Health

Your Health Care, Illegally Funded

Obama administration has sidestepped the law for years

The accusations have been flying around for some time now, and a federal judge even ruled on the issue. But last week, in an investigation that has been more than a year in the making, two leading House committees released the findings of a report they say clearly shows the Obama administration has been illegally funding “Cost Sharing Reduction” (CSR) payments for years.

CSR payments are subsidies designed to reduce the portion of a claim that an insured person has to pay. Eligibility is based on income, but cost-sharing subsidies are only available on so-called “silver” plans. The reimbursements go directly to insurance carriers.

Since January 2014, the administration has been paying for the cost sharing reduction (CSR) program without a lawful congressional appropriation.

The House Ways and Means Committee and the House Energy and Commerce Committee launched the investigation in February 2015. Multiple agencies, they said, had “undertaken a concerted effort to hide the truth by refusing to provide, or unlawfully redacting, documents, refusing to answer questions or allow witnesses to testify, and selectively applying the law. In at least one case, the Obama administration pressured a witness into not revealing information, and in another case the administration prevented a witness from answering questions.”

The committees’ questions included these: Why did the administration initially request an annual appropriation for the CSR program from Congress? How was that decision made? Who made it? When did the administration determine that an annual appropriation for the CSR program was not necessary? Who made that decision? When was the decision made to use the permanent appropriation at 31 U.S.C. § 1324 to fund the CSR payments — and on what grounds?

“Congress passes laws, and the executive branch implements them,” says the report, which was released last week. “The Constitution further makes clear that the power of the purse lies with Congress — ‘No money shall be drawn from the Treasury but in Consequence of Appropriations made by Law[.]’ This requirement ensures that the executive branch does not spend taxpayer money without the approval of Congress.”

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The administration, however, has done just that, they state.

Since January 2014, the report finds the administration has been paying for the CSR program established by the Patient Protection and Affordable Care Act (ACA) without a lawful congressional appropriation. This action is a clear constitutional violation of the most fundamental tenet of appropriations law.

“It seems people care more about ‘The Bachelorette.’ Apathy is so deep and pervasive,” said one physician.

Found under Section 1402 of the ACA, the CSR program requires health insurance companies that offer qualified health plans to reduce copayments, deductibles, and other out-of-pocket expenses for eligible beneficiaries. Section 1412(c)(3) authorizes the federal government to make direct payments to insurance companies to offset estimated costs incurred by providing these CSRs to eligible beneficiaries. Nothing in the ACA provides an appropriation or a source of funding for the CSR program. So the administration needed to request an appropriation from Congress to make CSR payments to insurance companies.

The 150-page report, they say, proves the Obama administration funded an Obamacare cost-sharing program illegally.

House Republicans sued the administration over the issue and a federal judge ruled in May that the money was given without constitutional authority. Pending an appeal, however, the judge ordered everything to stay as is.

The administration filed a notice on Wednesday to challenge the initial decision.

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“Nothing will change,” said Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, and CEO of Foxhall Cardiology PC. “It seems as though people care more about ‘The Bachelorette.’ Apathy is so deep and pervasive. So many well-educated individuals simply accept as important and valid what they read on Facebook or watch on TV.”

Yet the issue is one we all should care about, Oskoui told LifeZette. Health care is consuming our budget and our disposable income, he said. “It is unsustainable.”

Reviewing the results of the report, he feels sadness — “sad that the system is so unaccountable and lawless. And the realization as a doctor that the system is getting close to collapse, whether we realize it or not.”

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