HCR Update from Mark Sanna: The Obama administration has ruled that neither the Affordable Care Act federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are “federal health care programs.” The surprise decision exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare.