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implementation
Health and Human Services Secretary [[Kathleen Sebelius]] appearing on Capitol Hill for questioning admitted to double-counting in the Obamacare budget. Rep. Joe Pitts of Pennsylvania said “The same dollar can’t be used twice. This is the largest of the many budget gimmicks Democrats used to claim Obamacare would reduce the deficit.” <ref>[http://dailycaller.com/2011/03/04/hhs-secretary-sebelius-admits-to-double-counting-in-obamacare-budget/ HHS Secretary Sebelius admits to double-counting in Obamacare, The Daily Caller, March 4, 2011]</ref>
Health and Human Services Secretary [[Kathleen Sebelius]] appearing on Capitol Hill for questioning admitted to double-counting in the Obamacare budget. Rep. Joe Pitts of Pennsylvania said “The same dollar can’t be used twice. This is the largest of the many budget gimmicks Democrats used to claim Obamacare would reduce the deficit.” <ref>[http://dailycaller.com/2011/03/04/hhs-secretary-sebelius-admits-to-double-counting-in-obamacare-budget/ HHS Secretary Sebelius admits to double-counting in Obamacare, The Daily Caller, March 4, 2011]</ref>
==Implementation==
The ACA as passed assumed that the eligibility for [[Medicaid]] would be automatically expanded in all 50 states. However, some states appealed this provision, and the US Supreme Court ruled that each state would have the right to decide whether to continue Medicaid on its present terms or to expand Medicaid to cover more low-income individuals. Although the ACA provided for the federal government to pay for all costs of medicaid expansion during the first four years, there was no statutory guarantee for full federal funding after that time. So, some states, particularly those with Republican Governors or Republican-controlled legislatures, refused to expand the eligibility requirements for the Medicaid program in their states. However, hospitals faced financial pressures to limit or end free charity care for indigent patients under the new structure, leaving low-income people in a difficult, un-insured dilemma.
Individuals and families who earned enough money to not qualify for Medicaid, and were not covered by employer-provided insurance, were then required to purchase insurance through health care exchanges in order to receive federal subsidies of insurance premiums and deductibles. However, there were massive problems with the online health care exchanges operated by the federal government for states that did not set up their own exchanges. This was true at the start of the open season in October 2013 as well as toward the end of the open season in March 2014. Despite these problems, 7.1 million people signed up for insurance on the exchanges.<ref>{{cite news|url=http://www.whitehouse.gov/blog/2014/04/01/more-7-million-americans-have-enrolled-private-health-coverage-under-affordable-care|title=7.1 Million Americans Have Enrolled in Private Health Coverage Under the Affordable Care Act|work=whitehouse.gov|date=April 1, 2014}}</ref> This number does not indicate a growth in the number of people covered by private health insurance. First, the 7.1 million includes people who became covered by Medicaid expansion. Second, some of the people were already covered by a grandfathered health plan, but were forced to purchase on the exchange so as to receive premium and deductible subsidies. Third, some states, like California, required insurance companies to cancel their existing insurance plans as a precondition of offering plans on the health care exchanges.
Some people thought that they had purchased insurance through the exchange, but because of malfunctions in the back office of the exchange, the insurance providers did not receive any record of the insurance purchase. The Obama Administration launched a crash program to fix the federal exchange software and eventually replaced the contractor responsible for building and operating the healthcare.gov website.
Although a number of Americans gave up their grandfathered health care plans for new policies. If the number of people purchasing policies under the ACA is not sufficient, insurance companies will raise their rates in future years, perhaps trapping these Americans who gave up their rights to switch back to the grandfathered plans.
The ACA imposed a mandate for employers who hire more than 50 full time employees. A full time employee is defined as someone who works 30 or more hours per week. In response, some employers have cutback the number of full time employees to avoid the duty to comply with the ACA's insurance requirements. The Obama Administration has postponed the implementation of the employer mandate until 2015. Some employers have cut the hours that their staff could work to under 30 hours per week. For example, adjunct faculty members have found that the number of classes per semester have been reduced so that they will not be covered by employer insurance. House Republicans have passed legislation through the House to increase the definition of full time worker to 40 hours per week.
The ACA requires health plans to offer women family planning and contraceptive services. Some employers object that such coverage violates religious principles. This issue has been taken to the United States Supreme Court with a decision expected by the summer of 2014.
== Obama Administration health care plan and liberal elitism ==
== Obama Administration health care plan and liberal elitism ==