to light only in recent days.
As the deadline for Americans without insurance to enroll in healthcare exchanges draws closer, a study conducted by Avalere Health Fund released on September 4, 2013 has pointed to a not-so-rosy scenario from the pricing angle. The study has looked at the three age groups of nonsmoking people: (1) 21-year olds; (2) 40-year olds; and (3) 60-year olds. The study has then focused on how the premiums stand up for those three age groups in reference to four tiers--Bronze plan (expected coverage 60%), Silver plan (expected coverage 70%), Gold plan (expected coverage 80%) and Platinum plan (expected coverage 90%)--of health insurance plans offered through the eight state health insurance exchanges and four federal health insurance exchanges that cover 11 states--California, Connecticut, Indiana, Maryland, New York, Ohio, Rhode Island, South Dakota, Vermont, Virginia and Washington--and District of Columbia. The Avalere study has focused on these 11 states and DC. Silver plan is considered the benchmark as it is the second lowest-cost plan, and tax credits will be applied for this plan. The pricing structures (prior to applying tax credits) for Silver plan are as follows:
* 21-year-old group: $270 a month
* 40-year-old group: $330 a month
* 60-year-old group: $615 a month
Under the Affordable Care Act, individuals who may afford to buy health insurance, but choose not to do so, will pay a fine of 1 percent of income in 2014, and the fine will increase to 2.5 percent in 2016. A breakdown of tax penalties is given below:
* Adult: $95.00 (2014); $325 (2015); $695 (2016)
* Child: $47.50 (2014); $162.50 (2015); $347.50 (2016)
* Family: $285 (2014) or 1 percent of family income whichever is higher; $975 (2015) or 1 percent of family income whichever is higher; $2,085 or 1 percent of family income whichever is higher
Penalties will increase by cost of living after 2016
October 1, 2013 is a landmark day for the Affordable Care Act as the health insurance exchanges have opened for enrollment for millions of uninsured Americans for comparison-shopping despite a partial government shutdown over the same issue. However, the operational challenges abound on the opening day, with tens of thousands of Americans unable to go beyond the security questions on the web site. As glitches and gridlocks hound the insurance exchanges, hundreds of thousands of Americans are being frustrated by denial and slowness of the process. However, the state-run exchanges were relatively more successful relative to federal HealthCare.gov online marketplace for insurance shopping, the primary source of insurance for millions of uninsured Americans in 36 states, including Texas.
On October 23, 2013, Obama administration extended the sign-up deadline by an extra six weeks to March 31, 2014 to bring more clarity to Americans on a firm timeline by which uninsured Americans need to buy insurance to avoid penalty. Administration said that there was no link between the extension of the sign-up deadline and the on-going hurdles with online insurance exchanges. When the Affordable Care Act became law in 2010, it was March 31, 2014 date that was thought to be the final timeline. However, to have an insurance by that date, an individual needs to sign up by not any later than six weeks prior to March 31, which would be January 15, 2014. Obama administration's October 23, 2013, move tried to ensure that individuals who would sign up by March 31, 2014 would avoid penalty.
On October 29, 2013, Administrator for Centers for Medicare and Medicaid Services Marilyn Tavenner appeared before the US House Ways and Means Committee, and apologized to customers for the bumpy rollout of Affordable Care Act although she had defended the handling of the issues. CMS is in charge of rolling out the enrollment process of federally run HealthCare.gov. Meanwhile, many of the 15 million Americans who buy insurance from the individual marketplaces are getting the cancellation notices because some of their plans are barebones or co-pays are associated with some preventive services. Under the Affordable Care Act, preventive services are offered free, pre-existing conditions are covered and coverage is more comprehensive than many existing individual plans. However, the cancellation notices pose a real political challenge to Obama administration as President himself said repeatedly that if consumers liked their plan they got to keep it.
On October 30, 2013, Obama administration mounted a two-pronged defense of its bungled rollout of Affordable Care Act. President Obama went to Massachusetts to drum up support for his landmark healthcare overhaul, comparing the measure with a similar measure Republican Governor Mitt Romney signed into law and drawing analogy to a similar bumpy start of that measure. HHS Secretary Kathleen Sebelius, appearing before the House Energy and Commerce Committee, apologized for the rollout glitches while spiritedly vowing to fix the problems.
On November 6, 2013, Republicans in Senate Finance Committee hearing demanded resignation of Kathleen Sebelius as President Obama, during the day, visited Dallas with a message that uninsured North Texans--about 550,000 in numbers--whose income in less than 138% of the poverty limit are not getting the benefit of Obamacare as Texas refused to expand Medicaid.
One of the major worries stemming from technical glitches in Healthcare.gov is that many with pre-existing conditions will remain in limbo after about a dozen of high-risk pools run by 35 states permanently close on January 1, 2014 and the people insured under these high-risk pools still are not able to buy insurance. When the Affordable Care Act was signed in 2010, there were high-risk pools by states and federal government created as a temporary bridge to insure patients with sever pre-existing conditions until they would all be integrated with health insurance exchanges set to operate effective January 1, 2014. The federal poo covers about 100,000 people.
On November 13, 2013, figures released from the Centers for Medicare and Medicaid Services showed dismal number of enrollment in the first month of rollout of Obamacare. According to the figures, 106,185 people enrolled through federal and state exchanges. Out of them, only 26,794 enrolled through the much maligned HealthCare.gov. A much larger number signed up through the health insurance exchanges set up by 14 states. Meanwhile, restive Democrats in the Congress who are facing tough re-election next year have started to distance from administration's position on debacle of Obamacare rollout, especially the cancellation of coverage of millions of Americans because their policies don't adhere to higher qualitative bars of Affordable Care Act. Many Democrats in House of Representatives are leaning towards supporting a measure proposed by Fred Upton, R-Michigan, Chairman of House Commerce and Energy Committee, that would allow Americans to continue with their existing insurance policies without penalties through 2014 as well as new customers to buy the plans, which may be sub-standard. The measure will come to vote on November 15, 2013.
In the face of Democratic revolt and bungled rollout of Affordable Care Act, President Barack Obama on November 14, 2013 took the blame upon himself for millions of cancellation notices sent to Americans who had bought insurances from the individual marketplaces, and made a reversal on the individual policies. Now, the consumers who want to keep these bare minimum coverage will be able to keep it for a year without any penalty, but will not be able to get subsidy as they would if they enroll through the healthcare exchanges. However, there is a catch here. Obama's step on November 14, 2013 doesn't automatically restore coverage for the people who have lost them in recent days. First, the insurance companies, who have sent cancellation notices to customers, have to extend the coverage, and the second, the state insurance commissioners have to approve it. President Obama's Director for the federal Center for Consumer Information and Insurance Oversight Gary Cohen on November 14, 2013 sent a letter to state insurance commissioners, explaining the "transition policy" under which "health insurance issuers may choose to continue coverage that would otherwise be terminated or cancelled, and affected individuals and small businesses may choose to re-enroll in such coverage".
On November 15, 2013, House of Representatives took up the Upton bill for vote, and passed it by 261-157, with 39 Democrats breaking party ranks. The measure, dead upon arrival at Senate and faces a sure presidential veto, allows insurers to:
(1) Renew for a year Individual health policies which have been cancelled because of insufficient coverage and other lack of adherence to the rules of Affordable Care Act;
(2) Sell the same bare-bone policies to new customers for 2014
On November 26, 2013, the U.S. Supreme Court agreed to hear a contentious provision of the Affordable Care Act that had plagued the country's lower courts with divided outcome and divergent interpretation of the 1993 Religious Freedom Restoration Act. Under the Obamacare, various religious institutions are exempt from the mandatory coverage of certain contraception procedures to women employees. However, for-profit institutions must provide the comprehensive contraception coverage to all their female employees. In June 2013, 10th U.S. Circuit Court of Appeals ruled that government mandate for comprehensive contraception coverage was illegal as the for-profit corporations are same as "personhood" whose religious views are protected under the 1993 Religious Freedom Restoration Act. The Denver-based appeals court ruled in the case of Hobby-Lobby vs. Sebelius. The court also cited the 2010 US Supreme Court ruling in Citizens United case, in which the country's apex court ruled that companies, unions and other for-profit entities could contribute unlimited amount in campaign contribution just like "individuals" as per the First Amendment rights. The court ruled that if for-profit could be deemed as "personhood" as part of the right of political expression, it could be deemed as "personhood" as part of the right of religious expression. However, a contrary verdict came from the Philadelphia-based 3rd U.S. Circuit Court of Appeals in July 2013 as the appellate court ruled that for-profit corporations were not entitled to benefits of the Religious Freedom Restoration Act. The 3rd U.S. Circuit Court of Appeals ruled in a case of Conestoga Wood Specialties vs. Sebelius. The apex court will hear both the cases in March 2014 and is expected to rule in the summer of 2014.
White House reported on December 1, 2013 the progress report of the beleaguered federal healthcare website Healthcare.gov that showed vast improvement in functional and system efficiency by November 30, 2013, self-imposed deadline, but still not perfect. The biggest achievement is to ensure that 50,000 concurrent users can log in and 800,000 visitors per day can shop for competing insurance offerings.
On December 11, 2013, the Obama administration provided update on enrollment figures through federal and state exchanges for October and November. Through October and November, 137,200 people enrolled through federally run Healthcare.gov, while 227,500 people enrolled through state exchanges. Although the combined October and November figure of about 365,000 still feels good compared to October's dismal figure of a little more than 106,000 disclosed on November 13, 2013, the enrollment process is lagging behind the administration's target number substantially. People need to enroll by December 23, 2013 to get coverage on January 1, 2014, and the enrollment period will last through March 31, 2014.
On December 19, 2013, Obama administration made another exemption to consumers whose cancelled individual policies from the insurance carriers had become a major headache for the administration. The exemption was put on HHS bulletin board: "If you have been notified that your individual market policy will not ne renewed, you will be eligible for a hardship exemption and will be able to enroll in catastrophic coverage".
Obama administration on December 23, 2013 extended the deadline to enroll in a plan (for coverage effective January 1, 2014) by 24 hours to accommodate the late-hour crush of potential enrollees. More than a million people logged on by 5 PM on December 23.
To critics, it's another sign of slipping deadlines, and to supporters, it's another sign of people's increasing interest in the insurance marketplace that Obama administration on December 24, 2013 announced that it would extend the enrollment timeline as long as consumers could show that they were held back by glitches in federal healthcare website. After a disastrous rollout in October, federal Healthcare.gov has been working much better in recent days, with 2 million visits on December 23, 2013, a record for one-day visit. Also, more than 250,000 people called the helpline on December 23, 2013, another one-day record of call volume.
When the concurrent users exceed 60,000 on December 23, the website put the visitors in a queuing system or asked for an e-mail address for invitation later. More than 129,000 users provided e-mail addresses. Meanwhile, the insurance industry is also extending the payment deadline to January 10, 2014 for policy to be effective retroactively from January 1. Also, Obama administration expressed satisfaction with the improved error rate, which is lower than 1 in 200, and pages uploaded quickly, in less than half a second.
President Barack Obama's signature healthcare law became effective on January 1, 2014 in a quieter way without much of a hoopla contrary to the rocky roll-out of the law on October 1, 2013. As many of the country's uninsured population bought healthcare coverage from the federal exchange as well as state exchanges in the three months since the measure's debut, its first day was full of hits and misses as Supreme Court Justice Sonia Sotomayor on late December 31, 2013 issued a ruling to put a temporary hold on the law's requirement for all employers to cover contraception and related treatment. Justice Sotomayor exempted Little Sisters of the Poor, a non-profit group that provides services to elderly poor, and more than 200 faith-based groups covered by Christian Brothers Employee Benefit Trust, which adheres to Catholic teachings. Justice Sotomayor's ruling was narrow in scope as it covered only Christian Brothers Employee Benefit Trust.
On January 13, 2014, Department Health and Human Services gave a more granular breakdown of enrollees in the new insurance marketplace that showed enrollment by a mere 24% of young people. As of December 28, 2013, total number of enrollees stood 2,153,421, short of original target of 3.3 million. Out of 2,153,421, age breakdown was available for 2,058,207 people.
Age-wise Breakdown:
(1) 55+ 681,081 (33%)
(2) 35-54 760,931 (37%)
(3) 18-34 489,460 (24%)
(4) 18- 126,735 (6%)
Gender-wise, women counted 54%.
On January 24, 2014, Obama administration reported that an approximate 3 million Americans had enrolled through insurance marketplace, an uptick of a million from the number of people who had enrolled by the end of December. It is yet to be seen whether the total number of enrollment by March 31, 2014, when the open enrollment for 2014 will close, reaches close to administration's target figure of 7 million.
Twin Reports Disconcerting for Obama Administration
A pair of reports raised the political firestorm one more time on Affordable Care Act as a non-partisan CBO report issued February 4, 2014 almost tripled the estimate of number of full-time workers who would drop out of the workforce due to ease of getting subsidy to buy their health insurance to 2.3 million by 2021 from a 2010 estimate of 800,000. However, this is not same as what many Republicans are claiming that the Obamacare will cost 2.3 million jobs by 2021. Instead, the fact is that as many as 2.3 million people, according to CBO estimate, will have less motivation in staying put in their work as they will get generous subsidy from federal government to buy health insurance if they don't remain employed full-time. It's the supply pool of full-time labor that would be lowered by 2.3 million.
A second report issued by Avalere Health on February 5, 2014 pointed only a third of targeted enrollment of uninsured through the expansion of Medicaid. The Avalere Health report estimated 1 million to 2 million of enrollment as in contrast to 6.3 million figure predicted by Obama administration.
Another Extension of Employer Mandate in Healthcare Overhaul
Obama administration's Treasury Department issued another set of complex rule set on February 10, 2014, extending the timeline of "employer mandate" provision that calls for fines if an employer with 50 or more employees doesn't provide insurance to its full-time employees--employees who work 30 or more hours a week--by an additional year for companies with 50 to 99 employees. Under the February 10, 2014, Treasury Department rules, companies with 50 to 99 employees have to provide health insurance to their employees effective January 1, 2016 to avert fines. Companies with 100 or more employees are still subject to the January 1, 2015, timeline to comply with the "employer mandate". Companies with less than 50 full-time employees are exempt from the law.
