NOV 16 2016 ObamaCare Expansion Enrollment Is Shattering Projections
NOV 162016ObamaCare ExpansionEnrollment is ShatteringProjectionsTA X PAY E R S A N DT H E T R U LYNEEDY WILLPAY T H EPRICEAUTHORED BY:Jonathan IngramVice President of ResearchNicholas HortonSenior Research FellowTheFGA.org
Overview of FindingsObamaCare’s Medicaid expansion has flooded state welfare rolls with moreable-bodied adults than supporters said would ever sign up. As a result,funding for the truly needy, education, infrastructure, and public safety arenow at direct risk.A 2012 U.S. Supreme Court decision allowed states to choose whether or notthey wanted to accept ObamaCare’s expansion of Medicaid to a new classof working-age, able-bodied, childless adults. States that opted in have seenmuch faster welfare growth than they bargained for.This enrollment explosion will soon unleash a fiscal crisis. Unlike the federalgovernment, states cannot print their own money and, starting in January2017, states’ share of Medicaid expansion costs will increase to 5 percent.Assuming the federal government keeps its funding promises – which is inquestion – state costs will gradually rise to 10 percent by 2020.1 With expansionenrollment and per-enrollee costs rising higher and faster than ObamaCareadvocates promised, those costs will rapidly swamp state budgets.Medicaid expansion already makes welfare for able-bodied adults a higherpriority than services for the nearly 600,000 seniors, children with developmentaldisabilities, individuals with brain injuries, and other vulnerable individualscurrently languishing on waiting lists for needed Medicaid services.2 Mountingoverruns will soon exacerbate pressure on policymakers to shift even moremoney away from the truly needy and towards ObamaCare’s able-bodiedadults.ObamaCare Expansion States Shatter EnrollmentProjectionsIn April 2015, the Foundation for Government Accountability released a study highlightingObamaCare expansion’s enrollment explosion, using data from the first year of expansion.3Now, new research finds the situation has only gotten worse.Enrollment in previously-reviewed states have blasted further past projected maximums andnew data from additional expansion states indicates the problem is even worse than previouslyknown.Newly-obtained data from these 24 states shows that at least 11.5 million able-bodied adultshave now enrolled in ObamaCare expansion – an overrun of 110 percent or more thandouble projections. Some states have signed up more than four times as many able-bodiedadults as they said would ever enroll.TheFGA.orgAltogether, 24 states that accepted ObamaCare’s expansion released enrollment projectionsin advance and have since reported at least one year of enrollment data.4 In total, these 24states promised that “only” 5.5 million adults would ever sign up for ObamaCare expansion.However, actual sign-ups have surpassed these projections – and not just by a little bit.2ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
STATEMAX ENROLLMENTACTUALENROLLMENTAS OF DATEOVER 000187,1109/2015140%New Hampshire45,50050,1508/201610%New Jersey300,000532,9171/201578%New Mexico149,095235,42512/201558%New York76,000285,56412/2015276%North 000625,9704/201618%Rhode 737/2016128%West ,466,254110%TheFGA.orgObamaCare expansion states have enrolled more than twice asmany adults as expected3ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
More recent expansion states – Alaska, Indiana, Louisiana, and Montana, which did not have atleast 12 months of public enrollment data – have also enrolled more able-bodied adults thanthey said would sign up at this point. And Delaware, Massachusetts, and Vermont, which allmaintain pre-ObamaCare Medicaid expansions, are seeing growing numbers of able-bodiedadults enroll.5-9Overall, each and every state that opted into ObamaCare expansion is facing a surge inMedicaid enrollment far higher than ever anticipated.51%ArkansasOVER 318SEPTEMBER 2016Although Arkansas’ “Private Option” ObamaCare expansion was billed as a fiscallyPROJECTEDconservative “alternative” to traditional expansion, Arkansassoon discovered that itsMAX 187,000plan was simply a more expensive way to expand welfare. Like other expansion states,ACTUALArkansas has experienced soaring expansion enrollment andrapidly rising446,135costs, puttingENROLLMENTadditional pressure on other spending priorities.OCTOBER 2016The Arkansas Department of Human Services initially said just 225,000 able-bodiedadults would ever be eligible for its Medicaid expansionand only 215,000 of thosePROJECTEDadults would ever possibly enroll.10-11 But in less than a year, Arkansasblew past thoseMAX 342,00012projections and enrollment has only continued to climb. BySeptember 2016, Arkansas’ACTUAL650,expansion enrollment reached nearly 325,000 able-bodiedadults51653percentENROLLMENT – nearly13more adults than the state said would ever enroll.APRIL 2016If the enrollment explosion were not bad enough on its own, Arkansas has also facedPROJECTEDsignificantly higher per-person costs under its expansion.Those costoverruns reachedMAX 188,00014 80 million after just 18 months of operation.ACTUAL439,044Ultimately, Arkansas’ out-of-control expansion means fewerresources for thetruly needy.ENROLLMENTNearly 3,000 Arkansas children and adults with developmental disabilitiesare alreadyDECEMBER2015languishing on Medicaid waiting lists for needed services.15PROJECTEDSadly, these individuals are now being pushed to the backof the line 149,095to make room forMAXObamaCare’s able-bodied adults: Arkansas’ waiting list has grown by more than 700ACTUALpeople since the state expanded Medicaid.16 The state nowreports that 79individuals235,425ENROLLMENTwith developmental disabilities on the waiting list have died since the state opted intoDECEMBER 2015ObamaCare.17As Arkansas moves forward with new tweaks to their PROJECTEDexpansion that could increase447,000MAXenrollment even more, hope for the state’s most vulnerable getsdimmer and dimmer.18714,595AUGUST 2016PROJECTEDMAXACTUALENROLLMENTObamaCare Expansion Enrollment is Shattering Projections November 16, 201695,000174,999DECEMBER 2015TheFGA.orgACTUALENROLLMENT4
ACTUALENROLLMENT324,318SEPTEMBER 2016139%ColoradoPROJECTEDMAX 187,000ACTUALENROLLMENTOVER PROJECTIONS446,135OCTOBER 2016Colorado officials initially predicted that their ObamaCare expansion would addPROJECTED187,000 able-bodied adults to the Medicaid rolls.19 But withinthreemonths of expandingMAX 342,000 20eligibility, Colorado had already surpassed its maximum enrollment projection.ACTUAL650, 653ENROLLMENTBy October 2016, the number of able-bodied adultsdependent on Colorado’s2016ObamaCare expansion had grown to more than 446,000 able-bodied APRILadults,nearlytwo and a half times as many adults as the state said would ever enroll.21PROJECTED215,000PROJECTEDMAX 188,000This enrollment explosion has translated into growing cost overruns.The state initiallyMAXsaid ObamaCare’s Medicaid expansion would cost less than 1.2 billion during its firstACTUALACTUALENROLLMENT18 months.22 But Colorado has actually spent more than 1.7billion on 324,318ObamaCare439,044ENROLLMENT23-28expansion – an overrun of more than 550 million.SEPTEMBER 2016DECEMBER 2015When Colorado begins paying its share of expansion costs starting in 2017, policymakersPROJECTED187,000will be scrambling to find up to 40 million in new fundingto coveroverrunsPROJECTEDMAXObamaCare149,095– even if the overruns do not continue to grow.29 That is 40 MAXmillion that cannot go toACTUALother core priorities like Colorado’s most vulnerable, education,and ENTOCTOBER 2016DECEMBER 201590%IllinoisOVER OLLMENTENROLLMENT342,000447,000650, 653714,595APRIL 2016AUGUST 2016When officials from then-governor Pat Quinn’s administration lobbied state legislators toPROJECTEDexpand Medicaid under ObamaCare, they promised lowand predictableenrollment.PROJECTEDMAX 188,00095,000MAXThe Illinois Department of Healthcare and Family Services projectedACTUAL 380,000 able-bodiedACTUAL439,044ENROLLMENTadults would ever be eligible for the expansion, with just342,000 of them174,999expected toENROLLMENT31DECEMBERever