Obamacare overview

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The Patient Protection and Affordable Care Act, commonly known as Obamacare, was passed in its finality on March 21, 2010, and signed into law by President Barack Obama on March 23, 2010.[1]

Law overview

The aim of the law was to provide an expansion of health insurance coverage to more Americans through both individual health insurance marketplaces as well as through employer-provided plans. Minimum requirements of coverage were established and both individual and employer mandates were established over a period of years in order to achieve the goal of expanded coverage. Subsidies and tax credits are provided to individual consumers based on income level and dependents, and existing programs such as medicaid and CHIP were expanded to increase reach. Small businesses receive tax credits based on the level of insurance offered to employees, as well.[2]

Ten essential benefits for coverage

The law included ten essential benefits that plans created after the law's passage needed to include. Existing plans were grandfathered in, but few of the grandfathered plans remain due to frequent changes to health insurance policies.[3] The ten essential benefits outlined by the ACA are:[4]

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Congressional passage


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The Patient Protection and Affordable Care Act (H.R. 3590) was sponsored by Rep. Charlie Rangel (D-NY) and co-sponsored by 37 House Democrats and 3 House Republicans.[5] On October 10, 2009, the bill passed through the House to the Senate. After amendments were added in the Senate, the bill was passed by Democrats in the Senate with voting strictly along party lines, 60-39.[6] The bill returned to the House for a vote on its final passage. All 178 House Republicans opposed the bill's passage along with 34 Democrats, while 219 Democrats voted in favor, leaving the final vote in favor of passage at 219-212.[7]

Democrats in opposition

Following is a list of U.S. House Democrats who voted against Obamacare's passage during the March 21, 2010 vote:[7]

Implementation timeline

The following is a timeline of the implementation dates of key aspects of Obamacare:[8]

2010

  • January 1: Small business tax credits provided for small businesses offering health insurance to employees
  • July 1: Pre-existing Condition Insurance Plans offered by either the federal government or individual state governments
  • July 1: Healthcare.gov minimal functioning website established to educate consumers on coverage options
  • July 1: Tax of 10 percent on indoor tanning services implemented
  • September 23: Adult children are permitted to remain on a parent's healthcare plan until age 26
  • September 23: Insurance plans prohibited from setting lifetime coverage limitations
  • September 23: Insurance plans required to allow appeals with an external review process
  • September 23: New plans required to cover the established minimum coverage

2011

  • January 1: Insurers required to provide rebate the following year if a minimum proportion of premiums were not spent on medical services
  • January 1: Limitations placed on uses for tax-free health accounts such as HSAs, FSA and HRAs
  • March 23: Grants awarded for the establishment of state health insurance exchanges

2012

  • September 23: All insurance providers must provide a uniform summary of care and benefits to consumers

2013

  • January 1: States required to notify the U.S. Department of Health and Human Services whether they would form their own exchanges or join the federal exchange
  • July 1: Consumer Operated and Oriented Plan (CO-OP) put into action to encourage non-profit, member-run health insurance companies

2014

  • January 1: Medicaid coverage expanded to those under 65 with income levels up to 138 percent of the federal poverty level
  • January 1: Minimum medical coverage required for people with individual insurance plans
  • January 1: Annual coverage limits on insurance plans prohibited

2015

  • January 1: Employers with more than 100 employees assessed fees, per employee, for not providing health insurance options

2016

  • January 1: Employers with 50-99 employees assessed fees, per employee, for not providing health insurance options

Individual mandate

Healthcare exchanges began a six month open enrollment period for individuals on October 1, 2013, during which uninsured individuals could sign up for health insurance plans to avoid fines assessed if not insured by the end of the period, March 31, 2014.