More People Sign Up for Health Plans
Department of Health and Human Services on February 12, 2014 reported an uptick of sign-up by young adults through federal and state exchanges in January 2014. Out of 1.1 million new enrollees in January 2014, 318,000 are young adults (ages 18-34), a critical age group to keep insurance rate affordable for the entire pool. What is heartening is that many young adults are choosing the silver, gold or platinum coverage instead of barebones bronze plan. According to HHS, as of January 31, 2014, 3.3 million people signed up for insurance through federal and state-run health insurance exchanges since the enrollment debuted on October 1, 2013, and of them, 807,500 people are of critical age group of 18-34.
Obama Administration Makes Another Extension of a Key Provision
Obama administration on March 5, 2014 extended the bare-bone, non-compliant individual insurance policies for an additional two years. At the height of mass cancellation of these policies by carriers and resulting political anger, Obama administration made its first exemption related to these bare-bones individual policies on December 19, 2013. On March 5, 2014, Obama administration, sensing an election year vulnerability over another wave of mass cancellation notices, said that individuals who liked to keep their policies would do so for an additional two years through 2016 provided state officials agreed.
Arguments over Contraceptive Provisions Begin at the Supreme Court
In a trial being closely watched by legal scholars, politicians, healthcare experts and women rights groups, attorneys for plaintiffs and US DOJ presented their positions in a very lively manner before the U.S. Supreme Court on the opening day (March 25, 2014). Two companies which challenged the provisions of Affordable Care Act to provide free contraception are owned by devout Christian families. Both Hobby Lobby and Conestoga Wood Specialties argued that providing some drugs and intrauterine devices were tantamount to abortion, and sought exemption from the law's contraception mandate citing the Religious Freedom Restoration Act of 1993.
Monthly Sign-up Breakdown
Monthly enrollment for ACA sign-up includes:
* October: 110,000
* November: 260,000
* December: 1.78 million
* January: 1.15 million
* February: 940,000
* March (as of March 27, 2014): 1.76 million
Obama Hails Record Sign-ups
President Barack Obama on April 1, 2014 hailed record sign-up of 7.1 million people for health insurances through federal and state exchanges. President Obama appeared before a friendly audience at the White House's Rose Garden to mark the record of beating its own target by the last day (March 31, 2014) of sign-up.
Majority Leader Reid Mocks Hypocritical Stand by Corporations Critical about Obamacare
In a Senate speech, Majority Leader Harry Reid, D-Nevada, on April 8, 2014 called out Koch Industries for duplicity and double-standard as it had applied for and received $1.4 million in federal subsidy for health insurance coverage of early retirees under a program, Early Retiree Reinsurance Program, created as part of Affordable Care Act in 2010. The law appropriated $5 billion in 2010 to cover subsidies related to insurance coverage for employees who would choose to retire before their Medicare eligibility age. Among corporations which had applied and received the subsidies are Dallas-based ATandT Corporation ($213 million) and UPS ($37 million).
CBO Estimates Lower Health Insurance Subsidies
Congressional Budget Office on April 14, 2014 released an update of its estimate of what it would cost in tax payers subsidies to fund health insurance coverage through Obamacare. According to the latest CBO estimate, the amount of subsidy over the next decade would be a little over $1 trillion, a drop from the previous estimate of $1.2 trillion.
Obama Brags Higher than Expected Enrollment Figures
President Barack Obama on April 17, 2014 took his health reform critics to tasks by boasting almost 8 million enrollment through health insurance exchanges. The figure beats the administration's own goal of insuring 7 million people through federal and state insurance marketplaces. The administration gave a grace period of 15 days for people who had started the enrollment process by March 31, 2014 but couldn't finish on time, thus boosting the enrollment volume. However, the administration didn't give breakdown on how many of the 8 million people who had enrolled through health insurance exchanges
* were previously uninsured; and
* had paid the premium
Supreme Court Hands out Defeat to Administration over Hobby-Lobby Suit
Ruling on a suit filed by Hobby Lobby and Conestoga Wood Specialties on June 30, 2014, a divided U.S. Supreme Court said that the exemption from the mandate to cover contraception on religious ground applied not only to "individuals", but also to a for-profit, closely held corporation. The 5-4 ruling was narrow in scope, but would have repercussion far beyond the scale of two privately held corporations. Judge Anthony Kennedy sided with the conservatives in the bench, namely Judges Antonin Scalia, John Roberts, Samuel Alito and Clarence Thomas, while four dissenters were Judges Ruth Bader Ginsburg, Elena Kagan, Sonia Sotomayor and Stephen Breyer.
A pair of Appellate Court Rulings Pointer to Confusion over Federal Subsidies
Two appellate courts on July 22, 2014 issued conflicting rulings on almost identical provision of Affordable Care Act. U.S. Court of Appeals for the District of Columbia ruled 2-1 that Obama administration had stretched the law too much to provide customers federal subsidies to buy coverage through the federal exchange. According to the majority, the subsidy was meant to encourage states to offer insurance coverage through state exchanges. A second appellate court, 4th U.S. Circuit Court of Appeals based in Richmond, VA, ruled 3-0 on July 22, 2014 that health insurance tax credits a "permissible exercise" of a federal agency's discretion in interpreting ambiguous legislative language. Nearly 6.7 million enrollees--85 percent of total enrollment--received tax credits, with 4.7 million of them having enrolled through federal insurance marketplace. According to HHS, monthly premium dropped 76 percent for those who had received tax credits.
Obama Administration Caps the Penalty for Lacking Insurance
On July 24, 2014, Obama administration announced the cap for not carrying health insurance at $2,448 per person and $12,240 for a family of five. The fine was touted as $95 per person or $47.50 per child, and it may rise as much as 1% of gross income. So, a person making $45,000 a year may owe as much as $450 in 2014 tax.
Enrollment Tops 11 Million
In a sweet surprise, Obama administration said on February 17, 2015 that it had beat its own goal by having 11.4 million people signing up for the coverage this year. The preliminary estimate was based on total number of new as well as returning enrollees to the insurance exchanges as of February 15, 2015, the last day of enrollment for this year. The final numbers are likely to be higher for the following two reasons:
(1) People who have started the enrollment process, but yet to finish, have until February 22, 2015 to complete the process
(2) Many Democratic lawmakers are asking the administration to re-open the enrollment process and accommodate many uninsured as they are likely to find out during incoming tax filing season that there's financial consequence for not having an insurance and may be inclined to get one
Extension Granted for Uninsured Facing Penalty
As the tax filing season gets underway, it's likely that many of the uninsured will figure out for the first time that it costs them money in the form of tax penalty for not having health insurance last year (2014). To help some of them avoid a repeat of penalty next year when they will file for 2015 tax returns, Obama administration, under pressure and prodding from some key Congressional Democrats as well as support groups, on February 20, 2015 has announced allowing those uninsured an additional six weeks in March and April to sign up in the health insurance exchanges.
Nearly 9 out of 10 Adults Have Insurance Coverage
A new report issued by Gallup-Healthways Well-being Index on April 13, 2015 came as a boon for Obamacare's success of accomplishing one of the three objectives: increasing the number of insured. According to the report, nearly 9 out of 10 people are now insured, a significant landmark for the Obama administration. In 2013, the rate of insured people was little over 8 in 10.
U.S. Supreme Court Upholds Insurance Subsidies
In an unwavering ruling of 6-3, the U.S. Supreme Court on June 25, 2015 tossed out King vs. Burwell, a lawsuit that challenged the legality of insurance subsidies to customers in states where insurance exchanges were set up and being run by the federal government. Critics stressed that the subsidies were meant for the consumers who buy insurance from state exchanges. Only 16 states had set up the insurance marketplaces, while federal government been running the insurance exchanges for 34 other states, including Texas. Writing for the majority, Chief Justice John Roberts stated that the intent of the Congress was to preserve the insurance marketplace, not destroy it, which was inevitable if insurance subsidies were proscribed from the insurance exchanges in 34 states being run by the federal government. In other words, according to majority opinion, country's apex court on June 25, 2015 fixed what Congress should have done in the first place. The majority included, beside Chief Justice Roberts, Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Dissenting voices were all conservative judges: Judge Clarence Thomas, Judge Antonin Scalia and Judge Samuel Alito. The Supreme Court verdict was a significant victory to President Barack Obama who made Affordable Care Act as one of his significant legacy-building efforts that would have a lasting national footprint in years to come.
Congress Sends a Measure Overturning ACA
Congress on January 6, 2016 sent President Barack Obama a piece of legislation that the president would surely use his veto pen to reject. House of Representative on January 6, 2016 for the sixty-second time voted (240-181) to reject president's signature healthcare law, Affordable Care Act. The only difference this time, though, was that Congress was able to send the measure scrapping the ACA to President. The measure was already approved by the U.S. Senate. The overall package also includes a provision to defund Planned Parenthood. President Barack Obama is sure to use veto for the eighth time in his presidency.
Insurance Coverage Rate Stalls; Obama Administration Claims Strong Sign-up Numbers
A major independent survey, Gallup-Healthways WellBeing Index, released January 7, 2016 confirmed what was already known about the scale of insurance coverage. According to the survey, 11.9 percent of the people lacked any insurance coverage in the last three months of 2015, same as in the first quarter of the year. Meanwhile, the head of the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt said on January 7, 2016 that 11.3 million people had so far signed up for the coverage under Obamacare with three weeks to go. Among the states, Florida tops with 1.5 million, California with 1.4 million and Texas with more than 1.1 million sign-ups.
Obama Vetoes the ACA Repeal Measure
Two days after Congress sent a measure to President Barack Obama repealing his signature healthcare overhaul, president used his veto pen on January 8, 2016 for the eighth time in his presidency.
2016 Enrollment Okay, but not Great
The Health and Human Services Secretary Sylvia Burwell reported on February 4, 2016 that about 12.7 million people either newly enrolled, or re-enrolled, in federal, or state, insurance exchanges since November 1, 2015 when the enrollment process for 2016 had begun. The government had projected between 11 and 14 million people to enroll through HealthCare.gov. So, the figure reported by the HHS Secretary fell right in the middle of the range, but nearly a million over the last year's (2015) 11.7 million initial enrollment. The Obama administration's primary challenge is to improve retention rate, and Ms. Burwell disclosed that this year's (2016) target would be 10 million enrollees by the end of 2016.
2017 Enrollment Drops
Trump administration reported on February 3, 2017 that a total of 9.2 million people had enrolled in ACA through the marketplaces after a three-month enrollment period ended on January 31, 2017, a steep drop of about a half-a-million people and a sharp reversal from the previous year, especially in the final three weeks when the ads promoting ACA had been pulled off.
2015 Attrition Rate Significant
The Obama administration on March 11, 2016 reported that the attrition rate of enrollees was a whopping 25 percent last year (2015) as the year that began with 11.7 million sign-ups ended with about 8.8 million paying consumers, even lower than 9.1 million target set by the Health and Human Services Secretary Sylvia Burwell.
Obama Administration Receives a Legal Setback
A federal judge, the U.S. District Judge Rosemary Collyer, on May 12, 2016 ruled that Obama administration didn't have authority to provide subsidies to consumers of the healthcare exchanges without approval by Congress. The administration's argument was that the approximately $175 billion subsidies under the Obamacare were part of the mandatory spending such as Medicare, Medicaid and Social Security and the administration didn't need Congressional approval. Judge Collyer rejected that central argument. The suit was brought by the House Republicans in 2014, one of plethora of lawsuits filed by the Congressional Republicans to undercut President Obama's landmark healthcare overhaul.
Medicaid Expansion Costs Growing Faster than Anticipated
In a recent report submitted to Congress, the Centers for Medicare and Medicaid Services, or CMS, said that the Medicaid expansion costs under Obamacare had been increasing more than anticipated, according to an article by The Associated Press, providing the political fodder to GOP in the midst of a heated election season. In 2015, the annual cost to cover an individual under the Medicaid expansion was pegged at 6,366, about 49 percent higher than previously estimated. 19 states have so far expanded Medicaid to cover an estimated 9 to 10 million people.
*************************** OBAMACARE REPEAL EFFORT ***********************
House Republicans Unveil ACA Repeal Plan
House Republicans on March 6, 2017 unveiled a plan that would repeal and replace Affordable Care Act. This marked an arduous, if not a stumbled, beginning of a long-drawn process that would fulfill a long-nurtured Republican promise to repeal and replace ACA. The highlight of the Republican plan, American Health Care Act, unveiled on March 6, 2017 includes:
* Replacing federal insurance subsidies by tax credits to individuals purchasing their own health insurance
* Expanding contributions to health savings accounts
* Repealing tax penalties on uninsured people
* Scrapping income-based tax credits
* Maintaining the requirement for coverage of pre-existing conditions
* Preserving the provision for children to stay on parent's insurance until age 26
* Retaining ACA's higher federal financing to expanded Medicaid program until the end of 2019
* Repealing taxes on high income earners, health insurance plans and medical device manufacturers
GOP Plan Attracts Conservative Wrath
A day after unveiling a replacement plan for ACA, conservatives in the House on March 7, 2017 rebelled against the plan, formally known as American Health Care Act, ridiculing it in derogatory terms such as Obamacare 2.0, Obamacare Lite, etc.
GOP Plan Gives Big Tax Benefit to Wealthy
The GOP plan unveiled March 6, 2017 aims to cut the taxes on wealthy and give them a tax relief of about $157 billion over the next decade. The two provisions slammed as part of ACA included a
* Tax on capital gains and other investment-related incomes
* Surcharge on Medicare tax
CBO Predicts Spike in Uninsured Ranks
Venerable Congressional Budget Office on March 13, 2017 struck a significant blow to the Republican effort to repeal and replace Obamacare. According to the CBO estimate, the ranks of uninsured will swell by an additional 24 million by 2026 to 52 million (under Obamacare, the figure was slated to rise to 28 million by 2026) while the savings will be as significant too: $337 billion over the time. The CBO estimate dealt a blow to President Donald Trump's campaign promise that repeal of Obamacare would be beautifully done with premium to fall and no one to lose insurance coverage. Next year (2018), the ranks of uninsured will increase by 14 million, mostly due to dropping of insurance coverage by healthy young adults now being penalized for not carrying insurance. But, later in the decade, another 10 million people will lose the coverage because many states will end the expansion of Medicaid. Under the American Health Care Act, people who will discontinue their health plan in the middle of the year will have to pay a 30 percent surcharge to renew their insurance for that year. Under the American Health Care Act,
* Federal Medicaid spending will be 25 percent lower by 2026
* Older people will fare worse as the tax credit for older population will be lower by 2026 compared to Obamacare
-- Under the current law, a single 21-year-old who earns $26,500 with an insurance plan that costs $5,100 will receive a tax credit of $3,400 and will have to pay $1,700 out of pocket. Under the Republican plan, the out-of-pocket premium will reduce to $1,450.