enroll.30 But Illinois shattered its maximum projections in under threemonths.2015By April 2016, more than 650,000 able-bodied adults had signed up for the state’sPROJECTED149,095ObamaCare expansion.32 That means nearly twice as many MAXable-bodiedadults haveenrolled in the expansion than the state thought would ever even be eligible.ACTUAL235,425ENROLLMENTOnce again, skyrocketing enrollment has resulted in significant cost overruns. While stateDECEMBER2015officials pegged expansion costs at 2.7 billion for its first two years, actualObamaCareexpansion costs totaled at least 4.7 billion during that timeframe – 70 percent morethan expected.33-34 The state’s share of those costs couldreach 2 billion between 2017PROJECTED447,00035MAXand 2020, more than three times as much as initially expected.ACTUALENROLLMENT714,595AUGUST 2016ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016PROJECTEDMAXACTUAL95,000TheFGA.orgDECEMBER 20155
SEPTEMBER 2016PROJECTEDMAX 187,000Illinois’ finances are already in a precarious position, to put it mildly. Unpaid bills for thestate surpass 9 billion and the Land of Lincoln is home toACTUALthe worst fundedpension446,135ENROLLMENT36-37system in the country.Now, as policymakers scramble to find new revenue to coverOCTOBER 2016mounting ObamaCare expansion costs, funding for seniors, children, and individualswith disabilities will likely be on the chopping block.38 Unfortunately, these types of cutsPROJECTEDwould not be unprecedented: on the same day lawmakersexpanded ObamaCareMAX 342,000nearly two years early, they cut lifesaving medications and services for medically fragileACTUAL costs rise.children.39 More painful choices are all but inevitable as expansion650, 653ENROLLMENTAPRIL 2016134%KentuckyOVER PROJECTIONSPROJECTEDMAX 188,000ACTUALENROLLMENT439,044DECEMBER 2015Although the Kentucky legislature refused to authorize ObamaCare’s MedicaidPROJECTEDexpansion, former governor Steve Beshear unilaterally expandedMedicaidby executive149,095MAX40order. Beshear’s office initially projected that 188,000 able-bodied adults would everACTUALenrollment shatteredsign up for the new welfare program.41 But within two months, actual235,425ENROLLMENT42those projections. By December 2015, more than 439,000 able-bodied adults hadDECEMBER 2015enrolled in Kentucky’s ObamaCare expansion.43As a result, the state now faces large and growing costoverruns. While the statePROJECTED447,000originally expected costs to total 1.8 billion during the first 18 months,statedata showsMAXObamaCare expansion actually cost 3.6 billion during that period – more than twiceACTUAL714,595 1.4what was expected.44-46 State estimates also show thatexpansion ran anotherENROLLMENTbillion over budget in fiscal year 2016, bringing total cost overruns to 3.3 AUGUSTbillion sofar.472016TheFGA.orgDespite promises by ObamaCare lobbyists that expansion would save the state money,the Kentucky Cabinet for Health and Family Services now PROJECTEDsays the programis “financially95,000MAXunsustainable” and “does not pay for itself” as promised by expansion advocates.48ACTUALRather than saving money as advocates originally promised,Kentucky budget officials174,999ENROLLMENTnow expect that the program will cost state taxpayers more than 1.2 billion over theDECEMBER2015next five years.49 As Kentucky officials explain, these out-of-control costswill ultimatelyjeopardize “funding for education, pension obligations, public safety, and the traditionalMedicaid program” which serves seniors, children, and individuals with disabilities.506ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
