The Patient Protection and Affordable Care Act of March 23, 2010- Part II of a II Part Series

(1/27/23)-More than 16.3 million people selected a plan on the ACA marketplace, based on data released by government officials recently. Open enrollment began on the federal exchange on November 1, 2022 and ended on January15th, although it is still open on some of the state exchanges.

That represents a 13% increase from the same time last year, or an increase of 1.8 million people.

The number of uninsured under the age of 65 has dropped to a record low of 8% from 10.5%in 2021..

(9/20/21)-Officials from the Centers for Medicare and Medicaid Services (CMS) have extended the annual open-enrollment period on the federal exchange, so that it will run from Nov.1 rough January 15, 2022.

CMS will also let marketplaces offer a monthly special enrollment for certain low-income people who are eligible for subsidies that reduce premium costs.

Funding will be increased for “navigators” who assist people to enroll. To pay for this funding the user fees on health insurers will rise to 2.75% of premiums from 2.25%.

CMS is also repealing a rule that required insurers to send a separate bill to consumers for portions of a policy holder’s premium related to abortions.

(4/3/21)- The Biden administration announced $2.3 million in grants to nonprofits that help enroll coverage in health-care plans under the Affordable Care Act.

The government will spend about $100 million in advertising to encourage Americans to enroll in health-care plans under the act, which is about double what the prior administration spent. It will also increase the subsidies so that the premiums for coverage can be sharply reduced.

About 6 million Americans will be able to find health plans that will not cost them anything in premiums. Maximizing subsidies, will however, require an enrollee to go back into his/her account and re-enroll to get the immediate benefit of the increased subsidy. Failure to do so would mean delay in getting money back for the differential.

(3/21/21)- The Senate, in a 50 to 49 vote confirmed California Attorney General Xavier Becerra as secretary of the Department of Health and Human Services (HHS). The agency has operated since late January without a confirmed head. The agency operates with a $1.2 trillion budget, including a network of shelters for child migrants that have been the focus for the number of  such unaccompanied by parents that have been entering the U. S.

He will be the first Latino to head the agency. Senator Susan Collins of Maine was the only Republican voting in favor of his confirmation.

(5/1/20)- In an 8-to-1, the U. S. Supreme Court ruling, the government will have to reimburse the insurance companies for losses they incurred under the Affordable Care Act for the so-called risk corridor wherein for participating in the federal market place set up under the law, any losses they incurred from 2014 through 2016 would be reimbursed.

Under the terms of ACA, if premiums exceeded medical expenses, the insurers would be required to pay some of its profits to the government. If however losses exceeded profits the government would reimburse the insurers for the loss. It turns out that the losses came to about $12 billion.

Congress never appropriated the funding for this obligation and that is why the insurers brought the lawsuit, but a divided three judge panel of the United States Court of Appeals for the Federal Circuit ruled against the insurers.

(11/8/19)- New York State will spend $43 million to promote its state run health-care market place, for which New Yorkers have until December 15 to enroll. 38 states and the District of Columbia use the federal marketplace set up under the terms of the Affordable Care Act.

Coverage becomes effective for those who enroll on January 1 and until January 31 for coverage starting March 1, 2020.New York health officials said more than4.8 million New Yorkers have such coverage. The number of uninsured people in the state has declined by 1.2 million since 2010, the year the ACA was passed.

These same officials predicted that most New Yorkers will not see an increase in their premiums in the coming year

(10/25/19)- Premiums for the most popular health plans sold under the Affordable Care Act will drop for the 2nd consecutive year, according to Trump administration officials. Average rates for the most popular, middle-priced plan will fall 4% in 2020 for a 27-year old buying health insurance on the federal exchange.

20 more insurance providers will participate in states that use the federal exchange, resulting in bringing the total to 175 issuers, compared with 132 in 2018. There are now 39 states and the District of Columbia that use the federal exchange.

The average benchmark premium for an unsubsidized 27-year old will drop to $338 a month in 2020 from $406 in 2019. The average maximum subsidy amount for a 27-year old who meets eligibility requirements in 2020 will be $323.

(9/25/19)- In his article in the New York Times “Results Lag in Medicare Innovation Programs” on September 24, Austin Frakt posits that these programs have not proven to be as successful as had been hoped for.