Health insurance exchanges

See also: Healthcare.gov website rollout
Image from the Healthcare.gov sign-up page
Healthcare.gov is the website published by the federal government that is intended to serve as the central online hub for the rollout of Obamacare. The federal website is intended to provide insurance options and administer government subsidies for residents of 36 states.[9] Fourteen states elected to create their own healthcare exchanges, including the District of Columbia.[10]

Rollout issues

The rollout date was met with high demand for the website, both by those seeking insurance and those curious to see how the site worked. Attempts to use the website have resulted in errors, including:

  • Error messages while creating an account and trying to log in[11]
  • Data transfer problems from the exchange to healthcare providers[12]
  • Errors in price quotes when not logged in[13]
  • Lack of ability to sign up directly through individual insurance providers[14]

Post-enrollment period data inconsistencies

The HHS inspector general released a report in June 2014 that from October to December 2013, 2.6 million data inconsistencies were not able to be resolved and pressured the Centers for Medicare and Medicaid to establish a public plan for resolving the inconsistencies. The healthcare exchange's data hub was designed to fact check applications against federal information from the Internal Revenue Service, Social Security Administration and U.S. Department of Homeland Security, but the initial tech issues with the data hub created the inconsistencies that possibly mislead customers about their eligibility to certain plans and tax credits. The inconsistencies that could not be resolved by the federal exchange dealt with citizenship status, income verification, and employee-sponsored minimum essential coverage. Eleven state marketplaces also reported inconsistencies during the rollout, but only four states have reported having unresolved problems. If the customer received a premium tax credit due to an inconsistency, the IRS would likely either seek benefits that were not supposed to be given or award tax credits to those who should have been eligible. The report stated, "If the applicant chooses the advance premium tax credit, the Internal Revenue Service (IRS) will reconcile the actual credit amount made on behalf of the individual when an individual files a tax return at the close of the year."[15]

Cost overruns

The Government Accountability Office (GAO) investigated the costs of the Healthcare.gov federal exchange website, estimating that the total cost, as of March 2014, was $840 million.[16] GAO Director of Acquisition and Sourcing Management William Woods claimed that the overrun was due to inconsistent oversight and constantly changing requirements, which were noted by contractors when asked to testify during the website rollout. Woods stated in his written testimony, "We found that CMS undertook the development of HealthCare.gov and its related systems without effective planning or oversight practices, despite facing a number of challenges that increased both the level of risk and the need for effective oversight. According to [Center for Medicare and Medicaid Services] program and contracting officials, the task of developing a first-of-its-kind federal marketplace was a complex effort that was exacerbated by compressed time frames and changing requirements."[17] According to Kathleen Sebelius' House testimony on October 30, 2013, the website had a cost of $118 million plus another $56 million for IT support.[18] However, by February 2014, the costs for the federal marketplace jumped from $56 million to $209 million and the data hub went from $30 million to nearly $85 million. Additionally, in January 2014 the firm Accenture took over parts of the build from the original contractor, CGI Federal, with a contract initially worth an estimated $91 million that bumped up to $175 million by March 2014.[17]

The GAO released five recommendations for the Centers for Medicare and Medicaid, including:[17]

  • addressing the cost overruns and managing them appropriately,
  • collecting quality assurance plans on a regular basis and
  • formalizing the guidelines and expectations of contract managers.

Eligibility-verification sting operation

The Government Accountability Office (GAO) conducted a sting operation on the verification system of the federal healthcare exchange in which they submitted fake account information while signing up. The verification system allowed 11 of the 18 fake accounts to sign up for subsidized health insurance. The GAO tried telephone and online signups, while failing in their attempts at using in-person navigators. Several Republican members of Congress requested the operation prior to the Healthcare.gov website rollout.[19] Acting Director of Forensic Audits Seto Bagdoyan insisted that the investigation was ongoing and members of Congress "can’t draw any conclusions" from the small sample size. Bagdoyan admitted that the sample raised questions about the effectiveness of the verification program but did not suggest that the sting was any more than a small sample.[20]