58%New MexicoACTUALENROLLMENTPROJECTEDMAXDECEMBER 095439,044SEPTEMBER 2016ACTUAL235,425ENROLLMENTPROJECTEDDECEMBER 2015MAX 187,000OVER PROJECTIONSWhen New Mexico expanded Medicaid under ObamaCare, state officials expectedACTUALPROJECTED446,135170,000 able-bodied adults to ever be eligible, with 149,000enrolling atanypoint in theENROLLMENT447,000MAX51-52future.By July 2014, the number of able-bodied adults in New Mexico’sObamaCareOCTOBER201653ACTUALexpansion had already exceeded the projected maximum.714,595ENROLLMENTPROJECTEDEnrollment continues to climb, reaching a whopping 235,000by December2015– farAUGUST2016342,000MAX54more than state officials expected would ever even be eligible. As a result, more thanACTUAL40 percent of all residents are now dependent on Medicaidin New Mexico.55PROJECTED650, 653ENROLLMENT95,000MAXState officials initially said expansion would cost 1.2 billion during its firstAPRIL18 months2016 ofoperation.56 But actual spending on the expansion reachedACTUAL 1.8 billion duringthat174,999 time57-61 ENROLLMENT– more than 45 percent higher than anticipated.PROJECTEDDECEMBER 2015MAX 188,000By 2020, state officials said expansion would cost state taxpayers no more than 42ACTUALmillion and perhaps even “save” as much as 17 million in statefunds by shiftingcertain439,044ENROLLMENT62spending to federal taxpayers. But, as is the case in other expansion states, thoseDECEMBER2015“savings” never materialized and the state costs are now expected to reach 518 millionover that time.63PROJECTEDAlready facing significant shortfalls in Medicaid, the New MAXMexico 149,095Human ServicesDepartment was forced to slash provider reimbursement ratesby 161 million in 2016,ACTUAL235,425with even larger Medicaid cuts now on the horizon.64 ENROLLMENTDECEMBER 201560%OhioOVER 595AUGUST 2016In 2013, Ohio lawmakers passed legislation prohibiting Republican Governor JohnPROJECTEDKasich from expanding Medicaid under ObamaCare. Kasichproceededto use a line95,000MAXitem veto to scrap that provision from the budget and expand Medicaid unilaterally.65ACTUALHis office initially predicted that no more than 447,000 able-bodiedadultswould ever174,999ENROLLMENT66sign up for the new ObamaCare welfare program.DECEMBER 2015To make matters worse, per-person costs have also been significantly higher thananticipated, putting even further strain on Ohio’s Medicaid budget.69 By September2016, Ohio’s ObamaCare expansion total costs hit 10.1 billion – a whopping 4.7 billionmore than anticipated.70 The state’s total cost overruns are now expected to reach morethan 8 billion by the end of 2017.71TheFGA.orgBut actual enrollment blew past the state’s projected maximum in less than a year.67 ByAugust 2016, nearly 715,000 able-bodied adults had signed up for Ohio’s ObamaCareexpansion, with no sign of slowing down.687ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
PROJECTEDMAX 188,000ACTUALENROLLMENT439,044Lawmakers will soon be scrambling to find funding to cover the state’s shareof the2015costs,DECEMBERwhich are now on track to run more than twice as high as expected.72 Medicaid alreadymakes up more than half of the state’s general operating budget, leaving little room forPROJECTED149,095policymakers to sweep existing funding from other priorities.73MAXGov. Kasich has already proposed slashing payments ACTUALto pediatric hospitals and235,425ENROLLMENTcutting eligibility levels for pregnant women in order to rein in the Medicaid budget.74 InDECEMBER20152016, Kasich’s administration also eliminated Medicaid eligibility for morethan 34,000individuals with disabilities.75 With cost overruns mounting and state lawmakers alreadyPROJECTEDfacing a Medicaid shortfall of more than 1 billion, thesecuts may simply be a sign of447,000MAX76what is to come.ACTUALENROLLMENT714,595AUGUST 201684%West VirginiaOVER 99DECEMBER 2015When Democratic Governor Earl Ray Tomblin unilaterally expanded Medicaid throughexecutive order, his administration predicted 95,000 able-bodied adults would everenroll.77 But actual enrollment shattered that supposed maximum in fewer than threemonths, with enrollment continuing the climb thereafter.78 By December 2015, nearly175,000 able-bodied adults had signed up for the state’s ObamaCare expansion –nearly twice as many as the state said would ever enroll.79Cost overruns are now mounting as a result. ObamaCare expansion was supposed tocost taxpayers 429 million in fiscal year 2015, per state estimates.80 But according tofederal data, actual expansion