endless problems. Operations stabilized in 2014, although not all planned features were complete. The Government Accountability Office released a non-partisan study in 2014 that concluded that the administration did not provide "effective planning or oversight practices" in developing the exchanges. In Burwell v. Hobby Lobby the Supreme Court exempted closely held corporations with religious convictions from the contraception rule. At the beginning of the 2015, 11.7 million had signed up (ex-Medicaid). By the end of the year about 8.8 million consumers had stayed in the program. Congress repeatedly delayed the onset of the "Cadillac tax" on expensive insurance plans first until 2020 and later until 2022. An estimated 9 million to 10 million people had gained Medicaid coverage in 2016, mostly low-income adults. The five major national insurers expected to lose money on PPACA policies in 2016, in part because the enrollees were lower income, older and sicker than expected. More than 9.2 million people enrolled on the national exchange in 2017, down some 400,000 from 2016. This decline was due primarily to the election of President Trump. Of the 9.2 million, 3.0 million were new customers and 6.2 million were returning. The 9.2 million excludes the 11 states that run their own exchanges, which signed up around 3 million additional people. The IRS announced that it would not require that tax returns indicate that a person has health insurance, reducing the effectiveness of the individual mandate, in response to Trump's executive order. The CBO reported in March that the healthcare exchanges were expected to be stable. In May the House voted to repeal PPACA using the American Health Care Act. The individual mandate was repealed starting in 2019 via the Tax Cuts and Jobs Act. The CBO estimated that the repeal would cause 13 million fewer people to have health insurance in 2027. By 2019, 35 states and the District of Columbia had either expanded coverage via traditional Medicaid or via an alternative program. The 2017 Individual Market Stabilization Bill was proposed to fund cost cost-sharing reductions, provide more flexibility for state waivers, allow a new "Copper Plan" offering only catastrophic coverage, allow interstate insurance compacts, and redirect consumer fees to states for outreach. The bill failed. See also Acronyms in healthcare Community Living Assistance Services and Supports Act ("Class Act") Comparison of the health care systems in Canada and the United States EBSA form 700 Health care reform Health systems by country Individual shared responsibility provision King v. Burwell Massachusetts health care reform (sometimes called "Romneycare") Medicaid Medicaid estate recovery Medicare Access and CHIP Reauthorization Act of 2015 (Reform to the American Health Care system signed into law by President Obama) National health insurance Single-payer health care Universal health care Universal health coverage by country U.S. health care compared with 8 other countries (tabular form) Florida shuffle References Further reading 1183pp Preliminary CBO documents Patient Protection And Affordable Care Act, Incorporating The Manager's Amendment, December 19, 2009 Effects Of The Patient Protection And Affordable Care Act On The Federal Budget And The Balance In The Hospital Insurance Trust Fund (December 23, 2009) Estimated Effect Of The Patient Protection And Affordable Care Act (Incorporating The Manager's Amendment) On The Hospital Insurance Trust Fund (December 23, 2009) Base Analysis – H.R. 3590, Patient Protection and Affordable Care Act, November 18, 2009.(The additional and/or related CBO reporting that follows can be accessed from the above link) Estimated Distribution Of Individual Mandate Penalties (November 20, 2009) Estimated Effects On Medicare Advantage Enrollment And Benefits Not Covered By Medicare (November 21, 2009) Estimated Effects On The Status Of The Hospital Insurance Trust Fund