Health insurance policy cancellations

See also: Health insurance policy cancellations since Obamacare

Leading up to the passage of Obamacare into law, one statement made repeatedly by the President, administration and Congressional supporters, was some form of the line Obama gave in an August 22, 2009, internet address, claiming, "If you like your private health insurance plan, you can keep your plan. Period."[21]

However, when the law was enacted on October 1, 2013, many individually insured people began receiving letters from their insurance carriers notifying them that their current plans would be canceled at the end of the policy term. The plans were canceled because they did not meet new minimum coverage requirements set by the law.[22]

On November 14, 2013, under pressure from Democratic members of Congress, President Obama announced the administration's intention to allow people whose insurance plans had been canceled to re-enroll in their plans.[23] On December 19, 2013, the administration announced that those whose plans were canceled under the law met the Health and Human Services Department's "hardship exemption." The stated exemption covers those who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan."[24]

On March 5, 2014, the administration announced that the delayed mandate could extend to two years, one more than was offered in the original delay due to canceled plans. Sen. Mitch McConnell stated his opposition to the new delay, stating, "By announcing a new delay in requiring that policies meet minimum coverage standards, the administration avoids a new round of health policy cancellations set to hit shortly before the November elections."[25]

Enrollment numbers by deadline

March/April enrollment official report

The official report for the closing of the open enrollment period was released May 1, 2014. Below are some notes from the report:

  • At the conclusion of the open enrollment period, 8,019,763 users had selected a plan. Of those signups, 5,446,178 signed up through the federal exchange.[26]
  • Of the signups, 34 percent were age 34 and under, while 48 percent were between the ages of 45 and 64.[26]

Enrollment goals

  • The federal government expected that seven million Americans who were previously uninsured would buy a health insurance plan by March 31, 2014. The White House hoped to have about 2.7 million of the enrollees be young adults in order to offset the costs of insuring those with pre-existing conditions.[27]
  • Ezra Klein of the Washington Post, wrote on November 26, 2013, that when asked what the measurement of success would be for enrollment on Healthcare.gov, the administration claimed the ratio for success would be having 39 percent of the signups be young, healthy people. If the number of young and healthy people did not reach that number, Klein suggested the premium costs for next year could be disastrous.[28]

Increased funding for minority enrollment

HHS announced the Partnership to Increase Coverage in Communities on September 11, 2014, which was established to disburse funding to organizations focused on helping minorities enroll in healthcare coverage. The Centers for Disease Control and Prevention estimated that only 40 percent of Latinos and 25 percent of African Americans were enrolled following the first enrollment period. The director of the Office of Minority Health stated, "Racial and ethnic minorities have lower rates of health insurance coverage than the national average and stand to benefit greatly from the Affordable Care Act."[29]

Initial enrollment period results

In a report released June 18, 2014, the Health and Human Services Department announced that due to federal subsidies, 3.2 million Americans were paying less than $100 per month for their health insurance coverage. A senior HHS official claimed the average premium went from $346 to $82 because of the tax credits through the federal marketplace. Opponents of the credits claim the federal budget would suffer from the increased burden. President of the American Action Forum Douglas Holtz-Eakin noted, "The report does not demonstrate that families had more choices or that premiums are lower in the past. It does demonstrate that consumers avoid 76 percent of premiums because federal spending subsidizes the cost."[30]

Polling released by Gallup, the Commonwealth Fund and the Urban Institute on July 10, 2014, found that the number of uninsured people in the United States dropped by anywhere from 8-9.5 million Americans. Experts agreed there was no definitive number on the amount of people with health insurance that weren't previously insured, but the number of uninsured was lower than it was prior to Obamacare taking effect.[31]

Sebelius resignation

Sebelius resigned on April 10, 2014.
On April 10, 2014, Secretary of Health and Human Services Kathleen Sebelius resigned from her position following the troubled rollout of Obamacare. She and President Obama determined that the end of the open enrollment period provided a chance for change. Sebelius saw her public appearances dwindle as the problems with the Healthcare.gov rollout persisted. President Obama named Director of the Office of Management and Budget Sylvia Mathews Burwell as the nominee to succeed Sebelius.[32] Mathews Burwell was confirmed on June 5, 2014.[33]

