Articles on the implementation of ObamaCare.

Opt-out payments offered by employers may be used to determine affordability under the Affordable Care Act, depending on whether they are conditional or unconditional, according to IRS proposed rules.

Under the proposed rules, opt-out payments, cash payments given to employees who opt-out of their employer-sponsored health insurance, will be treated as a salary reduction for the purposes of determining health insurance affordability if they are considered unconditional.

An unconditional opt-out payment refers to an arrangement where the employee declines employer-sponsored health insurance without satisfying any other requirements.

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New failures are piling up among the member-run health insurance co-ops carrying out one of the Affordable Care Act’s most idealistic goals, leaving just seven remaining when the health law’s fourth enrollment season starts in the fall.

There were 23 in 2014.

For the rest — which all posted annual losses in 2015, according to the National Alliance of State Health Co-Ops — survival is job No. 1. Some are diversifying to serve larger employers, no longer limiting themselves to their ACA mandate to offer health plans to individuals and small businesses. A Maryland co-op has sued the federal government to avoid paying millions of dollars to other insurers under the ACA’s complex formula to keep premiums stable by balancing risks among insurers and helping ailing ones. Other co-ops are trying to renegotiate contracts with hospitals and other providers.

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Illinois moved Tuesday to take control of Land of Lincoln Health to begin an orderly shutdown of the insurance company, meaning about 49,000 people will lose their health coverage in the coming months.

The state said it will allow policyholders to buy coverage from a different insurer before their Land of Lincoln plans are terminated, but it’s unclear when the policies will lapse.

“It’s a bad day for the marketplace in Illinois and our consumers,” said Jason Montrie, president and interim CEO of Chicago-based Land of Lincoln. “This is the end.”

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Hillary Clinton on Saturday announced her plan to expand investments in community health care centers, the second of two proposals in a week apparently aimed at courting supporters of Sen. Bernie Sanders ahead of his possible endorsement.

The presumptive Democratic nominee’s proposal would double funding for primary care services at Federally Qualified Health Centers, which serve populations with limited access to health care. Community health care centers have been a key priority for Sanders, I-Vt., who successfully fought for the inclusion of $11 billion in funding for such centers in the Affordable Care Act of 2010.

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The number of insurers carrying out one of the Affordable Care Act’s most idealistic goals continues to plummet, with just seven nonprofit member-run health plans set to take part in the law’s fourth enrollment season this fall.

That’s down from 23 such plans — co-ops, as they are commonly known — that started in 2014. Eleven are still in business, but four in Oregon, Ohio, Connecticut and Illinois will fold soon because of financial insolvency. Just Tuesday, the Land of Lincoln Mutual Health Insurance Co. was ordered to close by Illinois regulators.

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President Obama on Monday called on Congress to revisit the controversial idea of providing a government-run insurance plan as part of the offerings under the Affordable Care Act.

What’s been described as the “public option” was jettisoned from the health law in 2009 by a handful of conservative Democrats in the Senate. Every Democrat’s vote was needed to pass the bill in the face of unanimous Republican opposition.

But in a “special communication” article published Monday on the website of JAMA, the American Medical Association’s top journal, the president says a lack of competition among insurance plan offerings in some regions may warrant a new look.

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Oregon’s nonprofit ObamaCare health insurance co-op is winding down operations due to financial problems, the second such announcement this week for the troubled co-op program.

The announcement is just the latest in a long string of failures of ObamaCare’s co-ops, non-profit health insurers set up to increase competition with established insurers. Before this week, just 10 of the original 23 co-ops remained functioning, and Republicans have seized on the problems.

Oregon’s Department of Consumer and Business Services announced Friday that it is taking over the insurer, known as Oregon’s Health CO-OP, and will liquidate the company.

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The Obama administration suffered a setback in its efforts to strengthen the individual insurance market when a federal appeals court last week struck down an HHS rule barring the sale of certain limited-benefit plans as stand-alone products.

In Central United Life v. Burwell, the U.S. Court of Appeals for the District of Columbia Circuit overturned a 2014 HHS rule restricting the sale of fixed-indemnity insurance plans that pay policyholders fixed dollar amounts to cover medical services regardless of how much the provider bills. These plans, which are cheaper to buy than comprehensive plans but exclude pre-existing conditions, do not comply with Affordable Care Act provisions on minimum essential benefits or guaranteed issue.

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A federal appeals court has ruled that consumers must be allowed to buy certain types of health insurance that do not meet the stringent standards of the Affordable Care Act, deciding that the administration had gone beyond the terms of federal law.

The court struck down a rule issued by the Obama administration that barred the sale of such insurance as a separate stand-alone product. “Disagreeing with Congress’s expressly codified policy choices isn’t a luxury administrative agencies enjoy,” the United States Court of Appeals for the District of Columbia Circuit said on Friday in a decision that criticized “administrative overreach” by the Department of Health and Human Services.

At issue is a type of insurance that pays consumers a fixed dollar amount, such as $500 a day for hospital care or $50 for a doctor’s visit, regardless of how much is actually owed to the provider.

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Connecticut’s financially “unstable” Obamacare health-insurance co-op was placed under state supervision on Tuesday, as regulators said 40,000 people covered by the company will ultimately have to find new plans for the coming year.

HealthyCT is the 14th of 23 original Obamacare co-ops to fail since they began selling health plans on government-run Affordable Care Act insurance exchanges. Several of the other remaining co-ops, at least, are believed to be on shaky financial ground.

Until last week, the nonprofit HealthyCT had “adequate capital and sustainable liquidity” — but that fell apart Thursday with a federal requirement that hit HealthyCT with a $13.4 million bill, according to the Connecticut Insurance Department.

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