-- A 64-year-old adult will fare much worse under the House bill as a $13,600 tax credit for an annual premium of $15,300 health plan will leave the consumer on hook for $1,700 under the Obamacare while under American Health Care Act, the consumer will be responsible for $14,600 toward an annual premium of $19,500 with a tax credit of only $4,900.
Ryan Offers Something to Moderates, Conservatives in His Own Ranks to Win Support
As Speaker Paul Ryan's effort to repeal and replace Obamacare looked more uncertain by the day, hectic political maneuvering was underway to win support from critical Freedom Caucus while retaining support among moderates. It was a fine balancing act on behalf of Speaker Paul Ryan. On March 21, 2017, Ryan offered conservatives an olive branch by giving states the freedom to impose work requirement for Medicaid eligibility except for single mothers with kids below 6 or with disabilities. Also, to soothe the frayed temper of the Freedom Caucus members, the amendment included the provision of Medicaid block grant to the states. The new amendments of Medicaid's work requirements were blasted by seven female Democratic House members and Rep. Jerrold Nadler, D-NY, as anti-family because new mothers might end up getting denied of Medicaid coverage if they failed to find a job within 60 days of child's birth. The statement was signed by seven female Democratic House members, beside Rep. Jerrold Nadler--Reps. Katherine Clark, Conn; Diana DeGette, Colorado; Jan Schakowsky, Illinois; Barbara Lee, TX; Judy Chu, California; Suzan DelBene, Washington; and Louise Slaughter, NY. On the other hand, to assuage the moderate Republicans, Ryan offered assistance for older Americans who were shortchanged under the original bill. Also, people will be allowed to deduct their taxes on any medical expenses over 5.8 percent of their income instead of 10 percent under the current threshold. This may end up costing $85 billion in lost revenue.
CBO Issues Revised Report on Healthcare Overhaul Legislation
Days after Paul Ryan and Republican leadership had modified parts of the American Health Care Act, Congressional Budget Office (CBO) issued a revised assessment on March 23, 2017 that lowered the projected benefit of the law from $337 billion over a decade to $150 billion, without making a significant dent in the ranks of uninsured.
Republicans Pull the Obamacare Repeal Measure
Sensing a near-certain defeat and facing an open rebellion from the Freedom Caucus led by GOP conservative Mark Meadow, R-N.C., Speaker Paul Ryan and his leadership team on March 24, 2017 withdrew the American Health Care Act. It was a stinging defeat for President Trump's agenda and a humiliating retreat for House Republican leadership.
Obamacare Replacement Act Passes House
Paul Ryan's second try to pass a health care legislation to repeal and replace Obamacare came to fruition on May 4, 2017 as House passed American Health Care Act (AHCA) by a narrow 217-213 votes. An ecstatic Donald Trump responded, surrounded by House leaders, that it was a "great plan". Under the AHCA:
* Medicaid will be slashed by $880 billion over the next decade
* Insurers will be allowed to charge older Americans more, leading advocacy groups such as AARP dubbing the provision as so-called "age tax"
* There will not be any individual mandate
* A high-risk pool will be set up to treat people with pre-existing conditions. The $23 billion set aside for this fund is estimated to cover only 110,000 patients, or roughly 5 percent of 2.2 million Americans who fall under this category
CBO Report Raises Uninsured Ranks under the Approved House Bill
The Congressional Budget Office, the legislative ombudsman of financial impact of Congressional legislations, on May 24, 2017 issued an ominous report on the latest GOP Obamacare repeal bill, American Health Care Act (AHCA), that had sailed through the House on May 4, 2017 by a meager 217-213 margin. According to the CBO report:
* Ranks of uninsured (in millions)
Under Obamacare: 26 (2017); 26 (2018); 27 (2019, 2020, 2021, 2022 and 2023); 28 (2024, 2025 and 2026)
Under House Bill: 28 (2017); 41 (2018); 43 (2019); 46 (2020); 48 (2021); 48 (2022); 49 (2023); 50 (2024); 50 (2025); and 51 (2026)
* Federal Budget Deficit will reduce by $119 billion over the next decade under the House bill passed on May 4, 2017 compared to if Obamacare would have stayed in place. The budget deficit savings were projected $150 billion on an earlier version of the House bill that had failed in late March 2017. How CBO arrived at $119 billion in savings (in $ billion):
1. Medicaid caps, matching funds (-834)
2. Reduced subsidies for non-group insurance (-276)
3. Patient/State grants to reduce premiums (117)
4. Reduced collection of penalties (210)
5. Repeal/Delay of other taxes (664)
Total Impact on Deficit: (-$119 billion)
Senate Republican Leaders Unveils Their Version of Obamacare Repeal Plan
After working behind the closed doors for months and excluding not only their Democratic colleagues, but also the chamber's rank-and-file Republican Senators, top Senate Republicans led by the Majority Leader Mitch McConnel on June 22, 2017 unveiled their first shot at repealing the Obamacare. The measure, Better Care Reconciliation Act, is sure to face fierce opposition from Democrats and few Republican Senators. Here are key areas of changes proposed by the Republican measure compared to Obamacare:
* Medicaid Expansion
Obamacare: Expanded the benefit of Medicaid to people up to 138 percent of the poverty level. The federal government picks up 90 percent of the tab for new enrollees.
BCRA: Allows 31 states that have expanded Medicaid to continue receiving the benefit through 2023, although the flow from the federal government will reduce substantially from 2021. In 2024, Medicaid expansion will end altogether. Separately, the measure will cap the federal contribution to the benefit and, some states, may receive block-grants if they switch over to that option. The CBO estimated that the cut for a similar House-passed measure would be around $800 billion over a decade.
* Repeals Taxes
Obamacare: Imposed new taxes on investment incomes, wages over $200,000, medical devices, prescription drugs and indoor tanning.
BCRA: Eliminates most of the taxes, but a tax on the Cadillac healthcare plans proposed under the Obamacare, but yet to take hold, will be effective beginning in 2026.
* Repeals Subsidies
Obamacare: Provides subsidies to low-income consumers to cover their out-of-pocket costs such as deductibles and copayments.
BCRA: The subsidies will continue until 2019, then they will be eliminated, leading to increased out-of-pocket payments, co-payments and premiums.
* Repeals the Individual Mandate
* Repeals Employer Mandate
* Changes Tax Credits for Premiums
Obamacare: Gives tax credits to middle-income and low-income consumers to help buy insurance premiums from the exchanges.
BCRA: Whittles down the benefit to consumers with incomes of up to 350 percent of poverty level, or $42,000 for a single person. The bill also expands the benefit to people below the poverty level, a segment that currently does not receive the tax credit.
* Health Savings Accounts
Obamacare: Allowed in 2017 for an individual to put $3,400 and a family to put $6,750 in an HSA
BCRA: Will allow consumers to put more money in HSA, including up to 100 percent of the deductibles.
* Older Customers vs. Younger Customers
Obamacare: Caps the amount that can be charged as premiums for older customers at the maximum of three times of what can be charged for the younger customers
BCRA: Changes the cap to as high as 5-to-1 ratio
* Coverage of Children until 26
BCRA retains this valuable Obamacare benefit.
GOP Senate Bill Teeters on the Brink of Failure after CBO Figures Released
The nonpartisan Congressional Budget Office on June 26, 2017 might have dealt a fatal blow to any prospect for the Senate to pass the Better Care Reconciliation Act unveiled four days ago. The CBO study of the bill released during the day revealed a grim picture that included:
* Additional 22 million people in the ranks of uninsured compared to that of Obamacare by 2026
* 15 million people would be without insurance next year alone
* Out-of-pocket expenses and premiums to soar
However, the federal deficit will decrease by $321 billion over the decade.
GOP Shelves the Repeal Bill
Sensing a sure defeat on the Senate floor and exposure of a fatal political rift within the ranks, GOP leaders on June 27, 2017 postponed vote on the Better Care Reconciliation Act.
Senate Unveils Its Own Version of Obamacare Repeal Bill
U.S. Senate GOP leaders on July 13, 2017 unveiled Senate version of Obamacare repeal bill, almost two-and-a-half months after House had passed its repeal bill on May 4, 2017 by a wafer-thin 217 by 213 votes. The bill, much of its has been discussed and formulated behind closed doors without input from Democrats, faces significant hurdle. The bill retains two Obamacare taxes:
(1) a 3.8 percent tax on investment income
(2) a 0.9 percent payroll tax on incomes of at least $200,000 for individuals and $250,000 for families
Senate's previous version aimed to eliminate those two taxes, thus reducing the flow of revenue by $231 billion over a decade, according to the Congressional Joint Committee on Taxation. CBO is yet to evaluate the new version of the bill. The previous version of Senate bill will results in 22 million more Americans without health insurance by 2026, according to the CBO analysis. Congressional Budget Office and Congressional Joint Committee on Taxation are the two nonpartisan panels that usually evaluate and submit recommendation to Congress on bills for overall guidance. The bill unveiled on July 13, 2017 envisions some forms of tax breaks for wealthy Americans while making the insurance premium cheaper for barebones plans. The bill will expand the so-called Health Savings Account (HSA) from the current benefit of paying deductibles and copayment to pay even the insurance premiums. Any HSA contribution will be tax deductible. In addition, under the Senate version of the bill unveiled July 13, 2017, the subsidies will be provided to household incomes of up to 350 percent of the federal poverty level, or $71,000 for a family of three.
McCain Returns to Senate after Brain Surgery, Appeals for Bipartisanship
As uncertainty grows over the fate of Senate measure to repeal Obamacare, Republican Senator John McCain returned to Senate floor to a hero's welcome on July 25, 2017 to give an impassioned speech, harping on the value of bipartisanship. Senate GOP won a key procedural vote to push the measure across a critical hurdle to debate by collecting 50 votes behind the move. Two GOP senators--Lisa Murkowski, Alaska, and Susan Collins of Maine voted against bringing the bill to floor debate on July 25, 2017. Now, Senators can add dozens of amendments to the measure, and will vote on them individually.
Senate Votes down the "Only Repeal" Measure; Cruz's Skimpy Coverage Amendment
An "only repeal" measure, with a replacement to wait for two years, as proposed by Kentucky Republican Rand Paul was defeated on July 26, 2017 by 55 to 45 votes. Seven Republicans--Susan Collins of Maine, John McCain of Arizona, Shelley Moore Capito of West Virginia, Dean Heller of Nevada, Rob Portman of Ohio, and Lamar Alexander of Tennessee--joined all Democrats to defeat the "only repeal" piece of amendment. Another amendment offered by Texas Senator Ted Cruz was defeated by 43-57 votes, with nine Republican defections. Cruz's Consumer Freedom amendment aims at waiving insurers from the minimum coverage compliance of the ACA. Under Cruz's amendment, insurers can offer just barebones coverage to consumers.
*************** Graham-Cassidy Bill to Repeal Obamacare
GOP Withdraws Graham-Cassidy Bill
After it was clear that the Maine Sen. Susan Collins would not vote for a measure that would take away insurance coverage from millions of Americans, Senate GOP leaders had no choice, but to withdraw the healthcare overhaul bill crafted by Lindsay Graham, R-S.C., and Bill Cassidy, R-La., on September 26, 2017. After the withdrawal of Graham-Cassidy bill, GOP faces increased hurdles of repealing Obamacare as they now need a filibuster-proof measure with the legislative provision that can skirt the filibuster is ending on September 30, 2017.
*************** Graham-Cassidy Bill to Repeal Obamacare
Trump to End Cost-Sharing Subsidies
After failing to repeal and replace Obamacare, Trump administration on October 12, 2017 chose an alternative--according to consumer rights groups, a harmful--route to nix the marketplace for the landmark healthcare law. White House said that it would scrap the so-called cost-sharing reduction (CSR) subsidies typically used to help low-income consumers pay their insurance premiums.
Another Shot to Partially Roll back Obamacare
What it couldn't accomplish by legislation, White House is trying to do it through judiciary by undermining the Affordable Care Act on piecemeal basis. First as part of the December 2017 tax cuts package, the administration eliminated the penalty for not carrying the health insurance. That set the stage for Texas and 19 other states to file a lawsuit in February 2018 in the U.S. District Court of Fort Worth asking the judge to rule the individual mandate invalid, and with it, the entire law. Trump administration on June 8, 2018 filed a brief supporting the states' move, but didn't go as far as scrapping the entire law. Instead, it asked to strike down the individual mandate provision and pre-existing condition [coverage] provision, while preserving the extension of Medicaid. The move is another indirect cheap shot by administration to undermine Obama's public health legacy.
*********************** Bare Bone Association Health Plan Trump Administration Issues Rules to Undermine Obamacare
In another shot to undermine the ACA marketplaces, Trump administration on June 19, 2018 issued new rules, allowing the so-called Association Health Plans to enter in the insurance marketplace. These plans are controversial as they are bare-bone plans that may refuse to cover many maternity treatments and discriminate based on age and health conditions. This is another indirect effort to assault on the Affordable Care Act after failing to repeal the act through Congressional act.
Judge Blocks Bare bone Health Plan
A federal judge, U.S. District Judge John Bates, on March 29, 2019 blocked President Donald Trump's June 19, 2018, rules to create bare-bone Association Health Plan for small businesses on the ground that administration's effort was tantamount to "an end-run" around consumer protections embedded in the Affordable Care Act.