Penalties

The penalty for not being enrolled in a health insurance plan by March 31, 2014, was a charge of either $95 per person or 1 percent of household income, whichever is greater.[34] White House Press Secretary Jay Carney would not say on October 21, 2013, whether the struggles of the website could delay the individual mandate.[35] The administration announced in March 2014, that uninsured users could still enroll April, paying their first premium, to avoid the penalty as long as a plan was selected by March 31, 2014.[36]

Employer mandate

For businesses with more than 100 employees, employers must extend health insurance options to 70 percent of full-time employees by 2015, and that number must rise to 95 percent by 2016 in order to avoid paying fines. For businesses with 50-99 employees, employers must extend health insurance to all employees by 2016.[8]

Boehner lawsuit

See also: Boehner's lawsuit against the Obama administration
John Boehner
Claiming President Obama "changed the healthcare law without a vote of Congress, effectively creating his own law by literally waiving the employer mandate and the penalties for failing to comply with it," Speaker of the House John Boehner (R-OH) announced a lawsuit focusing on the president's failure to enforce the employer mandate as written in the ACA.[37] A draft resolution to for a Bipartisan Legal Advisory Group (BLAG) was introduced on July 10, 2014, by House Rules Committee Chairman Pete Sessions (R-TX).[38][39]

Penalties

Fines consist of paying $2,000 per employee, after 30 employees, who are not extended health insurance, if there is at least one employee who receives a premium tax credit. Employers offering health insurance, but have at least one full-time employee receiving premium tax credit will be fined to less amount between $3,000 for each employee receiving a premium tax credit or $2,000 for each employee after the first 30 employees.[8]

Attempts to change or repeal

Congress

As of March 13, 2014, Congress made 51 attempts to change, defund or repeal the law since Obamacare's passage.[40] Bills have been introduced to defund the entire law and portions of the law, repeal Obamacare and various key parts of it and delay mandates. While some of the measures passed into law, none of the bills that passed altered the fundamentals of Obamacare.[41]

United States Supreme Court

See also: Obamacare lawsuits

Commerce clause

The United States Supreme Court ruled to uphold Obamacare in a court case decided June 28, 2012. The 5-4 decision to uphold the law hinged on the Commerce Clause of the United States Constitution. According to the Court, the Commerce Clause did not permit the federal penalties of remaining uninsured after the law went into effect. However, the penalties can be collected as a tax. Explaining the ruling, Justice John Roberts wrote, "The court today holds that our Constitution protects us from federal regulation under the Commerce Clause so long as we abstain from the regulated activity. But from its creation, the Constitution has made no such promise with respect to taxes."[42]

Contraception mandate

On March 25, 2014, the Supreme Court heard the case put forward by Hobby Lobby and Conestoga Wood Specialties. The case argued that mandated coverage of birth control violated religious freedoms. Both companies' appeals were heard together during a one-hour public session.[43]

The Supreme Court ruled in favor of Hobby Lobby in Burwell v. Hobby Lobby on June 30, 2014. The 5-4 decision allowed companies to opt out of offering contraceptives on the basis of religious beliefs. Justice Samuel Alito wrote the court's opinion, stating, "We doubt that the Congress that enacted RFRA — or, for that matter, ACA–would have believed it a tolerable result to put family-run businesses to the choice of violating their sincerely held religious beliefs or making all of their employees lose their existing healthcare plans."[44]

The dissenting justices claimed the ruling would allow companies to "opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs." Likewise, the Obama administration argued that companies that did not wish to provide the contraceptive coverage or other areas of coverage due to religious beliefs could decide not to provide any company-wide options.[44]

