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Emily Egan, American Action Forum "Weekly Check-Up"

"A major criticism of the Affordable Care Act (ACA) is its attempt to impose “one size fits all” health policy on states with different populations and markets. Whereas health insurance was historically regulated by the states, the ACA and accompanying regulation imposes numerous new rules onto health insurers and employer-provided plans. Millions of Americans will be eligible for subsidized health insurance coverage in 2014, and supposedly able to enroll in said coverage by October."

Edmund Haislmaier, The Heritage Foundation

"Thus, as it now stands, only 14 to 16 states (plus the District of Columbia) are likely to actually be operating state-run exchanges come October, when open season begins. There may be another two or three states with so-called partnership exchanges, but the feds will be responsible for most of the major functions in those states. Indeed, the final count could be lower as some states trying to set up their own exchanges—faced with significant technical challenges and limited remaining time—give up and default to a federally run exchange."

Nina Owcharenko & Edmund F. Haislmaier, The Heritage Foundation

"Recent decisions by the Obama Administration concerning the health care exchanges and Medicaid expansion underscore what a risky proposition the Patient Protection and Affordable Care Act (PPACA) is for the states. Congress presumed in PPACA (Obamacare) that the states would agree to build and run exchanges and could be forced to expand Medicaid. The Supreme Court, however, ruled the Medicaid expansion voluntary, which has made states increasingly concerned over new burdens related to costs, control, and coverage—in both the exchanges and Medicaid."

Robert F. Graboyes, Ph.D., Altarum Institute Health Policy Forum

"Many of the unintended consequences of the law have lain dormant until recently. Businesses and others withheld unpleasant actions in hopes that the Court or the election would sweep PPACA into the dustbin. That didn’t happen, so now the revelations have begun."

Emily Egan & Janine Hanrahan, The American Action Forum

"As key provisions of the Affordable Care Act (ACA) are moving closer to full implementation, the Department of Health and Human Services (HHS) is beginning to define regulations, with the latest round of draft rules released last Friday. Among the new regulations is a proposed 3.5 percent “user fee” to be charged to insurers that want to sell plans on the federally facilitated insurance exchanges (FFE)."

Dan Goldbeck, American Action Forum

"Nearly three weeks after President Obama’s reelection, the Administration has officially published three proposed rules implementing his signature legislative package, the Affordable Care Act (ACA). The proposals are relatively uncomplicated compared to other ACA rules; together, they take up a brisk 93 pages. Nevertheless, they represent some of the more notable changes mandated by the law."

James Capretta, Health Affairs

"The Democrats do not have supermajority control of the House and Senate, as they did in the 111th Congress when the PPACA was passed. Indeed, in 2013 and 2014, Republicans will have a rather sizeable majority in the House, along with 45 votes in the Senate. In addition, there are now 30 Republican Governors in the states, who will have much to say about health care policy in the coming years, too. So, unlike the birth of the PPACA, its implementation will proceed at a time when Republicans are controlling many levers of power."

Douglas Holtz-Eakin, The American Action Forum

"The ACA health insurance subsidies are the most significant expansion of entitlements since the 1960s. In light of the precarious fiscal outlook for the federal government, its cost is a central concern to policymakers and taxpayers alike. When the ACA passed in June 2010, the Congressional Budget Office projected the budget cost between fiscal 2012 and fiscal 2019 to be $462 billion. By June 2012, the cost for these same years had jumped to $574 billion, an increase of nearly 25 percent."

Gail R. Wilensky, Ph.D., New England Journal of Medicine

"U.S. health care suffers from three major problems: millions of people go without insurance, health care costs are rising at unaffordable rates, and the quality of care is not what it should be. The Affordable Care Act (ACA) primarily addresses the first — and easiest — of these problems by expanding coverage to a substantial number of the uninsured. Solutions to the other two remain aspirations and promises."

David M. Eddy & Roshan Shah, Health Affairs

"The Medicare Shared Savings Program, created under the Affordable Care Act, will reward participating accountable care organizations that succeed in lowering health care costs while improving performance... We used a simulation model to analyze the effects of the Shared Savings Program quality measures and performance targets on Medicare costs in a simulated population of patients ages 65–75 with type 2 diabetes. We found that a ten-percentage-point improvement in performance on diabetes quality measures would reduce Medicare costs only by up to about 1 percent. After the costs of performance improvement, such as additional tests or visits, are accounted for, the savings would decrease or become cost increases."

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