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The landmark health-care reform law – President Obama's signature domestic triumph – has suffered its first major body blow, dealt not by Republican lawmakers intent on dismantling "Obamacare" but by the administration's own Health and Human Services (HHS) Department.

The setback came in mid-October, and it means that a piece of the 2010 Affordable Care Act – a new program intended to help seniors and disabled people afford at-home care – will not be set up after all. The problem? HHS could not see how to make that program, called CLASS, "actuarially sound" for 75 years, as the law required.