Although the decision expanded the notion of corporate personhood to include religious rights "to provide protection for human beings," members of the public found it highly divisive in nature as it reaffirmed the Court's "pro-business" stance.[45] Senate Majority Leader Harry Reid (D-NV) pledged to restore the Affordable Care Act's contraception coverage, stating, "If the Supreme Court will not protect women’s access to health care, then Democrats will. We will continue to fight to preserve women’s access to contraceptive coverage and keep bosses out of the examination room."[46]

Constitutional challenges

Since the signing of the bill into law it has faced many challenges as to its legality on various constitutional fronts. It has been the subject of federal lawsuits filed by many states, individuals, and organizations. The majority of the legal arguments in these lawsuits maintain that the bill violates Article I, the Fifth Amendment, and/or the Tenth Amendment of the constitution. Some lawsuits have also been filed arguing violation of the First, Third, Fourth, Ninth, Fourteenth Amendments, and Articles II and IV.[47][48]

States' lawsuits

See here for more information on each attorney's general response.

In total, 28 state have filed suit against the federal government over the act. Of this number, 26 have sued as part of a multi-state lawsuit, Florida v. United States Department of Health and Human Services, filed in the Northern District of Florida.[48] Virginia has filed its own independent lawsuit, Commonwealth of Virginia v. Sebelius,[48] as has Oklahoma.

Multi-State Lawsuit

The federal lawsuit filed in Florida, sometimes called the Multi-State Lawsuit, consists of 26 states, two individuals, and an independent organization. A listing of the plaintiffs is as follows: The Attorneys General of Arizona, Indiana, Mississippi, Nevada, North Dakota, Alabama, Colorado, Florida, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Georgia, Alaska, Ohio, Wisconsin, Kansas, Maine, Iowa, and Wyoming, Mary Brown and Kaj Ahlburg, and the National Federation of Independent Business.[49]

The lawsuit was brought to the federal District Court for the District of Northern Florida by Florida state Attorney General Bill McCollum on March 23, 2010. Florida was joined at the time by South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington, Idaho and South Dakota.[50] Following this original action other states began considering joining the suit, and on Friday, May 14, 2010, Arizona, Indiana, North Dakota, Mississippi, Nevada, Georgia and Alaska, along with the National Federation of Independent Businesses (NFIB), formally joined with the filing of an amended complaint.[51] At this time individuals, Mary Brown and Kaj Ahlburg, also joined the complaint.[52] On January 19, 2011, Ohio, Wisconsin, Iowa, Kansas, Wyoming and Maine were granted permission by the court to join the lawsuit.[53]

This lawsuit challenges the Affordable Care Act on the grounds that the individual health insurance mandate exceeds Congress's authority to regulate interstate commerce under the Commerce Clause of Article I. The lawsuit also sues that the individual mandate does not fall within Congress's powers to tax. The complaint further alleges that the act violates the Tenth Amendment by infringing on state sovereignty by compelling it to follow federal regulations.[54]

This lawsuit has received rulings from the Northern District of Florida, Eleventh Circuit Court, and the U.S. Supreme Court.

Complaints and amendments

Below is a list of the complaints filed in the District of Northern Florida and the subsequent amendments.

  • Original complaint, retrieved from Florida Attorney's General office website on the lawsuit, filed March 23, 2010
  • Amended complaint, retrieved from Florida Attorney's General office website on the lawsuit, filed May 14, 2010
  • Second amended complaint, retrieved from Florida Attorney's General office website on the lawsuit, filed January 1, 2011

Virginia lawsuit

On March 22, 2010, Virginia Attorney General Ken Cuccinelli announced that the state would be filing suit against the federal government as soon as the act was signed, and indeed, did so on March 23, in the District Court for the Eastern District of Virginia. Cuccinelli has stated that he believes the state of Virginia to be in a unique position to sue because in 2010 the state passed a statute, Virginia Code 38.2-3430.1:1, declaring no resident of the Commonwealth of Virginia shall be required to have insurance or be penalized for not having it.[55][56] The case was filed as Commonwealth of Virginia v. Sebelius.