*********************** Bare Bone Association Health Plan
Trump Tries to Undermine Obamacare one More Time
What has become almost a monthly ritual for Trump administration to find ways to undermine and undercut, in whatever ways, small and large, the Obamacare has been displayed one more time on July 7, 2018 as the administration has announced scrapping billions of dollars in payment to insurers to stabilize the exchange marketplace. Without the so-called "risk adjustment" payments, the premiums are sure to go high in the upcoming enrollment season for most of the exchanges.
Texas Sues Feds to Overturn Obamacare
Texas' Attorney-General Ken Paxton on behalf of 20 states filed a lawsuit on September 5, 2018 in an effort to quash the Affordable Care Act. The lawsuit against the Trump administration justified the rationale behind the action by stating that once "individual mandate" had been scrapped by Congress, all of the law had become invalid. However, officials from the Trump administration's Justice Department feared that scrapping of the law would lead to chaos. The lawsuit was filed at the U.S. District Court of Judge Reed O' Connor of Fort Worth.
Texas Judge Rules Obamacare Unconstitutional
U.S. District Judge Reed O' Connor on December 14, 2018 issued a sweeping verdict, opining the entire Affordable Care Act unconstitutional on the ground that December 2017 tax overhaul law eliminated a key, but unpopular, provision of Obamacare requiring individual mandate for health insurance coverage, thus making the entire healthcare law unconstitutional. However, the judge didn't order immediate implementation of his ruling, thus allowing the ongoing enrollment process for the 2019 coverage renewal. About 17 million people will lose the coverage if Judge O' Connor's ruling is implemented.
Democratic State Officials File Legal Challenge
A group of 16 state AGs and that of District of Columbia, led by the California AG Xavier Becerra, on January 3, 2019 filed an appeal to the 5th U.S. Circuit Court of Appeals, against a federal judge's ruling that the entire Affordable Care Act was unconstitutional, calling the rationale for December 14, 2018, ruling by the U.S. District Judge Reed O' Connor "reckless", "ludicrous" and "flimsy". U.S. District Judge Reed O' Connor last week allowed the law to continue as the legal process continued through the nation's court system.
Trump Justice Department now for Obamacare Repeal
Trump administration's Department of Justice on March 26, 2019 filed a friendly brief in support of Republican states who won a significant victory from the U.S. District Judge Reed O'Connor on December 14, 2018. The U.S. DOJ filing on March 26, 2019 to the 5th U.S. Circuit Court of Appeals came as a surprise to many because, although opposed to Obamacare from the very outset, the administration stayed away so far from pushing the healthcare marketplace to disarray without a viable replacement of the Affordable Care Act.
Short-term Health Plan Expansion Challenge Rejected
In a setback to Obamacare, a federal judge on July 19, 2019 rejected a petition challenging Trump Administration's another end-run to undermine Obamacare. Under Affordable Care Act, short-term insurance plans can be marketed that would be limited to three months and these plans--offered by Health Insurance Innovations Inc. and eHealth Inc. among others--are often aimed at healthy young consumers. Trump administration last year expanded the short-term insurance plans to last as long as 364 days and renewable every three years, thus raising the fear that there would be an exodus of healthy consumers from ACA-compliant plans to these short-term insurance plans and raising premiums of the remaining consumers in the ACA-compliant plans. The rule went into effect in October 2018. U.S. District Judge Richard Leon ruled on July 19, 2019 that plaintiffs failed to prove any "potential negative impact" from the Trump administration's rule.
Adverse Ruling Puts an Additional Nail to Obamacare
As the Texas case against Obamacare is winding through the federal court system, it has suffered another setback on December 18, 2019 as a three-judge panel of the 5th U.S. Circuit Court of Appeals has ruled that the individual mandate is unconstitutional after Congress has passed the 2018 tax overhaul, abolishing the penalty for not carrying individual health care coverage. However, unlike the lower court, the appeals court refrained from deciding on the unconstitutionality of the remainder of the Obamacare.
However, in August 2011, the 11th U.S. Circuit Court of Appeals in Atlanta ruled against the mandatory coverage portion of the law. The ruling was 2 to 1, with the chief judge Joel Dubina and Judge Frank Hull ruling: "We have not found any generally applicable, judicially enforceable limiting principle that would permit us to uphold mandate without obliterating the boundaries inherent in the system of enumerated congressional powers". The mandate referred to in the ruling is the individual mandate to buy health insurance coverage.
On September 8, 2011, the 4th U.S. Circuit Court of Appeals in Richmond, Va., rejected the challenges to the constitutionality of the law. However, it said that threshold legal issues barred an immediate ruling.
The Obama administration on September 28, 2011 asked the Supreme Court to hear the case related to the Affordable Care Act. The administration notched up the fight by foregoing to the full 11th U.S. Circuit Court of Appeals and, instead, going straight to the Supreme Court to contest against the August ruling of the 3-member bench of the appeals court that ruled against the mandatory coverage option. So far three appeals courts--Sixth, Eleventh and Fourth--issued some sort of decisions on the Affordable Care Act, while a fourth hearing was held in the prior week by the U.S. Court of Appeals for the District of Columbia. The U.S. Solicitor General Donald Verrilli said in the September 28, 2011, filing that the individual mandate requires most people to buy insurance "rather than rely on a combination of attempted self-insurance and the backstop of care paid for by other market participants". The individual mandate thus "regulates economic conduct that substantially affects interstate commerce". Also pending before the apex court are several suits from individuals and a petition from Thomas More Law Center appealing the ruling of the Sixth U.S. Circuit Court of Appeals.
*** Long-Term Care Plan Abandoned ***
A key program in the Patient Protection and Affordable Care Act of 2010 was abandoned by the Obama administration on October 14, 2011 as HHS Secretary Kathleen Sebelius failed to certify twin requirements of the financial solvency of CLASS (Community Living Assistance Services and Support) for the next 75 years and affordable coverage easily accessible to all working adults, irrespective of health as needed by the law. The goal of the CLASS was very simple: Workers would pay an affordable premium during their careers, and could collect a modest daily amount, say $50, after they become disabled later in the life. They can either pay to a service provider for staying at home or nursing home costs. The program, championed by the late Sen. Teddy Kennedy, was scheduled to take off in 2013. The need for long-term care often comes unexpectedly: an old person takes a fall, a teen is badly injured in a car crash or a middle-aged worker suffers a devastating stroke. Medicare does not cover long-term care, and only about 3% adults have a private policy. Medicaid, federal-state program for the poors, covers the long-term care. Often middle-class family exhaust their saving before they become eligible for Medicaid.
*** Long-Term Care Plan Abandoned ***
On November 8, 2011, The U.S. Court of Appeals for the District of Columbia issued a split verdict upholding a lower court ruling that Congress had not overstepped its authority by passing President Obama's health care overhaul measure that required individuals to buy insurance or pay a penalty on their taxes, beginning in 2014. The 2-1 verdict included Judge Laurence Silberman, an appointee of President Ronald Reagan, and Judge Harry Edwards, an appointee of President Jimmy Carter in favor, while the dissenting voice was lent from the bench by Judge Brett Kavanaugh, a former aide to President George W. Bush who had appointed him to the court. The appeal was filed by the American Center for Law and Justice, a legal group founded by tele-evangelist Pat Robertson.
On November 14, 2011, the US Supreme Court agreed to hear the Obama administration's appeal, filed on September 28, 2011, to the ruling issued by the 11th Circuit Court of Appeals. The apex court will probably rule in the summer of 2012.
One of the biggest windfalls for seniors from the Affordable Care Act, signed by President Obama on March 23, 2010, is the narrowing of coverage gap, also known as doughnut hole, because of the Obama administration's aggressive bargaining, as part of the law, with the pharmaceutical companies to get discounts as deep as 50 percent for brand name drugs. The research results were published in The Dallas Morning News in its November 28, 2011, edition. As a result, the average savings to Medicare beneficiaries arising from the brand name drugs in 2011 are estimated to be around $581 from the brand name drugs alone with an additional $22. More than 2 million Americans already got some help, discounts mostly have gone to middle-class seniors as poors are automatically covered in the coverage gap at the expense of taxpayers. Medicare covers about 47 million older or disabled people, and about 9 out of 10 have some kind of prescription plan. Most rely on the drug benefit, also known as Part D, which is delivered through private insurance plans. The coverage gap starts after an individual reaches $2,840 threshold, and then for the next $3,600, is on the hook. After the individual exceeds $6,440, the catastrophic coverage kicks in, with the beneficiary paying a token amount.
On February 2, 2012, the Obama administration made public the first full-year of benefit of the healthcare overhaul law in closing the gap of doughnut hole. Approximately 3.6 million Americans saved $2.1 billion in 2011 because of the deep discount provided by the drug makers to help Medicare beneficiaries in the doughnut hole gap. The gap, created in the Medicare Part D program during the George W. Bush administration, was partly covered by $250 rebate in 2010 as part of the Affordable Care Act signed in March 2010. In 2011, the law provided beneficiaries a 50% discount on covered brand-name drugs and 7 percent coverage on generics when they hit the so-called doughnut hole. That came out to be $604 per Medicare beneficiary. Those benefits are slated to rise to 75 percent for brand name and generic drugs by 2020, when the coverage gap will be eliminated altogether.
In a landmark ruling, the US Supreme Court on June 28, 2012 upheld most of the provisions of Affordable Care Act, including two controversial ones: (A) Individual requirement for every American to have health insurance (by 5-4 votes), and (B) Expansion of Medicaid to cover an additional 17 million Americans (by 5-4 votes). On both occasions, Chief Justice John Roberts voted with the liberal bloc of the court: Justice Ruth Bader Ginsburg, Justice Stephen Breyer, Justice Sonya Sotomayor, and Justice Elena Kagan. Writing for the majority, Chief Justice Roberts struggled to explain his rationale to uphold the law. On "individual requirement" provision, a "mandate" for all Americans to carry insurance coverage is illegal, but if it is deemed as a tax, it is perfectly legal. On Medicaid expansion provision, the court found problems, but still stated that Congress had authority to expand Medicaid. However, court asked federal government not to punish any state if it didn't participate in the Medicaid expansion. The dissenting judges are Justice Anthony Kennedy, Justice Antonin Scalia, Justice Samuel Alito and Justice Clarence Thomas.
Key Provisions of Affordable Care Act Phase-In Timeline
2010
** High-risk health insurance pool set up to provide affordable coverage for uninsured people with medical problems.
** Lifetime dollar limits on insurance coverage barred.
** Tax credits given to small businesses (up to 25 employees) provide workers with insurance.
** Health Insurance plans required to maintain dependent coverage until age 26.
** Insurers prohibited to exclude children from coverage because of pre-existing conditions.
2012
** Prescription drug coverage for the Medicare gap, also called as doughnut hole, to be carried out by discounts.
2013
** Medical expense contributions to tax-sheltered flexible spending accounts to be limited to $2,500 a year, with annual increases based on COLA.
** Medicare payroll tax to be increased on couples making more than $250,000 a year and individuals making more than $200,000 a year.
** A new tax of 3.8 percent on investment income to be slapped.
** Program to create non-profit insurance co-ops to be set up.
2014
** States will create Health Insurance Exchanges--supermarkets for individuals and small businesses to buy coverage.
** Insurers will be prohibited from denying or limiting coverage based on pre-existing conditions.
** Income-based tax credits to be provided for most consumers in HIEs.
** Medicaid expansion to cover low-income people up to 133-percent of poverty level.
** Citizens and legal residents to be required to have health insurance, with exceptions, or pay fine.
** Employers with more than 50 workers to be penalized if insurance is not offered, and if their workers get coverage through HIE and receive tax credit.
2018
** A tax will be imposed on so-called cadillac health plans, employer-sponsored health insurance worth more than $10,200 for individual coverage or $27,500 for a family plan.
2020
** Doughnut hole coverage gap in Medicare prescription benefit will be phased out.
** Seniors will pay just 25 percent of the cost of brand-name and generic drugs.
The Supreme Court's decision to uphold the Affordable Care Act means an additional Medicare contributing tax of 3.8 percent to be imposed on wealthy come 2013. The tax will apply to non-business-related net income from interest, dividends, annuities, royalties and rents and capital gains, as well as income from a business that is considered a passive activity or a business that trades a financial instrument or commodity. The additional Medicare contributing tax of 3.8 percent will be applied to incomes over $200,000 threshold for single and $250,000 threshold for married couple, irrespective of actual income level. Let's take this example: an individual, who files tax return as a single, with $80,000 annual income has a net income of $400,000 from sale of a vacation home. The 3.8 percent additional Medicare contributing tax will be applied on the income of $280,000 (= $400,000 + $80,000 - $200,000). In this example, the additional 3.8 percent Medicare contributing tax will amount to $10,640.
According to Kaiser Family Foundation and the Urban Institute report issued on November 26, 2012, Medicaid expansion under the Obamacare may not be as burdensome on the states as many Republican governors are saying. States will receive more than $9 from the federal government for $1 they spend in expanding Medicaid to cover low-income Americans. According to the study, the expanding Medicaid will cost more than $1 trillion between 2013 and 2022, and will cover about 20 million more low-income people. Out of that, states will spend just $76 billion, while the federal government will spend the remaining $952 billion. Washington pays all of the cost for the first three years, gradually shifting to 90 percent.
Affordable Care Act presents a dilemma for Texans as the state has opted out from the expanded Medicaid option, which allows all U.S. citizens below 133 percent poverty level--or $25,390 for a family of three--to be covered by Medicaid. The U.S. Supreme Court last year (2012) ruled, while upholding the law, that states might reject the expanded Medicaid option offered by Affordable Care Act. However, the landmark healthcare overhaul bill allows legal immigrants with income less than the federal poverty limit, or $19,090 for a family of three, to receive federal subsidy to buy insurance from the private insurers in state health insurance market. By rejecting the expansion of Medicaid, the state of Texas will leave $101.1 billion (over the next 10 years) in federal Medicaid matching fund in lieu of raising $15.6 billion (over the next 10 years) in state money and set up a situation where some poor Texans are to be denied help in getting insurance coverage while the legal immigrants will receive federal subsidy.
Tennessee became the latest state on March 27, 2013 to reject Obama administration's Medicaid Expansion plan under the Affordable Care Act. Instead, Governor Bill Haslam wanted Medicaid expansion money to help individuals buy private health plan from insurance exchanges. So far, about 24 states, mostly led by Democratic governors, opted in for the Medicaid expansion plan, under which federal government will bear the full amount between 2014 and 2016, and after 2016, the federal share will go down gradually to 90 percent in 2020.
