The Department of Health and Human Services has spent $4.8 billion setting up the various healthcare exchanges under the Affordable Care Act.
A new report released by the Congressional Research Service cited the ACA’s open-ended financial commitment:
The ACA provided an indefinite appropriation for HHS grants to states to support the planning and establishment of exchanges. For each fiscal year, the HHS Secretary is to determine the total amount that will be made available to each state for exchange grants.
The vast majority ($4.6 billion) of the grant money went to establish the exchanges, while $48 million went to state planning grants and $129 million was spent on "Early Innovator" grants.
The law expects the exchanges to be “self-sufficient” by 2015. So, theoretically, no further appropriations will be needed for the exchanges beyond this year.