He may have rescued Barrycare again, but it's only a matter of time before reality sets in by next election.
Here are five remaining threats to Obama’s signature domestic program.
1.) Repeal
Republicans are already turning their attention back to repealing the law, perhaps using a fast-track process called reconciliation that could move legislation through the Senate with just 51 votes.
But there are major obstacles ahead. Senate rules limit what parts of the law can be repealed using the process, and whatever legislation emerges would likely face a veto from Obama....
2.) Marketplaces failing
Some of the 13 states that opted to set up ObamaCare marketplaces, known as exchanges, are considering turning over part of all of their operations to the federal government due to financial and technical problems.
New Mexico, Nevada and Oregon have already handed over the toughest aspects of their operations to the federal IT system. Hawaii decided earlier this year to follow suit, and other states, including Vermont and Minnesota, are considering their options.
“The chances are good that some of the state-based marketplaces struggle, especially in the smaller states,†said Michael Adelberg, who formerly helped oversee the exchanges in the Obama administration and is now a consultant at FaegreBD.
The stakes of failing state exchanges are far lower now that the Supreme Court has ruled that subsidies can be made available on federal or state exchanges. But states have invested significant resources into their exchanges, with some costing as much as $200 million.
“We’re going to work with states that want to do state-based exchanges,†Health and Human Services Secretary Sylvia Mathews Burwell told reporters last week. “We’ll do federal exchanges where there aren’t those.â€
3.) Rising costsRepublicans have latched on to proposed 2016 premium increases of as much as 30 percent in some states to argue that costs are skyrocketing under ObamaCare.
States are likely to block any premium increases of that size, and the average premium increase appears to be trending at somewhere between 4 percent and 6 percent.
A Kaiser Family Foundation study found that in 11 cities with complete data so far, premiums are set to rise 4.4 percent, compared to 2 percent last year. Similarly, an analysis from Avalere Health, a consulting firm, found that premiums will rise 5.8 percent across eight states with complete data.
“The growth looks to be pretty modest,†said Larry Levitt, a vice president at the Kaiser Family Foundation, though “somewhat bigger this year than last year.â€
Perhaps a bigger problem for the law is the cost of deductibles — the amount patients have to pay before insurance kicks in. A study from the Commonwealth Fund finds that 31 million people are “underinsured†because they face such high deductibles and out-of-pocket costs.
“Are the people buying lower cost plans in the Exchanges underinsured?†Adelberg said. “That is one place people are going to turn their attention.â€...
4.) Enrollment challenges
...“The biggest challenge ahead is increasing enrollment. Getting more people signed up is central to the law's primary aim,†Levitt said. “Increasing enrollment is also key to keeping premiums under control.â€
People who have signed up for ObamaCare so far tend to be sicker and poorer than the population at large. The challenge for the administration will be getting middle-income, healthier people enrolled. A higher penalty for lacking insurance next year (the greater of $695 or 2.5 percent of income) could help...
5.) Another lawsuit
The legal challenges to the law are not over....
http://thehill.com/policy/healthcare/246489-five-lingering-threats-to-obamacare