costs totaled nearly 627 million – 46 percent more thananticipated.81-84 Even if costs flatline, state policymakers will soon be searching underthe couch cushions for funds to cover tens of millions of dollars in higher-than-expectedcosts in 2017 and beyond.TheFGA.orgThese states are not outliers. Similar enrollment explosions – and associated cost overruns –have occurred in expansion states across the country.85-120 In fact, not one state that expandedMedicaid under ObamaCare has managed to keep its enrollment on target with its initialexpectations. Higher-than-expected enrollment and higher costs in these states will ultimatelyleave fewer resources available for all other priorities – including services for the most vulnerable,education, and public safety.8ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
Recent ObamaCare Expansion States AreFacing Similar ProblemsThis report primarily focuses on ObamaCare expansion states with at least 12 months ofavailable data. However, even recent expansion states are facing enrollment explosions.Alaska, for example, predicted that 20,000 able-bodied adults would sign up for its expansion inthe first year, costing taxpayers an estimated 145 million.121 But actual enrollment has alreadysurpassed those expectations, with costs already running more than 60 million over budget.122In Indiana, actuaries predicted fewer than 317,000 able-bodied adults would sign up forHIP 2.0 within the first 11 months.123 But actual enrollment during that time frame hit 362,000and continues to grow.124 Higher-than-expected enrollment caused the expansion to run anestimated 285 million over budget during that window of time.125In Louisiana, nearly 332,000 able-bodied adults signed up for ObamaCare expansion in the firstfive months – far more than the state’s maximum enrollment projection of 302,000 adults.126-127And, perhaps worst of all, Montana’s recent ObamaCare expansion has been over budgetsince the day it launched.128 Although state officials expected just 18,600 able-bodied adultsto enroll in the first six months, more than 20,000 had already enrolled on Day One.129 Withinfive months, enrollment surpassed the state’s maximum projections – with nearly 47,000 ablebodied adults on the program.130CONCLUSIONObamaCare Expansion Is AnUncontrollable Nightmare For StatesObamaCare expansion’s enrollment explosion, combined with higher-thanexpected costs for able-bodied adults, will spell disaster for ObamaCareexpansion states, taking limited taxpayer resources away from the truly needyand other core priorities, including education, public safety, and infrastructure.Finally, policymakers in non-expansion states should take notice of the disastersunfolding in states that have embraced ObamaCare and be glad that theyhave protected their own states from the same fate.TheFGA.orgObamaCare’s perverse funding formula for able-bodied adults createsa massive new incentive for states to siphon away resources from the trulyneedy, to help pay for these cost overruns. ObamaCare expansion remainsan optional program for states and federal officials have repeatedly assuredstates that they could roll back eligibility at any time. States should take themup on this offer.9ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
1.Nicholas Horton, “How the Senate just changed the ObamaCare debate forever,” Townhall (2016), ebate-forever-n2092170.2.Terence Ng et al., “Medicaid home and community-based services programs: 2012 data update,” Kaiser Family Foundation(2015), -update.3.Jonathan Ingram and Nicholas Horton, “The ObamaCare expansion enrollment explosion,” Foundation for GovernmentAccountability (2015), nsionEnrollmentExplosion-Final3.pdf.4.Alaska, Indiana, Louisiana, and Montana were excluded from the overall analysis because they had less than 12 monthsof available enrollment data. Delaware was excluded because it did not have publicly available enrollment projectionsmade prior to expansion and was an early expansion state. Massachusetts and Vermont were excluded because theywere early expansion