On April 1, 2013, Obama administration delayed the implementation of a key feature--geared towards catering the need of small businesses--of the Affordable Care Act. The landmark law signed in 2010 calls for a Small Business Health Options Program that each state exchange will offer, enroll, and help compare competing plans for employees of the small businesses. The coverage was originally thought to begin on January 1, 2014 with enrollment to start on October 1, 2013. However, the administration delayed the implementation as insurers needed "additional time to prepare for an employee choice model". Federal government will delay the program for the 33 states where it will run the exchanges to 2015, according to April 1, 2013 Obama administration announcement.
On July 2, 2013, the White House announced delay in implementation of a key component of Affordable Care Act by a year. Under the healthcare overhaul signed by President Obama in 2010, businesses with 50 or more employees are required to offer health insurance to its employees or pay a fine of $2,000 per employee beyond the first 30 employees. The provision, commonly known as employer mandate, will become effective on January 1, 2015 instead of January 1, 2014. Under the employer mandate, employers have to go through rigorous reporting requirement such as documenting how much they are paying their employees, how many hours a week the employees are working and how much employees are contributing to healthcare coverage. The mandate sets a threshold of 30 hours for full-time employees.
Another requirement that will test the Affordable Care Act is related to the so-called Cadillac tax that may hit hard municipal employees across America. Under the healthcare overhaul plan, beginning in 2018, a 40 percent tax will be slapped on the excess of the annual healthcare premium exceeding the threshold of $10, 200 for individuals and $27, 500 for families. The thresholds will rise with inflation after 2018.
Just like employer mandate provision, another key, but altogether different, provision was put on hold for an year. The out-of-pocket maximum provision supposed to take hold on January 1, 2014 will now be effective from 2015. Under this provision, the total out-of-pocket costs would cap $6,350 for individuals and $12,700 for families. The one-year extension was published in February 2013 on the Labor Department website under the maze of information. This grace period came to light only in recent days.
As the deadline for Americans without insurance to enroll in healthcare exchanges draws closer, a study conducted by Avalere Health Fund released on September 4, 2013 has pointed to a not-so-rosy scenario from the pricing angle. The study has looked at the three age groups of nonsmoking people: (1) 21-year olds; (2) 40-year olds; and (3) 60-year olds. The study has then focused on how the premiums stand up for those three age groups in reference to four tiers--Bronze plan (expected coverage 60%), Silver plan (expected coverage 70%), Gold plan (expected coverage 80%) and Platinum plan (expected coverage 90%)--of health insurance plans offered through the eight state health insurance exchanges and four federal health insurance exchanges that cover 11 states--California, Connecticut, Indiana, Maryland, New York, Ohio, Rhode Island, South Dakota, Vermont, Virginia and Washington--and District of Columbia. The Avalere study has focused on these 11 states and DC. Silver plan is considered the benchmark as it is the second lowest-cost plan, and tax credits will be applied for this plan. The pricing structures (prior to applying tax credits) for Silver plan are as follows:
* 21-year-old group: $270 a month
* 40-year-old group: $330 a month
* 60-year-old group: $615 a month
Under the Affordable Care Act, individuals who may afford to buy health insurance, but choose not to do so, will pay a fine of 1 percent of income in 2014, and the fine will increase to 2.5 percent in 2016. A breakdown of tax penalties is given below:
* Adult: $95.00 (2014); $325 (2015); $695 (2016)
* Child: $47.50 (2014); $162.50 (2015); $347.50 (2016)
* Family: $285 (2014) or 1 percent of family income whichever is higher; $975 (2015) or 1 percent of family income whichever is higher; $2,085 or 1 percent of family income whichever is higher
Penalties will increase by cost of living after 2016
October 1, 2013 is a landmark day for the Affordable Care Act as the health insurance exchanges have opened for enrollment for millions of uninsured Americans for comparison-shopping despite a partial government shutdown over the same issue. However, the operational challenges abound on the opening day, with tens of thousands of Americans unable to go beyond the security questions on the web site. As glitches and gridlocks hound the insurance exchanges, hundreds of thousands of Americans are being frustrated by denial and slowness of the process. However, the state-run exchanges were relatively more successful relative to federal HealthCare.gov online marketplace for insurance shopping, the primary source of insurance for millions of uninsured Americans in 36 states, including Texas.
On October 23, 2013, Obama administration extended the sign-up deadline by an extra six weeks to March 31, 2014 to bring more clarity to Americans on a firm timeline by which uninsured Americans need to buy insurance to avoid penalty. Administration said that there was no link between the extension of the sign-up deadline and the on-going hurdles with online insurance exchanges. When the Affordable Care Act became law in 2010, it was March 31, 2014 date that was thought to be the final timeline. However, to have an insurance by that date, an individual needs to sign up by not any later than six weeks prior to March 31, which would be January 15, 2014. Obama administration's October 23, 2013, move tried to ensure that individuals who would sign up by March 31, 2014 would avoid penalty.
On October 29, 2013, Administrator for Centers for Medicare and Medicaid Services Marilyn Tavenner appeared before the US House Ways and Means Committee, and apologized to customers for the bumpy rollout of Affordable Care Act although she had defended the handling of the issues. CMS is in charge of rolling out the enrollment process of federally run HealthCare.gov. Meanwhile, many of the 15 million Americans who buy insurance from the individual marketplaces are getting the cancellation notices because some of their plans are barebones or co-pays are associated with some preventive services. Under the Affordable Care Act, preventive services are offered free, pre-existing conditions are covered and coverage is more comprehensive than many existing individual plans. However, the cancellation notices pose a real political challenge to Obama administration as President himself said repeatedly that if consumers liked their plan they got to keep it.
On October 30, 2013, Obama administration mounted a two-pronged defense of its bungled rollout of Affordable Care Act. President Obama went to Massachusetts to drum up support for his landmark healthcare overhaul, comparing the measure with a similar measure Republican Governor Mitt Romney signed into law and drawing analogy to a similar bumpy start of that measure. HHS Secretary Kathleen Sebelius, appearing before the House Energy and Commerce Committee, apologized for the rollout glitches while spiritedly vowing to fix the problems.
On November 6, 2013, Republicans in Senate Finance Committee hearing demanded resignation of Kathleen Sebelius as President Obama, during the day, visited Dallas with a message that uninsured North Texans--about 550,000 in numbers--whose income in less than 138% of the poverty limit are not getting the benefit of Obamacare as Texas refused to expand Medicaid.
One of the major worries stemming from technical glitches in Healthcare.gov is that many with pre-existing conditions will remain in limbo after about a dozen of high-risk pools run by 35 states permanently close on January 1, 2014 and the people insured under these high-risk pools still are not able to buy insurance. When the Affordable Care Act was signed in 2010, there were high-risk pools by states and federal government created as a temporary bridge to insure patients with sever pre-existing conditions until they would all be integrated with health insurance exchanges set to operate effective January 1, 2014. The federal poo covers about 100,000 people.
On November 13, 2013, figures released from the Centers for Medicare and Medicaid Services showed dismal number of enrollment in the first month of rollout of Obamacare. According to the figures, 106,185 people enrolled through federal and state exchanges. Out of them, only 26,794 enrolled through the much maligned HealthCare.gov. A much larger number signed up through the health insurance exchanges set up by 14 states. Meanwhile, restive Democrats in the Congress who are facing tough re-election next year have started to distance from administration's position on debacle of Obamacare rollout, especially the cancellation of coverage of millions of Americans because their policies don't adhere to higher qualitative bars of Affordable Care Act. Many Democrats in House of Representatives are leaning towards supporting a measure proposed by Fred Upton, R-Michigan, Chairman of House Commerce and Energy Committee, that would allow Americans to continue with their existing insurance policies without penalties through 2014 as well as new customers to buy the plans, which may be sub-standard. The measure will come to vote on November 15, 2013.
In the face of Democratic revolt and bungled rollout of Affordable Care Act, President Barack Obama on November 14, 2013 took the blame upon himself for millions of cancellation notices sent to Americans who had bought insurances from the individual marketplaces, and made a reversal on the individual policies. Now, the consumers who want to keep these bare minimum coverage will be able to keep it for a year without any penalty, but will not be able to get subsidy as they would if they enroll through the healthcare exchanges. However, there is a catch here. Obama's step on November 14, 2013 doesn't automatically restore coverage for the people who have lost them in recent days. First, the insurance companies, who have sent cancellation notices to customers, have to extend the coverage, and the second, the state insurance commissioners have to approve it. President Obama's Director for the federal Center for Consumer Information and Insurance Oversight Gary Cohen on November 14, 2013 sent a letter to state insurance commissioners, explaining the "transition policy" under which "health insurance issuers may choose to continue coverage that would otherwise be terminated or cancelled, and affected individuals and small businesses may choose to re-enroll in such coverage".
On November 15, 2013, House of Representatives took up the Upton bill for vote, and passed it by 261-157, with 39 Democrats breaking party ranks. The measure, dead upon arrival at Senate and faces a sure presidential veto, allows insurers to:
(1) Renew for a year Individual health policies which have been cancelled because of insufficient coverage and other lack of adherence to the rules of Affordable Care Act;
(2) Sell the same bare-bone policies to new customers for 2014
On November 26, 2013, the U.S. Supreme Court agreed to hear a contentious provision of the Affordable Care Act that had plagued the country's lower courts with divided outcome and divergent interpretation of the 1993 Religious Freedom Restoration Act. Under the Obamacare, various religious institutions are exempt from the mandatory coverage of certain contraception procedures to women employees. However, for-profit institutions must provide the comprehensive contraception coverage to all their female employees. In June 2013, 10th U.S. Circuit Court of Appeals ruled that government mandate for comprehensive contraception coverage was illegal as the for-profit corporations are same as "personhood" whose religious views are protected under the 1993 Religious Freedom Restoration Act. The Denver-based appeals court ruled in the case of Hobby-Lobby vs. Sebelius. The court also cited the 2010 US Supreme Court ruling in Citizens United case, in which the country's apex court ruled that companies, unions and other for-profit entities could contribute unlimited amount in campaign contribution just like "individuals" as per the First Amendment rights. The court ruled that if for-profit could be deemed as "personhood" as part of the right of political expression, it could be deemed as "personhood" as part of the right of religious expression. However, a contrary verdict came from the Philadelphia-based 3rd U.S. Circuit Court of Appeals in July 2013 as the appellate court ruled that for-profit corporations were not entitled to benefits of the Religious Freedom Restoration Act. The 3rd U.S. Circuit Court of Appeals ruled in a case of Conestoga Wood Specialties vs. Sebelius. The apex court will hear both the cases in March 2014 and is expected to rule in the summer of 2014.
White House reported on December 1, 2013 the progress report of the beleaguered federal healthcare website Healthcare.gov that showed vast improvement in functional and system efficiency by November 30, 2013, self-imposed deadline, but still not perfect. The biggest achievement is to ensure that 50,000 concurrent users can log in and 800,000 visitors per day can shop for competing insurance offerings.
On December 11, 2013, the Obama administration provided update on enrollment figures through federal and state exchanges for October and November. Through October and November, 137,200 people enrolled through federally run Healthcare.gov, while 227,500 people enrolled through state exchanges. Although the combined October and November figure of about 365,000 still feels good compared to October's dismal figure of a little more than 106,000 disclosed on November 13, 2013, the enrollment process is lagging behind the administration's target number substantially. People need to enroll by December 23, 2013 to get coverage on January 1, 2014, and the enrollment period will last through March 31, 2014.
On December 19, 2013, Obama administration made another exemption to consumers whose cancelled individual policies from the insurance carriers had become a major headache for the administration. The exemption was put on HHS bulletin board: "If you have been notified that your individual market policy will not ne renewed, you will be eligible for a hardship exemption and will be able to enroll in catastrophic coverage".
Obama administration on December 23, 2013 extended the deadline to enroll in a plan (for coverage effective January 1, 2014) by 24 hours to accommodate the late-hour crush of potential enrollees. More than a million people logged on by 5 PM on December 23.
To critics, it's another sign of slipping deadlines, and to supporters, it's another sign of people's increasing interest in the insurance marketplace that Obama administration on December 24, 2013 announced that it would extend the enrollment timeline as long as consumers could show that they were held back by glitches in federal healthcare website. After a disastrous rollout in October, federal Healthcare.gov has been working much better in recent days, with 2 million visits on December 23, 2013, a record for one-day visit. Also, more than 250,000 people called the helpline on December 23, 2013, another one-day record of call volume.
When the concurrent users exceed 60,000 on December 23, the website put the visitors in a queuing system or asked for an e-mail address for invitation later. More than 129,000 users provided e-mail addresses. Meanwhile, the insurance industry is also extending the payment deadline to January 10, 2014 for policy to be effective retroactively from January 1. Also, Obama administration expressed satisfaction with the improved error rate, which is lower than 1 in 200, and pages uploaded quickly, in less than half a second.
President Barack Obama's signature healthcare law became effective on January 1, 2014 in a quieter way without much of a hoopla contrary to the rocky roll-out of the law on October 1, 2013. As many of the country's uninsured population bought healthcare coverage from the federal exchange as well as state exchanges in the three months since the measure's debut, its first day was full of hits and misses as Supreme Court Justice Sonia Sotomayor on late December 31, 2013 issued a ruling to put a temporary hold on the law's requirement for all employers to cover contraception and related treatment. Justice Sotomayor exempted Little Sisters of the Poor, a non-profit group that provides services to elderly poor, and more than 200 faith-based groups covered by Christian Brothers Employee Benefit Trust, which adheres to Catholic teachings. Justice Sotomayor's ruling was narrow in scope as it covered only Christian Brothers Employee Benefit Trust.
On January 13, 2014, Department Health and Human Services gave a more granular breakdown of enrollees in the new insurance marketplace that showed enrollment by a mere 24% of young people. As of December 28, 2013, total number of enrollees stood 2,153,421, short of original target of 3.3 million. Out of 2,153,421, age breakdown was available for 2,058,207 people.
