Obamacare, if it survives, will represent the most comprehensive overhaul of the American healthcare system since the creation of Medicare in the mid 1960′s. I say, "if it survives" only because, if the system cannot properly facilitate enrollment, if the government cannot enforce its rules, and if the frustration level of the voting public reaches a certain point, Congress may decide to defund it. Additionally, new legal challenges have surfaced which appear credible enough to proceed.
In this article, we'll take a look at the health insurance exchanges, the levels of coverage, some premium examples, and what could happen if any of the new lawsuits succeed.
The Exchanges
Despite numerous differences between supporters and opponents, Obamacare does contain some common ground. The establishment of health insurance exchanges are one example. The exchanges will allow a comparison of premiums on plans with very similar coverage on one website. This should enhance transparency and increase competition which, absent other factors, would have a suppressing effect on premiums. However, many of these "other factors" are significant. Therefore, unless you qualify for a subsidy, it's unlikely your premiums will decrease.
All states were required to establish a healthcare exchange or opt out, in which case its citizens would be compelled to use the federal exchange. According to one source, 17 states have created their own exchange (includes the District of Columbia), 7 will use a "partnership marketplace," and 27 will use the federal exchange. This conflicts with a recent LA Times article which reported, "36 states have decided against opening exchanges for now." Whatever the exact number actually is, before a health insurance plan can be listed on an exchange, it must meet minimum federal requirements for qualified health plans.
States who have created an exchange will retain some discretion over minimum coverage requirements (MCR) and premiums. These states can also decide which policies are allowed on its exchange and which will be excluded. In addition, states with their own exchanges will be able to set higher MCRs and negotiate premium limits with insurers. In short, these states will have some control over their health insurance marketplace.
The Cost of Healthcare.gov: Was It a Good Investment?
Carlos Osorio/AP DETROIT -- General Motors' third-quarter net income fell 53 percent compared with a year ago, as one-time expenses masked a strong performance in North America and a narrowed loss in Europe. The company earned $698 million in the quarter, or 45 cents a share. That compares with $1.48 billion, or 89 cents a share, a year ago. But without $900 million in one-time items, GM earned $1.7 billion, or 96 cents a share. That beat Wall Street expectations. Analysts polled by FactSet expected 94 cents a share. Revenue rose 4 percent to $39 billion, just short of Wall Street's estimate of $39.2 billion. Investors viewed the results favorably. GM (GM) shares rose 87 cents, or 2.4 percent, to $36.93 in morning trading. GM's performance in North America was especially strong, with pretax earnings up 28 percent to $2.2 billion on solid pickup truck sales and better pricing. GM rolled out updated versions of its Chevrolet Silverado and GMC Sierra pickups in the spring. The company's profit margin in North America -- the percentage of revenue it gets to keep after expenses -- was the highest in two years at 9.3 percent. GM has a goal of 10 percent pretax margins in the region. "The new trucks are doing great in the marketplace," Chief Financial Officer Dan Ammann said. "We're commanding good pricing. We're controlling costs." GM's average sales price rose 1 percent in the U.S. during the quarter to $34,566, according to Kelley Blue Book. Sales of the Silverado, its top-selling vehicle, were up 14 percent over last year's third quarter. Prices for the pickup rose by 2 percent to an average of $36,487. In Europe, GM cut its loss by more than half to $214 million. Revenue there rose year-over-year for the first time in two years. Ammann said the company cut $400 million in costs during the quarter, and updated versions of its Opel Mokka small crossover SUV, Adam subcompact and Insignia midsize car sold well. GM's International Operations, including Asia, saw pretax earnings fall 61 percent to $299 million due to struggles in India and other areas outside of China. South American profit rose 79 percent to $159 million. The company's financial unit saw a 20 percent rise in pretax earnings to $239 million. "We continue to have challenges in some markets," Ammann said. Some are due to industrywide issues such as competitors lowering prices, but some are execution problems on GM's part, he said. South American profit rose 79 percent to $284 million. The company's financial unit saw a 20 percent rise in pretax earnings to $239 million. One-time items included $800 million to buy preferred stock from a health care trust for union retirees and a $48 million impairment charge in South Korea. Several major U.S. corporations dodge domestic taxes by moving profits internationally to tax havens. For example, a company can utilize the "double Irish" formula to minimize their U.S. taxes. If the profits from the sale of a good stayed in the U.S., they would be taxed at the federal 35 percent rate. However, some companies sell the intellectual property rights to an Irish subsidiary to minimize tax obligations. The profits from that U.S. sale are paid overseas to the Irish subsidiary. As long as the Irish subsidiary is controlled by managers elsewhere - for instance, a Caribbean tax haven - the profits can move around the world without a dime of taxation. At this point, the profits are moved to a nation with no tax, skirting around the U.S. 35 percent rate. 