states and have no newly eligible enrollees under the Affordable Care Act.5.In Delaware, the total number of “Group VIII” enrollees had increased to more than 60,000 by December 2015, upfrom fewer than 47,000 in January 2014. Fewer than 15 percent of these able-bodied adults are “newly eligible” underObamaCare.6.In Massachusetts, the total number of “Group VIII” enrollees had increased to more than 384,000 by December 2015, upfrom fewer than 288,000 in January 2014. None of these able-bodied adults are “newly eligible” under ObamaCare.7.In Vermont, the total number of “Group VIII” enrollees had increased to nearly 61,000 by December 2015, up from 37,000 inJanuary 2014. None of these able-bodied adults are “newly eligible” under ObamaCare.8.Centers for Medicare and Medicaid Services, “January to March 2014 Medicaid MBES enrollment report,” U.S. Departmentof Health and Human Services (2015), .9.Centers for Medicare and Medicaid Services, “October to December 2015 Medicaid MBES enrollment report,” U.S.Department of Health and Human Services (2016), 5.pdf.10.Amy Webb, “Nearly 70 percent of Arkansans eligible for Private Option signed-up in first six months,” Arkansas Departmentof Human Services (2014), oomDocs/DMSPrivateOptionNRApril2014.pdf.11.Andy Allison, “Estimated Medicaid-related impact of the ACA with expansion: Updated November 13, 2012,” ArkansasDepartment of Human Services (2012), xpansion%20Nov%202012.pdf.12.Centers for Medicare and Medicaid Services, “October to December 2014 Medicaid MBES enrollment report,” U.S.Department of Health and Human Services (2015), 4.pdf.13.Cindy Gillespie, “Private Option eligibility, enrollment, and expenditure data – October 2016,” Arkansas Department ofHuman Services (2016), Jonathan Ingram and Nicholas Horton, “Arkansas’ failed Medicaid experiment: Not a model for Nebraska,” Plate Institute forEconomic Research (2016), nsas-Failed-Medicaid-Experiment.pdf.15.Jason Pederson, “Waiver commitment wavering,” KATV (2016), mitment-wavering.16.Ibid.17.Authors’ calculations based upon information provided by the Arkansas Department of Human Services.18.Nicholas Horton, “Arkansas’ latest idea: ObamaCare welfare for people who already have insurance,” Townhall 9.Kerry White, “Final fiscal note: Senate Bill 13-200,” Colorado Legislative Council Staff (2013), en&file SB200 f1.pdf.20.Centers for Medicare and Medicaid Services, “January to March 2014 Medicaid MBES enrollment report,” U.S. Departmentof Health and Human Services (2015), .21.Budget Division, “Fiscal year 2016-17 medical premiums, expenditure, and caseload report,” Colorado Department ofHealth Care Policy and Financing (2015), 20Monthly%20Premiums%20Report.pdf.22.Kerry White, “Final fiscal note: Senate Bill 13-200,” Colorado Legislative Council Staff (2013), en&file SB200 f1.pdf.23.Centers for Medicare and Medicaid Services, “January to March 2014 new adult group expenditure reports,” U.S.Department of Health and Human Services (2015), up-breakout.pdf.TheFGA.orgReferences10ObamaCare Expansion Enrollment is Shattering Projections November 16, 2016
Centers for Medicare and Medicaid Services, “April to June 2014 new adult group expenditure reports,” U.S. Departmentof Health and Human Services (2015), up-breakout-apr-jun-2014.pdf.25.Centers for Medicare and Medicaid Services, “July to September 2014 new adult group expenditure reports,” U.S.Department of Health and Human Services (2015), up-breakout-jul-sep-2014.pdf.26.Centers for Medicare and Medicaid Services, “October to December 2014 new adult group expenditure reports,” U.S.Department of Health and Human Services (2015), up-breakout-oct-dec-2014.pdf.27.Centers for Medicare and Medicaid Services, “January to March 2015 new adult group expenditure reports,” U.S.Department of Health and Human Services (2016), up-breakout-jan-mar-2015.pdf.28.Centers for Medicare and Medicaid Services, “April to June 2015 new adult group expenditure reports,” U.S. Departmentof Health and Human Services (2016), up-breakout-apr-jun-2015.pdf.29.Authors’ calculations based upon