“The Obama administration’s goal was for 90 percent of Medicare payments to hospitals and doctors be tied to measures of quality by 2018…”

The Medicare’s Hospital Readmission Reduction Program penalizes hospitals that have high rates of readmissions for certain illnesses. The question that arises from this program is whether or not this is beneficial for most patients even though it may be costly.

The Hospital Value-Based Purchasing Program rewards or penalizes hospitals based on 20 measures of quality. The program’s effect on quality of care and patient satisfaction is still a big question mark.

(9/17/19)- The Census Bureau said the number of Americans without health insurance increased to 27.5 million in 2018, which therefore was the first decrease in enrollment that has occurred since passage of the Affordable Care Act in 2010. The number of uninsured rose by about 2 million Americans.

The 27.5 million represent about 8.5% of Americans, up from 7.9% or 25.6 million people in 2017.

About 91.5% of Americans had health-insurance coverage for all or part of 2018, compared with 92.5% for all or part of 2017.

The average premium for a benchmark health plan bought on one of the ACA exchanges was about 34% higher than it was in 2017, according to a report from the Congressional Budget Office

(8/23/19)- Thirty-three states and the District of Columbia have adopted expanded Medicaid since 2014 and 14 have not, In three other states-  Idaho, Nebraska and Utah-voters approved measures last fall directing their legislatures to accept expanded Medicaid plans, but they have yet to do so.

A recent study by researchers at the Urban Institute, a nonprofit research group, found that states with expanded Medicaid programs have a much bigger increase for buprenorpghine, which eases craving and withdrawal symptoms for patients suffering from opioid addiction.

“Expanding Medicaid is probably the most important thing states can do to improve treatment rates” said Lisa Clemans-Cope, the study’s lead author.

 (2/12/19)- Seema Verma who is administer of the Centers for Medicare and Medicaid Services (CMS) announced that she had granted Republican-led states the authority to require Medicaid recipients to either work, be in a job-training program or involved in community service.

Her decisions will shape the coverage for the roughly 127 people involved in Medicare, Medicaid and the Affordable Care Act market (ACA).

The CMS is an agency with a trillion dollar budget that oversees implementation of the Affordable Care Act.

(10/24/18)- The latest attempt by the Trump administration to weaken the Affordable Care Act involves the issuance of guidelines to the states advising them that the federal government will consider state ACA waiver requests that would allow federal subsidies to  cover skimpier, less expensive plans that don’t meet the law’s requirements.

Seema Verma, who heads the Centers for Medicare and Medicaid Services (CMS), which oversees ACA, said the guidelines are a major step in lowering health-care prices.

(5/17/18)- An independent study of the cost to the government of President Trump’s latest plan to allow individuals to have “skimpy short-term” health insurance, as an alternatives to the Affordable Care Act plans in actuality would be much more expensive  than the government had originally estimated.

Not only would it cost the government more, it also would affect many more people.

The study done by Medicare’s chief actuary, Paul Spitainic, estimated that 1.4 million people would sign up for the short term coverage, with enrollment reaching 1.9 million in 2022. Under current rules, these short-term insurance plans cannot last for more than 3 months, which under the latest proposal would be increased to 364 days.

Mr. Spitainic’s independence is protected by federal law. The federal government subsidizes the premiums for low income individuals, and if the cost of the premiums increases, that means it costs the government even more, rising by $1.2 billion next year, and by a total of $38.7 billion over 10 years.

These short-term coverage plans would drain healthier individuals from coverage of the regular Affordable Care Act plans, and thus, in the long run, also cause increases in their premiums.

(4/6/18)- Officials of the Centers for Medicare and Medicaid Services (CMS) announced that the final figures for enrollment under the Affordable Care Act showed that 11.8 million peopled had enrolled in 2018. Although this was about 400,000 less than in 2017, this figure is quite impressive in light of the obstacles placed in the path to enrollment by President Trump, but would now be expanded to 364 days.

The biggest decrease came from the 39 states that used the federal marketplace,, as opposed to the 11 states that had set up their own health-insurance marketplace.

Monthly premiums for federal enrollees before any subsidies were applied rose by 30% this year to $621 from $476 in 2017. Subsidies, on average, covered about 86% of the premiums, for those who qualified,

New customers made up about 27% of the total enrollment, down from 31% the prior year. Overall, about 83% of the enrollees received subsidies. Only people with incomes between100% and 400% of the poverty level (for an individual $12,140 and $48,560) were eligible for subsidies.

