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(2012)
Implementing health reform: state innovation and Medicaid waivers
/jama-forum-how-realistic-is-romneys-pledge-to-repeal-and-replace-the -affordable-care-act
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Health care: repeal and replace Obamacare
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VIEWPOINT ONLINE FIRST What Are the Limits? Federal Health Insurance Exchanges John D. Kraemer, JD, MPH Executive agencies have considerable discretion to imple- Lawrence O. Gostin, JD ment ACA provisions that are ambiguous. One area of am- biguity is in the operation of federal health insurance ex- EALTH CARE REFORM REMAINS PRECARIOUS IN THE changes. The ACA authorizes states to establish their own United States, with intense political disagree- exchanges, but the federal government is empowered to cre- ment about the Affordable Care Act (ACA). ate them if states decline. Several governors have opposed HFormer Governor Romney vows to “repeal and creating exchanges or taken no steps to create them. The replace” President Obama’s signature domestic achieve- law also offers premium subsidies for people whose house- ment. Although repeal would face potentially insur- hold income is below 4 times the federal poverty level if they mountable political barriers, a Republican president could buy insurance from the exchanges. The ACA directs the In- selectively enforce the ACA, effectively blocking full ternal Revenue Service (IRS) to grant subsides as a tax credit. implementation. The president has wide discretion in Due to an apparent oversight, the ACA only explicitly of- implementing legislation,
JAMA – American Medical Association
Published: Nov 21, 2012
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