the fiscal year 2015 total Medicaid expansion cost overrun of 413 million and the stateshare required under the expansion’s enhanced FMAP rate.30.Division of Medical Programs, “Medicaid financing for the uninsured: How the revenues and costs are computed,” IllinoisDepartment of Healthcare and Family Services (2012), 5/03/HFS-estimates.pdf.31.Centers for Medicare and Medicaid Services, “January to March 2014 Medicaid MBES enrollment report,” U.S. Departmentof Health and Human Services (2015), .32.Authors’ calculations based upon enrollment data provided by the Illinois Department of Healthcare and Family Services.33.Division of Medical Programs, “Medicaid financing for the uninsured: How the revenues and costs are computed,” IllinoisDepartment of Healthcare and Family Services (2012), 5/03/HFS-estimates.pdf.34.Authors’ calculations based upon expenditure data provided by the Illinois Department of Healthcare and Family Services.This total does not include an estimated 100 million to 150 million in additional spending that had not yet beensubmitted for reimbursement.35.Ellen Jean Hirst, “Illinois Medicaid expansion could carry hefty price tag,” Chicago Tribune (2015), n-cost-0203-biz-20150202-story.html.36.Authors’ calculations based upon data provided by the Illinois Office of the Comptroller.37.Matthew C. Hoops et al., “State and local pension funding in the enhanced financial accounts,” Federal Reserve l.38.Jonathan Ingram, “Who is on the ObamaCare chopping block? The immoral funding formula of ObamaCare’sMedicaid expansion puts the neediest patients at risk,” Foundation for Government Accountability (2014), macareChoppingBlock.pdf.39.Nicholas Horton, “Illinois’ Medicaid expansion enrollment continues to climb, putting vulnerable at risk,” Illinois PolicyInstitute (2016), nerableat-risk.40.Christina Sandefur, “Affordable Care Act lawlessness plagues the states: Red states are at the forefront of these extralegalhealth care exp
ObamaCare expansion actually cost 3.6 billion during that period - more than twice what was expected.44-46 State estimates also show that expansion ran another 1.4 billion over budget in fiscal year 2016, bringing total cost overruns to 3.3 billion so far.47 Despite promises by ObamaCare lobbyists that expansion would save the state money,
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Nov 01, 2013 · 3 November 2012 Birthdays Elaine Dunn Nov 01 Ingrid Nov 01Durant Polly Wolf Nov 01 Pam Nov 02McNamara Ruth Dalby Nov 06 Kathryn Nov 06Kutch Nancy Cummings Nov 09 Pam Reeves Nov 09 Kelly Nov 09Tacker Anne Heerdt-Wingfield Nov 10 Alice E. Long Nov 10 Helen Nov 11Hood Mary Nov 12Saltzman Marlene Nov 12Werner Bonnie Yockstick Nov 12 Ruth Roberts Nov 13
Obamacare is the law of the land and must not be altered or abridged. Today some of those same union officials say that Obamacare is a disaster that will harm working people in general and union members in particular. Now—surprise!— they want Obamacare changed in ways to benefit their unions. President's promise 'simply not true'
The Irony of ObamaCare The Irony of ObamaCare: Making Inequality Worse The promise of Obamacare was the right one and the hope for extending healthcare coverage to the un-and under-insured a step in the right direction. Yet the unintended consequences will hit the average, hard-working American where it hurts: in the wallet.
Obamacare. The given response was: "in a word, staggering." This suggests a possible area for future research. 4 An informant with a great deal of experience in the legislative process was also consulted, and opined that the only way for Obamacare to become fully enacted into law would be through the courts.
12.2 Thermal Expansion Most materials expand when heated and contract when cooled. Thermal expansion is a consequence of the change in the dimensions of a body accompanying a change in temperature. 3 types of expansion: Linear expansion. area expansion, volume expansion In solid, all types of thermal expansion are occurred.
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