(12/25/17)- The Centers for Medicare and Medicaid Services (CMS) announced that about 8.8 million consumers had signed up for their health-care coverage on the federal marketplace site HealthCare. gov as of the federal cutoff date of December 15th.

This was about a 4% fall-off from the 2016 enrollment of 9.2 million, but considering the fact that the enrollment time frame was cut from 90 days in the four previous enrollment periods, to 45 in this one, and funding to promote enrollment was sharply curtailed, it was a surprisingly good number.

Eleven states have their own health insurance market place sites, with longer enrollment expiration dates. In N.Y. and CA. enrollment will remains open until January 31..About 2.4 million of the enrollees this year were new ones, and 6.4 million returned to to select plans or were automatically re-enrolled.

Among states using the federal exchange, the largest number of sign-ups were in Florida (1.7 million), Texas (1.1 million) North Carolina (524,000), Georgia (483,0000, Virginia (403,000), Pennsylvania (397,000) and Illinois (340,000)

(12/13/17)- About 3.6 million people had signed up for their health-insurance in the federal marketplace as of Dec. 2, about 22% more than at the same point last year. The enrollment period on the federal market-place site is only 45 days for this period, versus the 90-day timeframe for the prior 4 enrollment periods the previous years.

Even though the open-enrollment period ends on December 15th through the federal market place site, eleven states have later timeframes for the ending of the open-enrollment under the terms of the Affordable Care Act. In the state-run marketplaces it ends on January 31, 2018 in New York;

The deadline in Minn. Is Jan. 14, Jan. 15th in Washington State and Jan. 31 in Cal. Under their state-run marketplaces.

(12/6/17)- The Patients Protection and Affordable Care Act of 2010 has increased the number of Americans with health-insurance by 20 million, and reduced the uninsured rate to 9%. The present enrollment period for those enrolling for their coverage for 2018 will expire on December 15.

Total enrollment for this the 5th enrollment period under the terms of the act is expected to drop from the prior enrollment periods which had been for 90 days, and because the Trump administration has cut back sharply on advertising and for funding for navigators who assist potential enrollees desirous of signing up.

(12/2/17)- About 6.7 million tax filers, or 4.5%, paid the penalty in 2015, down from the 8.1 million in 2014. A tax filer may be either an individual or a family, so the number of people affected by the penalty is likely higher.

It is estimated that 29 million American did not have health insurance in 2015. More than 12 million tax filers claimed an exemption from having to pay the penalty in 2015.

The $25,000 to $50,000 income group had the highest share of people paying the penalty in 2015. Taxpayers earning less than $10,000 for an individual and $20,000 for a married couple in 2015 are exempted from the penalty.

(11/1/17)- A Department of Health and Human Services (HHS) report showed that the number of insurers participating on the federal health-marketplace exchange at under the terms of the Affordable Care Act will drop to132 in 2018 from 167 in 2017.

As a result, about 30% of consumers will have only one heath insurer to select from, as opposed to the 20% this year. Every county in the country will have at least one insurance company servicing every eligible individual eligible for coverage.

With the exception of a few states, the enrollment period will run for only 45 days, from November 1 up to December 15.

(10/24/17)-Several states including New York (November 1 thru Jan. 31, 2018) and California, and the District of Columbia have extended open enrollment deadlines past the federal health-insurance marketplace closing date of December 15. New York state hopes to renew coverage for 400,000 households during the Open Enrollment Period.

Open enrollment, which begins November 1, enables applicants to obtain health-insurance coverage on either the federal exchange,, or state run exchanges. The plans become effective January 1, 3018, and individuals who already have coverage and don’t pick a plan are automatically re-enrolled.

The federal market place will be closed for 12 hours every Sunday, except on December 1.

(10/11/17)- President Trump administration officials have reduced funds for the navigator program by 41%, to $36.9 million from %62.9 million last year. Navigators are the people who assist potential applicants for their health-plan and subsidy assistance that they are eligible for under the terms of the Affordable Care Act.

Among the states hit the hardest are Georgia, down 61%; Michigan, down 72%; New Jersey, down 62%; and Ohio, down71%.