Age-wise Breakdown:
(1) 55+ 681,081 (33%)
(2) 35-54 760,931 (37%)
(3) 18-34 489,460 (24%)
(4) 18- 126,735 (6%)
Gender-wise, women counted 54%.
On January 24, 2014, Obama administration reported that an approximate 3 million Americans had enrolled through insurance marketplace, an uptick of a million from the number of people who had enrolled by the end of December. It is yet to be seen whether the total number of enrollment by March 31, 2014, when the open enrollment for 2014 will close, reaches close to administration's target figure of 7 million.
Twin Reports Disconcerting for Obama Administration
A pair of reports raised the political firestorm one more time on Affordable Care Act as a non-partisan CBO report issued February 4, 2014 almost tripled the estimate of number of full-time workers who would drop out of the workforce due to ease of getting subsidy to buy their health insurance to 2.3 million by 2021 from a 2010 estimate of 800,000. However, this is not same as what many Republicans are claiming that the Obamacare will cost 2.3 million jobs by 2021. Instead, the fact is that as many as 2.3 million people, according to CBO estimate, will have less motivation in staying put in their work as they will get generous subsidy from federal government to buy health insurance if they don't remain employed full-time. It's the supply pool of full-time labor that would be lowered by 2.3 million.
A second report issued by Avalere Health on February 5, 2014 pointed only a third of targeted enrollment of uninsured through the expansion of Medicaid. The Avalere Health report estimated 1 million to 2 million of enrollment as in contrast to 6.3 million figure predicted by Obama administration.
Another Extension of Employer Mandate in Healthcare Overhaul
Obama administration's Treasury Department issued another set of complex rule set on February 10, 2014, extending the timeline of "employer mandate" provision that calls for fines if an employer with 50 or more employees doesn't provide insurance to its full-time employees--employees who work 30 or more hours a week--by an additional year for companies with 50 to 99 employees. Under the February 10, 2014, Treasury Department rules, companies with 50 to 99 employees have to provide health insurance to their employees effective January 1, 2016 to avert fines. Companies with 100 or more employees are still subject to the January 1, 2015, timeline to comply with the "employer mandate". Companies with less than 50 full-time employees are exempt from the law.
More People Sign Up for Health Plans
Department of Health and Human Services on February 12, 2014 reported an uptick of sign-up by young adults through federal and state exchanges in January 2014. Out of 1.1 million new enrollees in January 2014, 318,000 are young adults (ages 18-34), a critical age group to keep insurance rate affordable for the entire pool. What is heartening is that many young adults are choosing the silver, gold or platinum coverage instead of barebones bronze plan. According to HHS, as of January 31, 2014, 3.3 million people signed up for insurance through federal and state-run health insurance exchanges since the enrollment debuted on October 1, 2013, and of them, 807,500 people are of critical age group of 18-34.
Obama Administration Makes Another Extension of a Key Provision
Obama administration on March 5, 2014 extended the bare-bone, non-compliant individual insurance policies for an additional two years. At the height of mass cancellation of these policies by carriers and resulting political anger, Obama administration made its first exemption related to these bare-bones individual policies on December 19, 2013. On March 5, 2014, Obama administration, sensing an election year vulnerability over another wave of mass cancellation notices, said that individuals who liked to keep their policies would do so for an additional two years through 2016 provided state officials agreed.
Arguments over Contraceptive Provisions Begin at the Supreme Court
In a trial being closely watched by legal scholars, politicians, healthcare experts and women rights groups, attorneys for plaintiffs and US DOJ presented their positions in a very lively manner before the U.S. Supreme Court on the opening day (March 25, 2014). Two companies which challenged the provisions of Affordable Care Act to provide free contraception are owned by devout Christian families. Both Hobby Lobby and Conestoga Wood Specialties argued that providing some drugs and intrauterine devices were tantamount to abortion, and sought exemption from the law's contraception mandate citing the Religious Freedom Restoration Act of 1993.
Monthly Sign-up Breakdown
Monthly enrollment for ACA sign-up includes:
* October: 110,000
* November: 260,000
* December: 1.78 million
* January: 1.15 million
* February: 940,000
* March (as of March 27, 2014): 1.76 million
Obama Hails Record Sign-ups
President Barack Obama on April 1, 2014 hailed record sign-up of 7.1 million people for health insurances through federal and state exchanges. President Obama appeared before a friendly audience at the White House's Rose Garden to mark the record of beating its own target by the last day (March 31, 2014) of sign-up.
Majority Leader Reid Mocks Hypocritical Stand by Corporations Critical about Obamacare
In a Senate speech, Majority Leader Harry Reid, D-Nevada, on April 8, 2014 called out Koch Industries for duplicity and double-standard as it had applied for and received $1.4 million in federal subsidy for health insurance coverage of early retirees under a program, Early Retiree Reinsurance Program, created as part of Affordable Care Act in 2010. The law appropriated $5 billion in 2010 to cover subsidies related to insurance coverage for employees who would choose to retire before their Medicare eligibility age. Among corporations which had applied and received the subsidies are Dallas-based ATandT Corporation ($213 million) and UPS ($37 million).
CBO Estimates Lower Health Insurance Subsidies
Congressional Budget Office on April 14, 2014 released an update of its estimate of what it would cost in tax payers subsidies to fund health insurance coverage through Obamacare. According to the latest CBO estimate, the amount of subsidy over the next decade would be a little over $1 trillion, a drop from the previous estimate of $1.2 trillion.
Obama Brags Higher than Expected Enrollment Figures
President Barack Obama on April 17, 2014 took his health reform critics to tasks by boasting almost 8 million enrollment through health insurance exchanges. The figure beats the administration's own goal of insuring 7 million people through federal and state insurance marketplaces. The administration gave a grace period of 15 days for people who had started the enrollment process by March 31, 2014 but couldn't finish on time, thus boosting the enrollment volume. However, the administration didn't give breakdown on how many of the 8 million people who had enrolled through health insurance exchanges
* were previously uninsured; and
* had paid the premium
Supreme Court Hands out Defeat to Administration over Hobby-Lobby Suit
Ruling on a suit filed by Hobby Lobby and Conestoga Wood Specialties on June 30, 2014, a divided U.S. Supreme Court said that the exemption from the mandate to cover contraception on religious ground applied not only to "individuals", but also to a for-profit, closely held corporation. The 5-4 ruling was narrow in scope, but would have repercussion far beyond the scale of two privately held corporations. Judge Anthony Kennedy sided with the conservatives in the bench, namely Judges Antonin Scalia, John Roberts, Samuel Alito and Clarence Thomas, while four dissenters were Judges Ruth Bader Ginsburg, Elena Kagan, Sonia Sotomayor and Stephen Breyer.
A pair of Appellate Court Rulings Pointer to Confusion over Federal Subsidies
Two appellate courts on July 22, 2014 issued conflicting rulings on almost identical provision of Affordable Care Act. U.S. Court of Appeals for the District of Columbia ruled 2-1 that Obama administration had stretched the law too much to provide customers federal subsidies to buy coverage through the federal exchange. According to the majority, the subsidy was meant to encourage states to offer insurance coverage through state exchanges. A second appellate court, 4th U.S. Circuit Court of Appeals based in Richmond, VA, ruled 3-0 on July 22, 2014 that health insurance tax credits a "permissible exercise" of a federal agency's discretion in interpreting ambiguous legislative language. Nearly 6.7 million enrollees--85 percent of total enrollment--received tax credits, with 4.7 million of them having enrolled through federal insurance marketplace. According to HHS, monthly premium dropped 76 percent for those who had received tax credits.
Obama Administration Caps the Penalty for Lacking Insurance
On July 24, 2014, Obama administration announced the cap for not carrying health insurance at $2,448 per person and $12,240 for a family of five. The fine was touted as $95 per person or $47.50 per child, and it may rise as much as 1% of gross income. So, a person making $45,000 a year may owe as much as $450 in 2014 tax.
Enrollment Tops 11 Million
In a sweet surprise, Obama administration said on February 17, 2015 that it had beat its own goal by having 11.4 million people signing up for the coverage this year. The preliminary estimate was based on total number of new as well as returning enrollees to the insurance exchanges as of February 15, 2015, the last day of enrollment for this year. The final numbers are likely to be higher for the following two reasons:
(1) People who have started the enrollment process, but yet to finish, have until February 22, 2015 to complete the process
(2) Many Democratic lawmakers are asking the administration to re-open the enrollment process and accommodate many uninsured as they are likely to find out during incoming tax filing season that there's financial consequence for not having an insurance and may be inclined to get one
Extension Granted for Uninsured Facing Penalty
As the tax filing season gets underway, it's likely that many of the uninsured will figure out for the first time that it costs them money in the form of tax penalty for not having health insurance last year (2014). To help some of them avoid a repeat of penalty next year when they will file for 2015 tax returns, Obama administration, under pressure and prodding from some key Congressional Democrats as well as support groups, on February 20, 2015 has announced allowing those uninsured an additional six weeks in March and April to sign up in the health insurance exchanges.
Nearly 9 out of 10 Adults Have Insurance Coverage
A new report issued by Gallup-Healthways Well-being Index on April 13, 2015 came as a boon for Obamacare's success of accomplishing one of the three objectives: increasing the number of insured. According to the report, nearly 9 out of 10 people are now insured, a significant landmark for the Obama administration. In 2013, the rate of insured people was little over 8 in 10.
U.S. Supreme Court Upholds Insurance Subsidies
In an unwavering ruling of 6-3, the U.S. Supreme Court on June 25, 2015 tossed out King vs. Burwell, a lawsuit that challenged the legality of insurance subsidies to customers in states where insurance exchanges were set up and being run by the federal government. Critics stressed that the subsidies were meant for the consumers who buy insurance from state exchanges. Only 16 states had set up the insurance marketplaces, while federal government been running the insurance exchanges for 34 other states, including Texas. Writing for the majority, Chief Justice John Roberts stated that the intent of the Congress was to preserve the insurance marketplace, not destroy it, which was inevitable if insurance subsidies were proscribed from the insurance exchanges in 34 states being run by the federal government. In other words, according to majority opinion, country's apex court on June 25, 2015 fixed what Congress should have done in the first place. The majority included, beside Chief Justice Roberts, Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Dissenting voices were all conservative judges: Judge Clarence Thomas, Judge Antonin Scalia and Judge Samuel Alito. The Supreme Court verdict was a significant victory to President Barack Obama who made Affordable Care Act as one of his significant legacy-building efforts that would have a lasting national footprint in years to come.
Congress Sends a Measure Overturning ACA
Congress on January 6, 2016 sent President Barack Obama a piece of legislation that the president would surely use his veto pen to reject. House of Representative on January 6, 2016 for the sixty-second time voted (240-181) to reject president's signature healthcare law, Affordable Care Act. The only difference this time, though, was that Congress was able to send the measure scrapping the ACA to President. The measure was already approved by the U.S. Senate. The overall package also includes a provision to defund Planned Parenthood. President Barack Obama is sure to use veto for the eighth time in his presidency.
Insurance Coverage Rate Stalls; Obama Administration Claims Strong Sign-up Numbers
A major independent survey, Gallup-Healthways WellBeing Index, released January 7, 2016 confirmed what was already known about the scale of insurance coverage. According to the survey, 11.9 percent of the people lacked any insurance coverage in the last three months of 2015, same as in the first quarter of the year. Meanwhile, the head of the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt said on January 7, 2016 that 11.3 million people had so far signed up for the coverage under Obamacare with three weeks to go. Among the states, Florida tops with 1.5 million, California with 1.4 million and Texas with more than 1.1 million sign-ups.
Obama Vetoes the ACA Repeal Measure
Two days after Congress sent a measure to President Barack Obama repealing his signature healthcare overhaul, president used his veto pen on January 8, 2016 for the eighth time in his presidency.
2016 Enrollment Okay, but not Great
The Health and Human Services Secretary Sylvia Burwell reported on February 4, 2016 that about 12.7 million people either newly enrolled, or re-enrolled, in federal, or state, insurance exchanges since November 1, 2015 when the enrollment process for 2016 had begun. The government had projected between 11 and 14 million people to enroll through HealthCare.gov. So, the figure reported by the HHS Secretary fell right in the middle of the range, but nearly a million over the last year's (2015) 11.7 million initial enrollment. The Obama administration's primary challenge is to improve retention rate, and Ms. Burwell disclosed that this year's (2016) target would be 10 million enrollees by the end of 2016.
2017 Enrollment Drops
Trump administration reported on February 3, 2017 that a total of 9.2 million people had enrolled in ACA through the marketplaces after a three-month enrollment period ended on January 31, 2017, a steep drop of about a half-a-million people and a sharp reversal from the previous year, especially in the final three weeks when the ads promoting ACA had been pulled off.
2015 Attrition Rate Significant
The Obama administration on March 11, 2016 reported that the attrition rate of enrollees was a whopping 25 percent last year (2015) as the year that began with 11.7 million sign-ups ended with about 8.8 million paying consumers, even lower than 9.1 million target set by the Health and Human Services Secretary Sylvia Burwell.
Obama Administration Receives a Legal Setback
A federal judge, the U.S. District Judge Rosemary Collyer, on May 12, 2016 ruled that Obama administration didn't have authority to provide subsidies to consumers of the healthcare exchanges without approval by Congress. The administration's argument was that the approximately $175 billion subsidies under the Obamacare were part of the mandatory spending such as Medicare, Medicaid and Social Security and the administration didn't need Congressional approval. Judge Collyer rejected that central argument. The suit was brought by the House Republicans in 2014, one of plethora of lawsuits filed by the Congressional Republicans to undercut President Obama's landmark healthcare overhaul.
Medicaid Expansion Costs Growing Faster than Anticipated
In a recent report submitted to Congress, the Centers for Medicare and Medicaid Services, or CMS, said that the Medicaid expansion costs under Obamacare had been increasing more than anticipated, according to an article by The Associated Press, providing the political fodder to GOP in the midst of a heated election season. In 2015, the annual cost to cover an individual under the Medicaid expansion was pegged at 6,366, about 49 percent higher than previously estimated. 19 states have so far expanded Medicaid to cover an estimated 9 to 10 million people.
