Why Is ObamaCare So Confusing and Complicated?

Talk to anyone, and they will tell you never have they found anything so confusing and complicated as ObamaCare. Why is this?

The simple reason is that the ACA is federal bureaucracy run amuck.

A second reason is administrative incompetence with the proliferation of agencies, programs, forms, and rules and regulations .

A third reason is that government must account for every penny and satisfy multiple constituencies. As Jonathon Oberlander, a health care analyst at the University of North Carolina, explained in the December 9 New England Journal of Medicine , “The law is not a single program, It is a collection of mandates, public insurance expansions, and regulations that affect difference groups of Americans in different ways, at different times.” It means different things to different people.

A fourth reason is that it keeps changing to adjust to its flaws and to evolving political realities. Since the law was enacted, it has undergone 54 changes.

Here is a list of changes compiled and explained by Grace Marie Turner in a July 1 article in Forbes Magazine

“By our count at the Galen Institute, more than 54 significant changes have been made to the Patient Protection and Affordable Care Act since it was enacted in 2010 – at least 34 that the Obama administration has made unilaterally, 17 that Congress has passed and the president has signed, and three by the Supreme Court.

Our latest count has added two more changes made by the Obama administration contrary to statutory language, and one rewrite of the law’s text from the latest U.S. Supreme Court decision. Our latest additions:

Extension of credits to people receiving employer-sponsored coverage. Section 1511 of the ACA instructs the Labor Department to issue regulations requiring businesses with more than 200 employees to automatically enroll their employees in any health benefits plan offered by the employer. Section 36B correspondingly denies credits to employees covered by an employer plan. IRS regulations contradict the statutory language and allow credits to taxpayers when they are automatically enrolled in employer minimum essential coverage. Treasury implicitly acknowledges there is no statutory authority for its regulatory change. (May 23, 2012)

Illegal use of exchange grants. CMS issued guidance saying that states operating their own exchanges can use money from federal grants to do outreach and education to increase enrollment, even though the ACA stipulates the grants are to be used only to set up exchanges. (June 8, 2015)

The law doesn’t mean what it says: In King v. Burwell, the U.S. Supreme Court overruled the plain meaning of the ACA to limit tax credits to people living in states that created their own exchanges and instead allowed tax credits for insurance purchased through federally-facilitated exchanges as well. (June 25, 2015)

The court:

Allowing tax credits through federal exchanges: The latest change to the law was made by the U.S. Supreme Court on June 25, 2015, in King v. Burwell when it ruled that the law doesn’t mean what it says. The court ruled 5-4 that the spirit of the law’s goal to expand coverage, not the actual language, allows tax credits to flow through federal exchanges, despite seven instances in the law only allowing credits to citizens in states that set up their own exchanges.

This is the third change to the law made by the court. Three years ago, the Court determined that the law doesn’t mean what it says in calling the penalty for not purchasing health insurance a “tax” and deciding that Medicaid expansion could be optional for the states, in contradiction of the explicit language of the statute.

The administration:

Illegal use of grant money: The Center for Medicare and Medicaid Services issued guidance June 8, 2015, that allows states with their own health insurance exchanges to use money from federal grants for marketing and outreach.

The statute stipulates that the grants must be used to establish the exchanges. The CMS guidance expands allowable use of the establishment grants after January 1 to include “outreach and education, including in-person assistance, to support increasing total enrollment” to levels needed “for the viability of the marketplace.”

Double trouble for employers: The latest research about implementation of the Affordable Care Act by Andy S. Grewal, an associate professor at the University of Iowa College of Law, finds that Obama administration regulations are allowing taxpayer subsidized health insurance for some people receiving employer-sponsored coverage, in violation of the statute.

He described the regulatory changes he has uncovered while comparing regulations to the statute in testimony before the Senate Judiciary Subcommittee on Oversight on June 4, 2015.

Grewal explained that the ACA provides tax credits to U.S. citizens with incomes between 100 and 400% of the Federal Poverty Level (FPL). However, IRS regulations were written to extend credits to citizens below 100% FPL in some cases.

Also, Section 36B of the ACA grants credits to some non-citizens with low-incomes only if they are themselves lawfully present in the U.S. and cannot obtain Medicaid coverage. IRS regulations, however, contradict the statute and allow subsidies if “the taxpayer or a member of the taxpayer’s family is lawfully present in the United States,” and “the lawfully present taxpayer or family member is not eligible for the Medicaid program.”

In the latest addition to our list, he finds the IRS regulations allow persons to obtain premium tax credits when they are automatically enrolled in an employer plan, again in violation of the language of the Affordable Care Act.

Section 1511 of the ACA instructs the Labor Department to issue regulations requiring businesses with more than 200 employees to automatically enroll their employees in any health benefits plan offered by the employer. Section 36B correspondingly denies credits to employees covered by an employer plan.

IRS regulations contradict the statutory language and allow credits to taxpayers when they are automatically enrolled in employer minimum essential coverage. Treasury implicitly acknowledges there is no statutory authority for its regulatory change.

“It’s hard to get worked up over extending tax credits to our nation’s poorest, but the unfortunate structure of the ACA may lead to controversy,” he writes. “Under Section 4980H(a), a business can face severe penalties if it fails to offer health insurance coverage and even one of its employees receives a premium tax credit. Thus, the invalid extension of the tax credit, even when made to a sympathetic individual, can trigger adverse consequences.”

He highlights “the pitfalls associated with Treasury’s failure to recognize limits on its administrative authority.” The Supreme Court’s ruling in King v. Burwell embolden the administration to continue its illegal rampage.

The Galen Institute has been cataloguing the major changes made to the ACA. Prof. Grewal’s newly-uncovered finding and the latest Supreme Court decision bring our count to 54, including the 34th change made by the administration without statutory authority