Federal administrative improvements to the Affordable Care Act and state options for health care reform

Jan 10, 2018

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Key Findings

  1. The Affordable Care Act (ACA), also known as Obamacare, has not come close to reaching its supporter’s promises of providing universal health insurance coverage and decreasing ever-rising health care costs.
  2. Because legal specifics were not defined in the normal Conference Committee process, the law gives the Administration and the Secretary of the Department of Health and Human Services (HHS) sweeping control over the implementation and the oversight of the ACA. The law states vaguely that the “Secretary shall…” over 1,400 times.
  3. The U.S. House passed a health care reform bill in May 2017.  Leadership stated this was the first of three phases. 
  4.  Phase two is to be administrative changes to the ACA that the HHS Secretary can unilaterally accomplish. Phase three would hopefully be bipartisan, long-term solutions for the country’s health care system problems that Congress would pass.
  5. The ACA contains two broad areas that are open to administrative improvements. These are Section 1332 state waivers and Section 1115A Medicaid waivers.
  6. The Administration also has the ability to withdraw the cost-reduction subsidies in the health insurance exchanges, expand the use of “hardship” cases to allow more people an opt-out of the individual mandate, increase the time period of short-term limited-duration insurance, and potentially increase the use of catastrophic health insurance plans.
  7. If Congress is unwilling to reform the health care system, the executive branch should step up and use the administrative authority provided by Congress to achieve meaningful reform.
  8. In addition to administrative changes to the ACA, states can enact their own health care reform, regardless of federal actions.


The controversial Affordable Care Act (ACA), also known as Obamacare, has helped some people. The tragedy is that it has not come close to reaching its supporter’s promised goal of providing universal health insurance coverage and decreasing ever-rising health care costs. The complex law has not improved health care quality and has not provided patients with more health care choices.  It has, unfortunately, forced millions of people to lose coverage they liked, and to seek new health insurance while imposing a huge financial and regulatory burden on the vast majority of Americans.

The ACA has only insured 20 million of the 50 million people who were without health insurance when it became law. Nationally, half of these newly insured were forced into the substandard Medicaid entitlement program. In Washington state, 80 percent of the newly insured found themselves pushed into Medicaid. 

Obamacare has raised insurance premiums for virtually everyone in the country outside of the free Medicaid entitlement. Health care spending was 17 percent of the economy when the ACA became law. By 2021, with the ACA in place, estimates show that the country will spend 21 percent of the annual economy on health care.

The ACA has limited patients’ insurance options, has generated over 20,000 pages of new federal regulations, has not improved health quality, and has not decreased waste, fraud, and abuse in the medical system.

Download the full Policy Brief.

Download the three-page summary