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ACA: A List of Reasons for the White House To Be Thankful — and Not-So-Thankful

On the eve of the launch of the second Affordable Care Act open enrollment period, the Obama administration released its Faces of Health Care series, showcasing U.S. residents who have obtained coverage thanks to the law. Today — on the eve of Thanksgiving — California Healthline considers which ACA-related initiatives and developments in the past year the administration might be thankful, and some things it might not be so thankful for.

Giving Thanks for …

The ACA’s effect on the economy. The Obama administration started the year off strong with the release of a CMS report in January attributing a deceleration in health care spending in 2012 to the ACA. Two months earlier, a separate White House Council of Economic Advisers report found that the health care spending growth rate was 1.3% between 2010 and 2013, the lowest three-year growth margin since the metric was first calculated in 1965. The panel attributed the low growth rate in large part to changes implemented under the ACA.

Smooth transition at HHS helm. The Obama administration scored another victory in June when the Senate voted to confirm Sylvia Mathews Burwell to succeed Kathleen Sebelius as the HHS secretary. Mathews Burwell received bipartisan support in the confirmation process, which was less contentious than observers had expected, considering her support of the health reform law and the partisan scrutiny her predecessor faced.

Enrollment goals met. Despite the technical glitches and setbacks faced by the administration during the first enrollment period, an Avalere Health study showed that nearly half of states met or exceeded their enrollment goals, while revised HHS data show that 6.7 million people enrolled in coverage through the federal exchange, surpassing the Congressional Budget Office’s estimate of six million.

Satisfied customers. A recent Gallup poll delivered more data for the Obama administration to give thanks for, revealing that the majority of consumers who purchased coverage through the exchanges described the quality of care and coverage as “good” or “excellent.”

Smoother second open enrollment period. Observers have been quick to note that the vast majority of technological glitches that marred the initial open enrollment period appeared to be fixed for the open enrollment period that launched earlier this month. Further, HHS released a new window-shopping feature that allows consumers in the 36 states using the federal insurance exchange to obtain premium and subsidy estimates for various plan options in their area. The tool, which HHS says was used by about 1.2 million U.S. residents on the first day, also aims to ease the search process by allowing consumers to sort plans by the premium amount and deductible size, as well as plans with specialized programs.

Steady premium rates. The Obama administration also is likely thankful for recent analyses of HHS data that ultimately concluded that premium plans sold through the federal health insurance exchange in 2015 increased at a rate comparable to those in the employer-based insurance market.

Better relationship with insurers. The health care reform law also has spurred “mutually beneficial partnerships” between the Obama administration and insurers, which have helped the White House stave off legal challenges to the law and address some of the technical issues that plagued the initial enrollment period.

… but not so Thankful About

Continued GOP opposition to the ACA. In March, the House voted to approve a bill (HR 4118) that would delay the law’s individual mandate, a move that CBO projected would leave as many as one million U.S. residents uninsured. Meanwhile, Medicaid expansion among states moved at a glacial pace in 2014, with just two states — New Hampshire and Pennsylvania — making moves to join the 24 other states that have reached agreements with HHS to expand their coverage. Republicans continue to block expansion in 20 states.  

A GOP victory in the midterm election. Relatedly, voters elected and re-elected several Republicans in November’s midterm election, giving the party control of both the House and Senate for the 114th Congress. Some observers have said that the results of the election will likely increase GOP attempts to change the ACA, such as by delaying or removing the individual or employer mandates. Meanwhile, the re-election of several GOP governors is unlikely to help speed up states’ adoption of the Medicaid expansion.

The contraceptive coverage ruling. The Obama administration also faced several legal challenges in 2014, suffering a setback in June when the Supreme Court ruled in a 5-4 decision that closely held corporations cannot be required to provide contraceptive coverage to their employees if doing so goes against the owners’ religious beliefs. The majority opinion, by Justice Samuel Alito, said that the Obama administration had failed to demonstrate that the federal contraceptive coverage rules are the “least restrictive means of advancing its interest” in guaranteeing women birth control coverage. The ruling prompted the White House to issue a brief saying it was reviving the contraceptive coverage accommodation to provide an alternative way for religiously affiliated not-for-profit organizations to object to providing contraceptive coverage to their employees.

Additional legal challenges. A couple upcoming court cases could chip away at the ACA:

  • The Supreme Court’s consideration of a case — King v. Burwell — that challenges subsidies to help U.S. residents purchase health insurance plans through the Affordable Care Act’s federal insurance exchange; and
  • An appeal filed by Sen. Ron Johnson (R-Wis.) over the dismissal of his lawsuit that challenged an ACA directive allowing lawmakers and some staff members to receive federally subsidized coverage through the law’s exchanges.

Record-low approval of the ACA. A Pew Research Center/USA Today poll conducted in April showed that 41% of U.S. residents approved of the law, while 55% disapproved. The numbers were lower than the 55% disapproval and 42% approval rates recorded before the open enrollment period launched. Meanwhile, a Gallup poll found that U.S. residents’ approval of the ACA fell by one percentage point to 37% between January and November — the lowest approval rating recorded by the polling company.

Future Thanks

As the ACA continues to mature, the Obama administration will undoubtedly continue to experience more initiatives and developments that it might be both thankful and not so thankful for. “Road to Reform” will continue to track all of this. Stay tuned.

Around the nation

Auto-enrollment. HHS is looking to give consumers using’s auto-enrollment tool different options, such as enrolling in the same plan or enrolling in the least-costly plan with comparable benefits, the New York Times‘ “The Upshot” reports.

HHS skimps on data: The Hill reports that the Obama administration is offering only minimal enrollment data for  

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