In the complaint filed, the state argued that the individual mandate exceeded powers granted to Congress by the commerce clause of Article I. It further asked that they entire act be declared invalid because the individual mandate is an "essential, non-severable" provision. Cuccinelli also asked the court to declare Virginia Code 38.2-3430.1:1 a valid exercise of state power.[57]

So far the Eastern District of Virginia and the Fourth Circuit Court have ruled on this lawsuit.

Complaint

Below is the complaint filed by the state of Virginia.

Oklahoma lawsuit

Original filing

On January 7, 2011, Oklahoma Attorney General Scott Pruitt announced that the state of Oklahoma would files its own lawsuit in the Eastern District of Oklahoma independently of the Virginia suit and the multi-state suit filed in Florida. Pruitt stated that because it has amended its constitution to prevent citizens from being forced to obtain health insurance, and because it is in a position to learn from filings in Virginia and Florida, the state has good reasons for filing independently. In a press release stating his intention to sue, Pruitt commented on his decision to file within the state saying, "The most logical way to defend our state Constitution is in an Oklahoma federal court not in another state."[58] The case was then filed as Oklahoma v. Sebelius on January 21, 2011.

The complaint filed in federal court resembles the Virginia filing closely in its chief arguments. Namely, it take issue with the individual mandate and asserts that Congress overstepped its authority as granted by the Commerce Clause of Article I. Like the Virginia complaint, the Oklahoma filing also states that the entire act should be voided because the mandate in an "essential, non-severable provision". The state also requests that a permanent injunction be made forbidding the government from enforcing the mandate in particular and the act as a whole.[59]

The was stayed by Judge Ronald White until the Supreme Court issued a ruling in the multi-state case.[60]

Amended filing

On September 19, 2012, Attorney General Pruitt filed an amended complaint with the U.S. District Court for the Eastern District of Oklahoma that challenges the federal government's implementation of certain parts of the act. Specifically, the new claims argue that the act only allows state-based healthcare exchanges to provide tax credits on premiums for low-income employed individuals and therefore the new IRS rule, which guarantees such tax credits for individuals in states with federal-based exchanges, conflicts with Congress's intentions. According to the filing, employers of those who receive tax credits after opting for a healthcare plan from a federally run exchange will be subject to costly obligations in the form the employer mandate. The complaint alleges that this IRS rule, called the "Final Rule," violates the Administrative Procedures Act and asks the court to declare it invalid.[61][60]

Complaint and amendment

Below is the complaint filed by the state of Oklahoma.

  • Copy of complaint, retrieved from Oklahoma Attorney's General website, filed on January 21, 2011
  • Amended complaint, retrieved from Oklahoma Attorney's General press release on the lawsuit, September 19, 2012


Comparing the states' legal actions

Legal actions taken by the states vary, with some choosing to act before the passing of the bill, some after the passing, and yet others did both. The actions include public referenda, lawsuits, and signing legislation into law that directly countered the federal bill, and most notably, the individual mandate. Refer to the map to the right for a comparison.

Other notable lawsuits

See here for a list of cases related to the Patient Protection and Affordable Care Act.

Liberty University lawsuit

On July 30, 2010, a lawsuit was filed by Liberty University and several individuals challenging the act under Virginia law, much like the Virginia state lawsuit. The original filing of the suit takes issue with the potential for public funds to be used for abortion and claims that the act shows preference for certain religion over others by being selective about those for which it offers exemptions. The suit also alleged that the act violates the constitutional guarantee of a Republican form of government.[62]

Though the original suit was dismissed by the United States Court of Appeals for the Fourth Circuit in 2011, the Supreme Court has ordered that the court reopen the case. The Supreme Court issued the order explaining that the suit remains active following its National Federation of Independent Business v. Sebelius, the multi-state lawsuit, ruling because Liberty University's challenges are to the employer mandates rather than the individual one. Since its original filing, the lawsuit has expanded to include a challenge to HHS contraception mandate.[63][64]

