Congressman Phil Gingrey, MD Georgia's 11th district

Even before the botched rollout of Healthcare.gov, the Obama administration gave a myriad of signs that their signature health care law wasn't - and isn't - ready for primetime. Among them, are a list of changes and implementation changes that were made by administrative action.

Most Americans may have eventually heard of some of these political shufflings on the nightly news, but President Obama did his best to make sure that the information stayed as contained as possible. By hiding rule changes deep in thousand-page procedural documents, spreading word of them through personal letters, and slipping them into obscure FAQ and blog agency website pages, the administration did their best to hide these admissions of their 'train wreck' policy.

Below is the Galen Institute's list of administrative action changes to Obamacare, and their stealthy unveilings.


1. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013)

• Slipped through the Office of Personnel Management (OPM) - the federal human resources department - in a "Benefits Administration Letter."

   

2. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid February. (October 23, 2013)

• A White House Press Aide relayed the White House's loose interpretation to Washington journalists.

   

3. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

• Over a July weekend when Congress was back home working in their districts, this change was strategically dropped into the Treasury's blog section of their website.

   

4. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

• Hidden deep in an HHS Final Rule entitled, "Medicaid and Children's Health Insurance Programs: Essential Health Benefits for Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost-Sharing: Exchanges: Eligibility and Enrollment."

   

5. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and has instead delayed the implementation of the SHOP (Small-Employer Health Option Program) exchanges until 2015. (March 11, 2013)

• Hidden deep in an HHS Final Rule entitled, "Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program."

   

6. Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment. (February 15, 2013)

• On a Friday, just before Congress left for a district work week, the suspension was announced in a personal letter from the Director of the Centers for Medicare and Medicaid Services.

   

7. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay exodus of MA plans from the program. (April 19, 2011)

• On another Friday afternoon, the Center for Medicare sent a letter to Medicare subsidized organizations, informing them of a complicated new funding process. Rather than increase funding levels that Obamacare had already destroyed, the letter outlined a complicated mathematic formula restructuring that would slowly return some of the funds.

   

8. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (July 2, 2012)

• Over a July weekend when Congress was back home working in their districts, this change was strategically dropped into the Treasury's blog section of their website.

   

9. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowing maximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

• The U.S. Department of Labor strategically hid their open interpretation of the law in the FAQ section of their website when lawmakers were working in their districts.

   

10. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

• HHS Secretary Kathleen Sebelius revealed this delay - or new "step-by-step plan," as she called it - by sending a personal letter to Senator Maria Cantwell (D-WA) telling her of the delay, which showed up on the Senator's website six days later.

11. Introducing last-minute "fire-sale" catastrophic plans: In a sudden conciliatory unilateral move, the administration acted to offer stripped-down, "catastrophic," plans to the millions of Americans who have lost their health plans. (December 19, 2013)

• ​In a "common-sense clarification," HHS again moved to interpret the law outside of Congressional authority - just days after Members of Congress headed home for the holidays.