(10/2/17)- Trump administration officials announced plans to shut down, the website consumers use to sign up for their insurance under the Affordable Care Act for 12 hours on nearly every Sunday during the upcoming enrollment season which runs from November 1 thru December 15. Please keep in mind that the enrollment timeframe has been cut to 45 days from the prior 90 day period during the previous enrollment periods for the 38 states and District of Columbia that use the federal insurance marketplace for enrollment purposes.

The outages will occur from midnight through noon every Sunday except Dec. 10 because the officials claim that weekly maintenance is needed to keep the system operating properly and efficiently.

Officials from the Centers for Medicare and Medicaid Services (CMS) stated that: “Maintenance outages are regularly scheduled on every year during the enrollment period.”

(9/4/17)- The Department of Health and Human Services (HHS) announced that it would spend about $10 million on advertisements, including emails, texts, radio ads and digital promotions during the fifth annual open-enrollment period encouraging people to sign up for their health- insurance under the Affordable Care Act.


This is a 90% drop from about $100 million spent under the Obama administration during the last open-enrollment period. The Trump administration is also cutting grants to organizations that help consumers understand their coverage and financial aid options under the law.

The $36.8 million in grants given to these organizations represents about a 40% drop from the $62.5 million awarded in the previous enrollment period. The amount of the grant to each individual organization will depend on how successful it is in reaching its enrollment goal.


(9/1/17)- The fifth annual open enrollment period, when people can sign up for heath-insurance under the Affordable Care Act, or switch plans will run from November 1 through December 15. In the prior 4 years the open enrollment period lasted for 90 days, whereas for this fifth period it is only a 45 day limitation.

With the November date coming up shortly, administration officials have no concrete plans for a large advertising campaign to encourage people to vote. They have not stated if they will continue to make the subsidy payments to the insurers who enroll sicker individuals.

There have not been any grants given past September to navigator companies that help individuals sign up for their insurance under the act.

(8/27/17)- The good news is that the health insurer CareSource plans to offer Affordable Care Act exchange plans in counties that did not have marketplace offerings under the law next year.

CareSource is a nonprofit that focuses mainly on Medicaid individuals, and has actively sought out those counties that did not have a health insurance marketplace under the act. At last count there had been about 82 counties in the U.S. that lacked the marketplace.

For additional information on this topic please see our item dated 6/17/17 below

(8/23/17)- President Trump administration officials have extended the grants to the almost 100 community organizations that help people enroll in their health-care coverage under the terms of the Affordable Care Act, but only through the month of September, as we noted in our item dated 8/13/17 below. Under the Obama administration $63 million was awarded in grants.

With the next open enrollment period starting on November 1 being cut to a 45 day period from 90 days in all prior sign-up periods, it will make things even tougher for these navigator organizations. The administration recently ended $23 million worth of contracts with 2 companies that help people sign up under the act.

Making things even tougher to get people to sign-up for coverage will be the fact that the Centers for Medicare and Medicaid Services will not run any ads this year encouraging people to get coverage. The administration officials have not stated if the Internal Revenue Service would  enforce any penalty on those who do not sign up

(8/17/17)-The nonpartisan Congressional Budget Office (CBO) released the results of its study that showed that if subsidies to insurance companies are dropped, insurers would increase premiums for health-care coverage by about 20% next year. That in turn would mean the government would incur additional costs because of the financial assistance it provides to low income people.

The CBO study was prepared at the request of House Democratic leader Nancy Pelosi of California and Steny H.Hoyer, the Democratic House whip of Maryland.

There is a case pending before the U.S. Court of Appeals for the District of Columbia Circuit because the lower ruled that the subsidies were illegal since Congress had never appropriated money for that purpose..

 (8/13/17)- The Centers for Medicare and Medicaid Services (CMS)-awarded $63 million last year in grants to about 100 community organizations that helped people sign up for their health-plans under the Patient Protection Act. These expediters are known as “navigators”. These grants for the navigators are set to run through September 2018, but the contracts specifically state that the funding would be based on performance.

That means the Trump administration could end the funding for the contracts as early as September 2017. The administration has already cut back funding for ads encouraging  people to enroll in the act.

(8/5/17)- In a letter to the editors of the NY Times’ 8/3/17 edition, entitled “A Bipartisan Fix for Health Care”, Josh Gottheimer, a Democratic, representative from N.J., and Tom Reed, a Republican representative from N.Y. wrote about compromising on the health-care issue to which both parties could agree so that the weaknesses in Obama Care could be improved to benefit all of us.