Ballot measure challenges

Beginning early on during congressional debate over the bill, several legislative referrals and citizen initiatives appeared seeking to stop implementation of the act in a number of states. Most of these ballot measures proposed an amendment to the state's constitution declaring that citizens of the respective state could not be compelled to purchase health insurance or be fined for not doing so. Some measures, however, instead chose to focus on prohibiting the state's government from establishing a health insurance exchange. This particular tactic was used so as to gain additional legal leverage before the courts by making available the argument that the federal law violated state constitutions. Another aspect of this strategy was to demonstrate public disapproval of the bill by having such constitutional changes be decided by voters rather than state legislators. This effort was not universally successful however, because some states' voters refused to approve these constitutional amendments. Interestingly, despite Florida being at the forefront of the massive lawsuit that finally reached the U.S. Supreme court, its own such amendment failed during the 2012 general election.

The following is a list of states that saw such constitutional amendments on their ballots since 2008. Successful measures are indicate with a Approveda.


Recent news

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All stories may not be relevant to this page due to the nature of the search engine.

Obamacare News Feed

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See also

External links

References

  1. New York Times, "Obama Signs Health Care Overhaul Bill, With a Flourish," March 23, 2010
  2. Kaiser Family Foundation, "Summary of the Affordable Care Act," March 12, 2014
  3. Washington Post, "This is why Obamacare is canceling some people's insurance plans," October 29, 2013
  4. National Association of Insurance Commissioners, "Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges," April 20, 2010
  5. Congress.gov, "H.R.3590 - Patient Protection and Affordable Care Act," accessed March 12, 2014
  6. GovTrack, H.R. 3590 (111th): Patient Protection and Affordable Care Act," December 24, 2009
  7. 7.0 7.1 GovTrack, "H.R. 3590 (111th): Patient Protection and Affordable Care Act," March 21, 2010
  8. 8.0 8.1 8.2 Kaiser Family Foundation, "Health Reform Implementation Timeline," accessed March 12, 2014
  9. NBC News, "Better use the phone: Why Obamacare website is such a fail," October 21, 2013
  10. Reuters, "State Obamacare exchanges enroll 3 pct of target so far -report," November 11, 2013
  11. USA Today, "Obama adviser: Demand overwhelmed Healthcare.gov," October 6, 2013
  12. Bloomberg, "Insurers Getting Faulty Data From U.S. Health Exchanges," October 8, 2013
  13. CBS News, "HealthCare.gov pricing feature can be off the mark," October 23, 2013
  14. Politico, "Another obstacle to signing up for ACA crops up," October 21, 2013
  15. Department of Health and Human Services, "Marketplaces Faced Early Challenges Resolving Inconsistencies With Applicant Data," June 2014
  16. Wall Street Journal, "Poorly Managed HealthCare.gov Construction Cost $840 Million, Watchdog Finds," July 30, 2014
  17. 17.0 17.1 17.2 CBS News, "HealthCare.gov has already cost $840 million," July 30, 2014
  18. USA Today, "Health chief Sebelius apologizes for botched website," October 30, 2013
  19. National Journal, "GAO Launched an Obamacare Sting Operation—and Almost All Fake Insurance Applications Were Approved," July 23, 2014
  20. Politico, "GAO: Too early to draw Obamacare fraud conclusions," July 23, 2014
  21. Boston Globe, "Obama slams 'outrageous myths' on health care; Republicans say president 'plays fast and loose' with facts," August 22, 2009
  22. New York Times, "Cancellation of Health Care Plans Replaces Website Problems as Prime Target," October 29, 2013
  23. Cite error: Invalid <ref> tag; no text was provided for refs named NYTfix