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House Republicans Unveil ACA Repeal Plan
House Republicans on March 6, 2017 unveiled a plan that would repeal and replace Affordable Care Act. This marked an arduous, if not a stumbled, beginning of a long-drawn process that would fulfill a long-nurtured Republican promise to repeal and replace ACA. The highlight of the Republican plan, American Health Care Act, unveiled on March 6, 2017 includes:
* Replacing federal insurance subsidies by tax credits to individuals purchasing their own health insurance
* Expanding contributions to health savings accounts
* Repealing tax penalties on uninsured people
* Scrapping income-based tax credits
* Maintaining the requirement for coverage of pre-existing conditions
* Preserving the provision for children to stay on parent's insurance until age 26
* Retaining ACA's higher federal financing to expanded Medicaid program until the end of 2019
* Repealing taxes on high income earners, health insurance plans and medical device manufacturers
GOP Plan Attracts Conservative Wrath
A day after unveiling a replacement plan for ACA, conservatives in the House on March 7, 2017 rebelled against the plan, formally known as American Health Care Act, ridiculing it in derogatory terms such as Obamacare 2.0, Obamacare Lite, etc.
GOP Plan Gives Big Tax Benefit to Wealthy
The GOP plan unveiled March 6, 2017 aims to cut the taxes on wealthy and give them a tax relief of about $157 billion over the next decade. The two provisions slammed as part of ACA included a
* Tax on capital gains and other investment-related incomes
* Surcharge on Medicare tax
CBO Predicts Spike in Uninsured Ranks
Venerable Congressional Budget Office on March 13, 2017 struck a significant blow to the Republican effort to repeal and replace Obamacare. According to the CBO estimate, the ranks of uninsured will swell by an additional 24 million by 2026 to 52 million (under Obamacare, the figure was slated to rise to 28 million by 2026) while the savings will be as significant too: $337 billion over the time. The CBO estimate dealt a blow to President Donald Trump's campaign promise that repeal of Obamacare would be beautifully done with premium to fall and no one to lose insurance coverage. Next year (2018), the ranks of uninsured will increase by 14 million, mostly due to dropping of insurance coverage by healthy young adults now being penalized for not carrying insurance. But, later in the decade, another 10 million people will lose the coverage because many states will end the expansion of Medicaid. Under the American Health Care Act, people who will discontinue their health plan in the middle of the year will have to pay a 30 percent surcharge to renew their insurance for that year. Under the American Health Care Act,
* Federal Medicaid spending will be 25 percent lower by 2026
* Older people will fare worse as the tax credit for older population will be lower by 2026 compared to Obamacare
-- Under the current law, a single 21-year-old who earns $26,500 with an insurance plan that costs $5,100 will receive a tax credit of $3,400 and will have to pay $1,700 out of pocket. Under the Republican plan, the out-of-pocket premium will reduce to $1,450.
-- A 64-year-old adult will fare much worse under the House bill as a $13,600 tax credit for an annual premium of $15,300 health plan will leave the consumer on hook for $1,700 under the Obamacare while under American Health Care Act, the consumer will be responsible for $14,600 toward an annual premium of $19,500 with a tax credit of only $4,900.
Ryan Offers Something to Moderates, Conservatives in His Own Ranks to Win Support
As Speaker Paul Ryan's effort to repeal and replace Obamacare looked more uncertain by the day, hectic political maneuvering was underway to win support from critical Freedom Caucus while retaining support among moderates. It was a fine balancing act on behalf of Speaker Paul Ryan. On March 21, 2017, Ryan offered conservatives an olive branch by giving states the freedom to impose work requirement for Medicaid eligibility except for single mothers with kids below 6 or with disabilities. Also, to soothe the frayed temper of the Freedom Caucus members, the amendment included the provision of Medicaid block grant to the states. The new amendments of Medicaid's work requirements were blasted by seven female Democratic House members and Rep. Jerrold Nadler, D-NY, as anti-family because new mothers might end up getting denied of Medicaid coverage if they failed to find a job within 60 days of child's birth. The statement was signed by seven female Democratic House members, beside Rep. Jerrold Nadler--Reps. Katherine Clark, Conn; Diana DeGette, Colorado; Jan Schakowsky, Illinois; Barbara Lee, TX; Judy Chu, California; Suzan DelBene, Washington; and Louise Slaughter, NY. On the other hand, to assuage the moderate Republicans, Ryan offered assistance for older Americans who were shortchanged under the original bill. Also, people will be allowed to deduct their taxes on any medical expenses over 5.8 percent of their income instead of 10 percent under the current threshold. This may end up costing $85 billion in lost revenue.
CBO Issues Revised Report on Healthcare Overhaul Legislation
Days after Paul Ryan and Republican leadership had modified parts of the American Health Care Act, Congressional Budget Office (CBO) issued a revised assessment on March 23, 2017 that lowered the projected benefit of the law from $337 billion over a decade to $150 billion, without making a significant dent in the ranks of uninsured.
Republicans Pull the Obamacare Repeal Measure
Sensing a near-certain defeat and facing an open rebellion from the Freedom Caucus led by GOP conservative Mark Meadow, R-N.C., Speaker Paul Ryan and his leadership team on March 24, 2017 withdrew the American Health Care Act. It was a stinging defeat for President Trump's agenda and a humiliating retreat for House Republican leadership.
Obamacare Replacement Act Passes House
Paul Ryan's second try to pass a health care legislation to repeal and replace Obamacare came to fruition on May 4, 2017 as House passed American Health Care Act (AHCA) by a narrow 217-213 votes. An ecstatic Donald Trump responded, surrounded by House leaders, that it was a "great plan". Under the AHCA:
* Medicaid will be slashed by $880 billion over the next decade
* Insurers will be allowed to charge older Americans more, leading advocacy groups such as AARP dubbing the provision as so-called "age tax"
* There will not be any individual mandate
* A high-risk pool will be set up to treat people with pre-existing conditions. The $23 billion set aside for this fund is estimated to cover only 110,000 patients, or roughly 5 percent of 2.2 million Americans who fall under this category
CBO Report Raises Uninsured Ranks under the Approved House Bill
The Congressional Budget Office, the legislative ombudsman of financial impact of Congressional legislations, on May 24, 2017 issued an ominous report on the latest GOP Obamacare repeal bill, American Health Care Act (AHCA), that had sailed through the House on May 4, 2017 by a meager 217-213 margin. According to the CBO report:
* Ranks of uninsured (in millions)
Under Obamacare: 26 (2017); 26 (2018); 27 (2019, 2020, 2021, 2022 and 2023); 28 (2024, 2025 and 2026)
Under House Bill: 28 (2017); 41 (2018); 43 (2019); 46 (2020); 48 (2021); 48 (2022); 49 (2023); 50 (2024); 50 (2025); and 51 (2026)
* Federal Budget Deficit will reduce by $119 billion over the next decade under the House bill passed on May 4, 2017 compared to if Obamacare would have stayed in place. The budget deficit savings were projected $150 billion on an earlier version of the House bill that had failed in late March 2017. How CBO arrived at $119 billion in savings (in $ billion):
1. Medicaid caps, matching funds (-834)
2. Reduced subsidies for non-group insurance (-276)
3. Patient/State grants to reduce premiums (117)
4. Reduced collection of penalties (210)
5. Repeal/Delay of other taxes (664)
Total Impact on Deficit: (-$119 billion)
Senate Republican Leaders Unveils Their Version of Obamacare Repeal Plan
After working behind the closed doors for months and excluding not only their Democratic colleagues, but also the chamber's rank-and-file Republican Senators, top Senate Republicans led by the Majority Leader Mitch McConnel on June 22, 2017 unveiled their first shot at repealing the Obamacare. The measure, Better Care Reconciliation Act, is sure to face fierce opposition from Democrats and few Republican Senators. Here are key areas of changes proposed by the Republican measure compared to Obamacare:
* Medicaid Expansion
Obamacare: Expanded the benefit of Medicaid to people up to 138 percent of the poverty level. The federal government picks up 90 percent of the tab for new enrollees.
BCRA: Allows 31 states that have expanded Medicaid to continue receiving the benefit through 2023, although the flow from the federal government will reduce substantially from 2021. In 2024, Medicaid expansion will end altogether. Separately, the measure will cap the federal contribution to the benefit and, some states, may receive block-grants if they switch over to that option. The CBO estimated that the cut for a similar House-passed measure would be around $800 billion over a decade.
* Repeals Taxes
Obamacare: Imposed new taxes on investment incomes, wages over $200,000, medical devices, prescription drugs and indoor tanning.
BCRA: Eliminates most of the taxes, but a tax on the Cadillac healthcare plans proposed under the Obamacare, but yet to take hold, will be effective beginning in 2026.
* Repeals Subsidies
Obamacare: Provides subsidies to low-income consumers to cover their out-of-pocket costs such as deductibles and copayments.
BCRA: The subsidies will continue until 2019, then they will be eliminated, leading to increased out-of-pocket payments, co-payments and premiums.
* Repeals the Individual Mandate
* Repeals Employer Mandate
* Changes Tax Credits for Premiums
Obamacare: Gives tax credits to middle-income and low-income consumers to help buy insurance premiums from the exchanges.
BCRA: Whittles down the benefit to consumers with incomes of up to 350 percent of poverty level, or $42,000 for a single person. The bill also expands the benefit to people below the poverty level, a segment that currently does not receive the tax credit.
* Health Savings Accounts
Obamacare: Allowed in 2017 for an individual to put $3,400 and a family to put $6,750 in an HSA
BCRA: Will allow consumers to put more money in HSA, including up to 100 percent of the deductibles.
* Older Customers vs. Younger Customers
Obamacare: Caps the amount that can be charged as premiums for older customers at the maximum of three times of what can be charged for the younger customers
BCRA: Changes the cap to as high as 5-to-1 ratio
* Coverage of Children until 26
BCRA retains this valuable Obamacare benefit.
GOP Senate Bill Teeters on the Brink of Failure after CBO Figures Released
The nonpartisan Congressional Budget Office on June 26, 2017 might have dealt a fatal blow to any prospect for the Senate to pass the Better Care Reconciliation Act unveiled four days ago. The CBO study of the bill released during the day revealed a grim picture that included:
* Additional 22 million people in the ranks of uninsured compared to that of Obamacare by 2026
* 15 million people would be without insurance next year alone
* Out-of-pocket expenses and premiums to soar
However, the federal deficit will decrease by $321 billion over the decade.
GOP Shelves the Repeal Bill
Sensing a sure defeat on the Senate floor and exposure of a fatal political rift within the ranks, GOP leaders on June 27, 2017 postponed vote on the Better Care Reconciliation Act.
Senate Unveils Its Own Version of Obamacare Repeal Bill
U.S. Senate GOP leaders on July 13, 2017 unveiled Senate version of Obamacare repeal bill, almost two-and-a-half months after House had passed its repeal bill on May 4, 2017 by a wafer-thin 217 by 213 votes. The bill, much of its has been discussed and formulated behind closed doors without input from Democrats, faces significant hurdle. The bill retains two Obamacare taxes:
(1) a 3.8 percent tax on investment income
(2) a 0.9 percent payroll tax on incomes of at least $200,000 for individuals and $250,000 for families
Senate's previous version aimed to eliminate those two taxes, thus reducing the flow of revenue by $231 billion over a decade, according to the Congressional Joint Committee on Taxation. CBO is yet to evaluate the new version of the bill. The previous version of Senate bill will results in 22 million more Americans without health insurance by 2026, according to the CBO analysis. Congressional Budget Office and Congressional Joint Committee on Taxation are the two nonpartisan panels that usually evaluate and submit recommendation to Congress on bills for overall guidance. The bill unveiled on July 13, 2017 envisions some forms of tax breaks for wealthy Americans while making the insurance premium cheaper for barebones plans. The bill will expand the so-called Health Savings Account (HSA) from the current benefit of paying deductibles and copayment to pay even the insurance premiums. Any HSA contribution will be tax deductible. In addition, under the Senate version of the bill unveiled July 13, 2017, the subsidies will be provided to household incomes of up to 350 percent of the federal poverty level, or $71,000 for a family of three.
McCain Returns to Senate after Brain Surgery, Appeals for Bipartisanship
As uncertainty grows over the fate of Senate measure to repeal Obamacare, Republican Senator John McCain returned to Senate floor to a hero's welcome on July 25, 2017 to give an impassioned speech, harping on the value of bipartisanship. Senate GOP won a key procedural vote to push the measure across a critical hurdle to debate by collecting 50 votes behind the move. Two GOP senators--Lisa Murkowski, Alaska, and Susan Collins of Maine voted against bringing the bill to floor debate on July 25, 2017. Now, Senators can add dozens of amendments to the measure, and will vote on them individually.
Senate Votes down the "Only Repeal" Measure; Cruz's Skimpy Coverage Amendment
An "only repeal" measure, with a replacement to wait for two years, as proposed by Kentucky Republican Rand Paul was defeated on July 26, 2017 by 55 to 45 votes. Seven Republicans--Susan Collins of Maine, John McCain of Arizona, Shelley Moore Capito of West Virginia, Dean Heller of Nevada, Rob Portman of Ohio, and Lamar Alexander of Tennessee--joined all Democrats to defeat the "only repeal" piece of amendment. Another amendment offered by Texas Senator Ted Cruz was defeated by 43-57 votes, with nine Republican defections. Cruz's Consumer Freedom amendment aims at waiving insurers from the minimum coverage compliance of the ACA. Under Cruz's amendment, insurers can offer just barebones coverage to consumers.
*************** Graham-Cassidy Bill to Repeal Obamacare
GOP Withdraws Graham-Cassidy Bill
After it was clear that the Maine Sen. Susan Collins would not vote for a measure that would take away insurance coverage from millions of Americans, Senate GOP leaders had no choice, but to withdraw the healthcare overhaul bill crafted by Lindsay Graham, R-S.C., and Bill Cassidy, R-La., on September 26, 2017. After the withdrawal of Graham-Cassidy bill, GOP faces increased hurdles of repealing Obamacare as they now need a filibuster-proof measure with the legislative provision that can skirt the filibuster is ending on September 30, 2017.
*************** Graham-Cassidy Bill to Repeal Obamacare
Trump to End Cost-Sharing Subsidies
After failing to repeal and replace Obamacare, Trump administration on October 12, 2017 chose an alternative--according to consumer rights groups, a harmful--route to nix the marketplace for the landmark healthcare law. White House said that it would scrap the so-called cost-sharing reduction (CSR) subsidies typically used to help low-income consumers pay their insurance premiums.