They wrote that “On Aug.16, insurers must submit their 2018 rates to state regulators for approval; many may be forced to leave the individual-market place altogether.”….

“The costliest 5% of patients account for nearly half of all health-care spending in the country. We propose a dedicated stability fund-essentially a form of reinsurance-that states could use to reduce premiums and limit losses for providing coverage for these high-cost patients””

(7/31/17)- The Republican party’s 7-year attempt to repeal the Affordable Care Act of 2010 continues to meet failure. Republican Senators Susan Collins of Maine, Lisa Murkowski of Alaska  were joined by Senator John McCain, Republican of Arizona and all Democratic senators who, by a 40-51 vote, said “nay” to the last ditch effort to repeal the act.

(7/3/17)- Centene Corp. said it would offer Affordable Care Act health-care market place plans in 40 Missouri counties next year, including  several counties that recently appeared to have no plans being offered. Please see our item dated 6/15/17 below for additional states that Centene will cover in 2018.

The Kaiser Family Foundation said that there are 36 counties in Ohio, Indiana and Nevada that appeared to have no plans covering them in 2018

(6/25/17)- Anthem Inc. said it will exit the health-insurance marketplace in Wisconsin and Indiana in 2018, as well as Ohio as we noted in our item dated 6/8/17 below. MDwise, a small non-profit health insurer said it would also exit the Indiana exchange next year, leaviing 4 Indiana counties at risk of having no insurer under the Affordable Care Act.

On the other hand, Oscar Insurance Corp., said it was planning to expand its exchange offerings to include regions within a half-dozen states.

Initial federal applications to offer 2018 health-insurance market-place plans had to be in by June 21 in the 39 states and District of Columbia under the act. The companies have until late September to make their final decision

(6/15/17)- Reversing the recent trend amongst health-insurance companies withdrawing from the market-place set up under the terms of the Affordable Care Act, Centene announced that it would aggressively expand its coverage areas to include, for the first time, individual policies in Nevada, Missouri and Kansas.

The company said it would also increase its presence in 6 other states. Centene now covers 1.2 million people through state marketplaces.

(6/8/17)- Anthem Inc. announced that it would pull out of the health-insurance exchange in Ohio in 2018, leaving that state without marketplace options under the Affordable care Act. Please see our item dated 5/26/17 below where Blue Cross and Blue Shield of Kansas City announced it would pull out of the market-place leaving some residents there with no options available to them under the act.

Anthem’s exit will lease at least 18 Ohio counties with no health-care market place exchange to choose their coverage. The Kaiser Foundation estimated that 32% of U.S. counties-a total of 1,021 counties are down to just one exchange in 2017-up from 7%, or 225, in 2016.

(5/26/17)- Blue Cross and Blue Shield of Kansas City announced that it would leave the Affordable Care residents in 25 counties in western Missouri with no health-care exchanges in 2018.This could mean that parts of northwestern Missouri residents would have no health-care insurance market place choices under the act.

The company would stop offering exchange plan choices in 30 counties in northwestern Missouri, and 2 counties in Kansas. The move will affect about 67,000 individuals

(5/25/17)- The non-partisan Congressional Budget Office (CBO) estimated that the American Health Care Act (AHCA) that was passed by the U.S. House of Representatives on May 4th to replace Obamacare, would result in 23 million Americans losing their health insurance by 2026. The House acted on the bill before the CBO was able to fully analyze the data from that bill.

The CBO also estimated that the AHCA would reduce the deficit by $119 billion over the coming 10 years. The previous estimate was that it would reduce the deficit by $150 billion

(5/14/17)- BlueCross BlueShield of Tennesee will offer Affordable Care Act (ACA) marketplace health-insurance in the Knoxville region next year, thus filling a void that would have been left when Humana Inc. said it would pull out of all the exchanges that it does business.

Aetna Inc., said it would pull out of the Affordable care health-insurance exchanges next year in Delaware, Nebraska, Iowa and Virginia. The company said its individual plans were projected to lose about $200 million this year

Medica, a nonprofit insurer, said it was considering withdrawing from Iowa’s exchange next year., possibly leaving that state with no insurers in the marketplace under ACA

Please also see: The Patient Protection and Affordable Care Act of March 23, 2010- Part I



by Allan Rubin,
updated January 27, 2023

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