  24. Washington Post, "The individual mandate no longer applies to people whose plans were canceled," December 19, 2013
  25. Fox News, "Administration offers 2-year ObamaCare extension for canceled health plans," March 5, 2014
  26. Cite error: Invalid <ref> tag; no text was provided for refs named Marchofficialreport
  27. The Hill, "White House stands by Sebelius amid ouster calls over ObamaCare rollout," October 15, 2013
  28. Washington Post, "Obamacare won’t get 7 million enrollees in 2014 — and that’s okay," November 26, 2013
  29. The Hill, "HHS pledges more funds to enroll minorities in O-Care," September 11, 2014
  30. The Hill, "HHS touts O-Care subsidies as reducing average premium to $82," June 18, 2014
  31. Politico, "The verdict is in: Obamacare lowers uninsured," July 10, 2014
  32. New York Times, "Health Secretary Resigns After Woes of HealthCare.gov," April 10, 2014
  33. The Washington Post, "Senate confirms Burwell as new secretary of HHS," June 5, 2014
  34. Bloomberg, "Four things we think we know about Obamacare," October 18, 2013
  35. The Hill, "Carney hedges on whether ObamaCare mandate could be delayed," October 21, 2013
  36. Cite error: Invalid <ref> tag; no text was provided for refs named foxdelay
  37. L.A. Times, "House lawsuit over Obamacare to focus on employer mandate delay," July 10, 2014
  38. CNN.com, "Boehner plans lawsuit against Obama over executive orders," accessed July 8, 2014
  39. Politico, "GOP’s Obama lawsuit to focus on employer mandate," July 10, 2014
  40. Fox Business, "Attempt No. 51: Tying 'Doc Fix' to Obamacare Repeal," March 12, 2014
  41. Politico, "If at first you don't succeed," January 30, 2014
  42. Christian-Science Monitor, "How John Roberts upheld health-care law while limiting congressional power," June 28, 2012
  43. CNN, "Justices to hear 'Hobby Lobby' case on Obamacare birth control rule," March 23, 2014
  44. 44.0 44.1 Politico, "Supreme Court sides with Hobby Lobby on contraception mandate," June 30, 2014
  45. Reuters, "U.S. birth control ruling fuels battle over corporate rights," July 1, 2014
  46. Politico, "SCOTUS sides with Hobby Lobby on birth control," June 30, 2014
  47. Health Care Lawsuits listing of lawsuits
  48. 48.0 48.1 48.2 Healthcare Financial Management Association legal challenges page
  49. Copy of the complaint via South Dakota Attorney General's website
  50. Original complaint, retrieved from Florida Attorney's General office website on the lawsuit
  51. BNO News "Arizona joins the multistate healthcare lawsuit," May 14, 2010
  52. Indiana Attorney General press release "Attorney General joins multi-state legal challenge to healthcare bill," March 29, 2010
  53. Bloomberg "Ohio, Wisconsin, Four More States Join Challenge to Obama Health Care," January 20, 2011
  54. Florida Attorney's General office website on the lawsuit
  55. Virginia Attorney's General office press release "Virginia Attorney General to file suit against federal government over passage of healthcare bill," March 22, 2010
  56. Letter from Virginia Attorney General to constituents "Letter from Virginia Attorney General Kenneth T. Cuccinelli"
  57. Copy of complaint, retrieved Virginia Attorney's General website (dead link)
  58. Oklahoma Attorney General press release "Oklahoma Attorney General-elect Will File Lawsuit Against Federal Health Care Reform Bill," January 7, 2011
  59. Copy of complaint, retrieved from Oklahoma Attorney's General website
  60. 60.0 60.1 Oklahoma Attorney General Press Release, "Attorney General’s Federalism Unit Files Amended Lawsuit against Affordable Care Act Implementation," September 19, 2012
  61. HealthReformGPS.org,"Oklahoma challenges ACA in lawsuit," September 20, 2012
  62. Cite error: Invalid <ref> tag; no text was provided for refs named Liberty_U
  63. HealthcareLawsuits.org,"Supreme Court Says Liberty University Case is Not Over," November 26, 2012
  64. HealthReformGPS.org,"Supreme Court orders Fourth Circuit to hear Liberty case," November 26, 2012