Another Shot to Partially Roll back Obamacare
What it couldn't accomplish by legislation, White House is trying to do it through judiciary by undermining the Affordable Care Act on piecemeal basis. First as part of the December 2017 tax cuts package, the administration eliminated the penalty for not carrying the health insurance. That set the stage for Texas and 19 other states to file a lawsuit in February 2018 in the U.S. District Court of Fort Worth asking the judge to rule the individual mandate invalid, and with it, the entire law. Trump administration on June 8, 2018 filed a brief supporting the states' move, but didn't go as far as scrapping the entire law. Instead, it asked to strike down the individual mandate provision and pre-existing condition [coverage] provision, while preserving the extension of Medicaid. The move is another indirect cheap shot by administration to undermine Obama's public health legacy.
*********************** Bare Bone Association Health Plan Trump Administration Issues Rules to Undermine Obamacare
In another shot to undermine the ACA marketplaces, Trump administration on June 19, 2018 issued new rules, allowing the so-called Association Health Plans to enter in the insurance marketplace. These plans are controversial as they are bare-bone plans that may refuse to cover many maternity treatments and discriminate based on age and health conditions. This is another indirect effort to assault on the Affordable Care Act after failing to repeal the act through Congressional act.
Judge Blocks Bare bone Health Plan
A federal judge, U.S. District Judge John Bates, on March 29, 2019 blocked President Donald Trump's June 19, 2018, rules to create bare-bone Association Health Plan for small businesses on the ground that administration's effort was tantamount to "an end-run" around consumer protections embedded in the Affordable Care Act.
*********************** Bare Bone Association Health Plan
Trump Tries to Undermine Obamacare one More Time
What has become almost a monthly ritual for Trump administration to find ways to undermine and undercut, in whatever ways, small and large, the Obamacare has been displayed one more time on July 7, 2018 as the administration has announced scrapping billions of dollars in payment to insurers to stabilize the exchange marketplace. Without the so-called "risk adjustment" payments, the premiums are sure to go high in the upcoming enrollment season for most of the exchanges.
Texas Sues Feds to Overturn Obamacare
Texas' Attorney-General Ken Paxton on behalf of 20 states filed a lawsuit on September 5, 2018 in an effort to quash the Affordable Care Act. The lawsuit against the Trump administration justified the rationale behind the action by stating that once "individual mandate" had been scrapped by Congress, all of the law had become invalid. However, officials from the Trump administration's Justice Department feared that scrapping of the law would lead to chaos. The lawsuit was filed at the U.S. District Court of Judge Reed O' Connor of Fort Worth.
Texas Judge Rules Obamacare Unconstitutional
U.S. District Judge Reed O' Connor on December 14, 2018 issued a sweeping verdict, opining the entire Affordable Care Act unconstitutional on the ground that December 2017 tax overhaul law eliminated a key, but unpopular, provision of Obamacare requiring individual mandate for health insurance coverage, thus making the entire healthcare law unconstitutional. However, the judge didn't order immediate implementation of his ruling, thus allowing the ongoing enrollment process for the 2019 coverage renewal. About 17 million people will lose the coverage if Judge O' Connor's ruling is implemented.
Democratic State Officials File Legal Challenge
A group of 16 state AGs and that of District of Columbia, led by the California AG Xavier Becerra, on January 3, 2019 filed an appeal to the 5th U.S. Circuit Court of Appeals, against a federal judge's ruling that the entire Affordable Care Act was unconstitutional, calling the rationale for December 14, 2018, ruling by the U.S. District Judge Reed O' Connor "reckless", "ludicrous" and "flimsy". U.S. District Judge Reed O' Connor last week allowed the law to continue as the legal process continued through the nation's court system.
Trump Justice Department now for Obamacare Repeal
Trump administration's Department of Justice on March 26, 2019 filed a friendly brief in support of Republican states who won a significant victory from the U.S. District Judge Reed O'Connor on December 14, 2018. The U.S. DOJ filing on March 26, 2019 to the 5th U.S. Circuit Court of Appeals came as a surprise to many because, although opposed to Obamacare from the very outset, the administration stayed away so far from pushing the healthcare marketplace to disarray without a viable replacement of the Affordable Care Act.
Short-term Health Plan Expansion Challenge Rejected
In a setback to Obamacare, a federal judge on July 19, 2019 rejected a petition challenging Trump Administration's another end-run to undermine Obamacare. Under Affordable Care Act, short-term insurance plans can be marketed that would be limited to three months and these plans--offered by Health Insurance Innovations Inc. and eHealth Inc. among others--are often aimed at healthy young consumers. Trump administration last year expanded the short-term insurance plans to last as long as 364 days and renewable every three years, thus raising the fear that there would be an exodus of healthy consumers from ACA-compliant plans to these short-term insurance plans and raising premiums of the remaining consumers in the ACA-compliant plans. The rule went into effect in October 2018. U.S. District Judge Richard Leon ruled on July 19, 2019 that plaintiffs failed to prove any "potential negative impact" from the Trump administration's rule.
Adverse Ruling Puts an Additional Nail to Obamacare
As the Texas case against Obamacare is winding through the federal court system, it has suffered another setback on December 18, 2019 as a three-judge panel of the 5th U.S. Circuit Court of Appeals has ruled that the individual mandate is unconstitutional after Congress has passed the 2018 tax overhaul, abolishing the penalty for not carrying individual health care coverage. However, unlike the lower court, the appeals court refrained from deciding on the unconstitutionality of the remainder of the Obamacare.
Supreme Court Rescues ACA One More Time
U.S. Supreme Court on June 17, 2021 by 7-2 votes upheld the Affordable Care Act in its entirety, with the majority dismissing Texas, 17 other states and two individuals on the ground that they didn’t have legal standing to bring the lawsuit to begin with. Texas Attorney-General Ken Paxton brought the lawsuit after Congress in 2017 reduced the penalty of not carrying the insurance coverage as part of the individual mandate to zero. Conservatives bank on the fact that not requiring the individual mandate means the entire law is unconstitutional. Country’s apex court’s seven justices surely didn’t read the law that way as, they believed, the individual mandate continued to be requirement, only the related penalty had been zeroed out. Justice Neil Gorsuch and Justice Samuel Alito dissented. Compared to earlier two Supreme Court verdicts over the Affordable Care Act in 2012 and 2015, this time the verdict was lopsided.
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U.S. Supreme Court Upholds Religious Exemption to Deny Contraceptives
U.S. Supreme Court in an expansive ruling on July 8, 2020 upheld the rights of employers, colleges and medical facilities to deny coverage of contraceptives to their as mandated by the Affordable Care Act on the ground of their "religious" belief. The 7-2 ruling, with only Justices Ruth Bader Ginsburg and Sonia Sotomayor dissenting, will deny the coverage of contraceptive costs for up to 120,000 females who, under the Affordable Care Act, are mandated to be provided with contraceptive coverage by employers employing more than 50 workers. However, this is not a complete victory for religious conservatives and Trump administration as the case goes back to the Philadelphia-based 3rd U.S. Circuit Court of Appeals which will now judge whether the "religious exemption" rule will stand the muster of Administrative Procedure Act. The case has been going on for the past seven years between Little Sisters of the Poor vs. Pennsylvania.
More than half-a-million Sign up for ACA in Extended Window and Numbers are Poised to grow
As part of President Joe Biden's effort to build on Affordable Care Act, the Center for Medicare and Medicaid Services, or CMS, has extended the enrollment period through August 15, 2021. The results are promising so far as CMS has made public on April 7, 2021 of new enrollments of 528,005 between February 15, 2021 through March 31, 2021. The figure only includes the enrollments from 36 states where federal government runs the Healthcare.gov insurance marketplace. States like New York and California manage their own insurance markets, and people who have bought insurance coverage in those markets will increase the final number of new enrollments. There were big spikes in new enrollments in Texas and Florida. In addition, about 870,000 people who visited Healthcare.gov in the period of February 15, 2021 and March 31, 2021 found that they were eligible for Medicaid coverage under the Obamacare law, according to the CMS report. Subsidized insurance marketplace and expanded Medicaid coverage are the twin pillars of Affordable Care Act, and President Joe Biden wants to strengthen both the pillars and go even beyond that by offering a public option.
Strong ACA Enrollment Reported
Generous subsidies provided by Biden administration's $1.9 trillion COVID-19 relief package, American Rescue Plan, helped increase the new enrollment and re-enrollment of existing members in the midst of a once-in-a-century pandemic. HHS Secretary Xavier Becerra said on January 13, 2022 that 14.1 million people had either enrolled as new members or returning members as of January 8, 2022, a week before the final day of enrollment, 2 million more than the current levels. The generous subsidies will be exhausted soon as Democrats are at a loggerhead over passing the Build Back Better package that includes extension of generous ACA subsidies. CMS head, Chiquita Brooks-LaSure, put the [ACA] enrollment growth, especially in Texas and Florida, in correct perspective: "dependable health care coverage is in reach at an affordable rate".
A Record ACA Enrollment Reported
The Washington Post on January 27, 2022 reported that record number of people had enrolled in the Affordable Care Act-offered health insurance coverage either through federally offered Healthcare.gov or state-offered exchanges. The enrollment period of the federal marketplace has closed on January 15, 2022, but the state exchanges for five states plus District of Columbia are still allowing residents to enroll in their individual insurance marketplaces. As of January 15, 2022, a total of 14.5 million people have enrolled for this year, including about 10 million people through the Healthcare.gov and an additional 4.5 million people through state exchanges. 17 states and D.C. have their own insurance marketplaces while 33 states exclusively rely on the Healthcare.gov federal marketplace. The 14.5 million figure shatters previous record and the final number is sure to go higher.
Religious Groups File Lawsuit against ACA Mandate for HIV Drug Coverage
The Dallas Morning News reported on September 2, 2022 that a group of Christian organizations has filed lawsuit against Affordable Care Act's provision for mandatory coverage of preventive HIV medication PrEP (Pre-exposure Prophylaxis), arguing that it violates their religious freedom. The plaintiffs are represented by Jonathan Mitchell, legal brain behind the TX Senate 8 law that has empowered everyday Texan to file civil lawsuits against abortion providers and abettors. The plaintiffs include Fort Worth orthodontist John Kelley, Ashley and Zach Maxwell of Hood County and Joel Miller of Parker County. The Kelly vs. Becerra was filed in the court of U.S. District Judge Reed O' Connor. The lawsuit alleged, without proof, that PrEP medications encouraged "prostitution, promiscuity and intravenous drug use".
CDC approved the PrEP medications a decade ago. Manufactured by Gilead Sciences, Truvada and Descovy are once-daily pills. Providers can also inject a PrEP shot, Apretude, every two months. According to the CDC research, PrEP medications prevent HIV infection from sex by 99% and HIV infection from IV drugs by 74%. Some PrEP medications, along with other drugs, are also used to treat HIV.
Fort Worth Judge Rules against Mandatory Coverage of PrEP
U.S. District Judge Reed O'Connor on September 7, 2022 sided with the social Conservatives, ruling that mandatory coverage mandate for HIV drugs PrEP (Pre-Exposure Prophylaxis) under the Affordable Care Act violated the religious freedom of the employers.
Over 5 million Uninsured in Texas in 2022
Texas has the nation's maximum number of uninsured people among any state. Out of about 5 million uninsured in 2022, based on a front-page report by The Dallas Morning News on October 25, 2022, there are five broad categories:
* 2,169,000 already eligible for subsidies, but a perception of higher cost most likely has prevented them from enrolling
* Eligible after "family glitch" fix: 635,000 ("family glitch" happens when a breadwinner can get the coverage for themselves, but can't afford to cover the family members who are no more eligible to receive subsidies on the Healthcare.gov platform)
* Mostly kids eligible for Medicaid: 662,000
* Lost opportunity due to Texas' reluctance to expand Medicaid: 771,000
* Ineligible because of lack of citizenship requirement: 733,000
Record Enrollment in ACA
The Dallas Morning News ran a front-page article on January 27, 2024 on the popularity, perception and success of the Affordable Care Act. According to the HHS data released on January 24, 2024, a record 21.3 million people are now enrolled in Former President Barack Obama's signature health insurance plan. There are many subsidized plans offered through the federal marketplace, HealthCare.gov. 18 states also run their own insurance exchanges. Texas has 3.4 million enrollees in the ACA, largest of any states. Texas has also the largest share of uninsured population, with 16.6% uninsurance rate followed by Oklahoma (11.7%), Georgia (11.7%), Wyoming (11.5%), Florida (11.2%), Nevada (11.1%), Alaska (11.0%), Mississippi (10.8%), Arizona (10.3%), and Tennessee (9.3%), respectively. The increase in ACA enrollment was a gargantuan 30%, signifying the popularity of the program. Since Joe Biden became the president, ACA enrollment swelled almost 80%. Many of the new enrollees are booted out of the Medicaid as the federal government has unwound the pandemic-era suspension of the Medicaid eligibility verification process starting in April 2023. According to various estimates, circa 15 million people are likely to be dropped off the Medicaid roll. Nearly 3 million are likely to be eligible for subsidized coverage from the ACA marketplace. So far, about 1 million people enrolled in the ACA. The American Rescue Plan Act of 2021, or ARPA, expanded the number of eligible people to buy a subsidized health plan by about 20%, and the Inflation Reduction Act of 2022 extended those subsidies. Conservatives allege that ARPA made ACA popular and that's a failure of ACA by itself. Consumers are able to find affordable plans as cheap as $10 in the marketplace. However, those subsidies are set to expire next year.
Biden Offers ACA Marketplace Access to Dreamers
Biden administration published its updated rule on May 3, 2024, allowing about 100,000 Dreamers to get access to the subsidized healthcare plans under the Affordable Care Act. The rules will allow the Dreamers to shop and buy healthcare coverage effective this year's enrollment period set to open to public on November 1, 2024. In April 2023, Biden administration unveiled its rules, opening up Medicaid and ACA to Dreamers. The final rule published May 3, 2024 strips the Medicaid provision off the plan.
