The Pitfalls of Affordable Care Act Implementation

By: Tuesday December 4, 2012 12:30 pm

All of this will happen during 2014, a midterm election year, where Democrats will struggle to hold the Senate, while trying a heavy lift of adding 17 seats in the House. What if the dominant story becomes the failures of Obamacare? Certainly that narrative is already being written in some circles? The ACA already indirectly led to one nightmare election for Democrats, in 2010. Could it lead to another?


Health Care Law Faces Sprint After Election

By: Wednesday November 7, 2012 4:05 pm

One signature consequence, perhaps the leading consequence, of last night’s electoral victory for Democrats is that the implementation of Obamacare will now proceed unfettered. At least at the federal level. But as we’ve noted for many months, the law’s facility will rise or fall on the willingness of the states to carry it out. After the Supreme Court ruling in June, states can now decide on whether or not to expand Medicaid to their populations. There are now 30 Republican governors, one more than before last night (North Carolina flipped to the Republicans), which in my book means 30 potential land mines for the Medicaid expansion.

“New Public Option” Not a Public Option

By: Tuesday October 30, 2012 1:45 pm

The need to offer a substitute to placate those desiring a public option created this Frankenstein monster, which was admittedly not well thought-out. Those who did it ended up with the worst of all possible worlds; no public option supporter really even knew about these multi-state plans, and they have the potential to disrupt the exchanges and cause a race to the bottom.

Health Care Challenges Could Lock States Into Current Medicaid Spending

By: Friday July 20, 2012 4:39 pm

It looks like the sloppy wording in the Affordable Care Act cuts both ways.

We’ve been talking about the various challenges to the law arising out of drafting errors, in particular the vagaries of whether individuals seeking coverage on federally-run exchanges substitutes for state exchanges if the state refuses to implement one, can qualify for coverage subsidies. But there’s another drafting issue that could lock states which choose not to expand Medicaid into maintaining their current level of coverage and not cutting it further. The Hill explains.

GOP House Passes Health Care Repeal, Again

By: Wednesday July 11, 2012 4:12 pm

The House succeeded in passing a repeal of the Affordable Care Act today, by a vote of 244-185. This is, according to House Republicans, the 33rd time they have repealed some or all of the law in the 112th Congress.

Conservatives Raise Court Challenge on Allowing Insurance Subsidies on Federally-Run Exchanges

By: Sunday July 8, 2012 12:48 pm

Robert Pear today writes about an emerging lawsuit over the health care law that I touched on Thursday. The language around the insurance exchanges and whether the state or federal government runs them is sufficiently vague that conservative legal functionaries think they can exploit it.

States Opting Out of Medicaid Expansion Could Reduce Their Rolls Without Consequences

By: Thursday July 5, 2012 6:48 am

Phil Galewitz of Kaiser Health News sketches out a terrifying scenario for Medicaid in states that opt out of the expansion. Not only could they refuse to cover low-income adults up to 133% of the federal poverty line, but they could actually roll back their current Medicaid plans without any consequence.

Republicans Can Also Opt Out of Exchanges, Not Fund Federally Administered Ones

By: Tuesday July 3, 2012 11:40 am

I believe that the ability for Republicans to undermine the Medicaid expansion in the health care law is really terrible, because this is one of the few unquestionably good parts of the legislation. But it’s worth noting that Republicans have plenty of opportunities to undermine the rest of the law too, even if they never get in the position to “repeal and replace.”

Non-Trivial Number of Poor People Would Be Ineligible for Insurance Subsidies if Their State Denies Medicaid Expansion

By: Thursday June 28, 2012 3:32 pm

Because the authors of the Affordable Care Act saw no issue with the expansion of Medicaid and presumably found it constitutional, they wrote the exchange subsidies as affecting everyone above the rate of Medicaid, specifically about the federal poverty level (FPL). But what about people who make below the poverty level? They may be ineligible for subsidies, but that’s OK, because they can always hook up with Medicaid, which is now expanded to 133% FPL. However, if the part of the ruling reducing the leverage for the federal government to extend this Medicaid expansion to the states winds up in big fights among red-state governors, those under 100% FPL could find themselves out of luck.

The New Contraceptive Rules, and the Fragmentation of US Health Care

By: Monday March 19, 2012 8:50 am

Late on Friday, the Administration laid out a series of new details on the contraceptive mandate that has caused such controversy over the past several weeks. And it turns out that the White House determined that they could not enforce the mandate on self-insured plans, which may affect 200,000 students at colleges that self insure.

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