Articles on the implementation of ObamaCare.

Minuteman Health of Massachusetts and New Hampshire announced it is withdrawing from the Affordable Care Act exchanges in 2018, leaving only four co-ops in operation. The co-op will stop writing business on January 1 and organize a new company, Minuteman Insurance Company, instead.

The company cited issues with Obamacare’s risk-adjustment program, which is the program that shifts money away from those with healthier customers to those with sicker enrollees. Minuteman Health said that the negative impact of this program had been “substantial.”

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Highlighting the continued uncertainty around the Affordable Care Act marketplaces, insurers announced major changes to their offerings for next year, including pullbacks that potentially leave more counties without exchange plans.

Anthem Inc. said it will exit the marketplaces in Wisconsin and Indiana next year, while nonprofit MDwise said it too would leave the Indiana exchange. Those moves may leave four Indiana counties at risk of having no exchange insurers in 2018, according to the Kaiser Family Foundation, though its researchers cautioned the outlook remains unclear. An estimated 44 counties in Ohio, Washington and Missouri will likely face a similar situation.

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nsurance startup Oscar Insurance Corp. said it plans to expand its offerings in the Affordable Care Act marketplaces, as insurers face a federal deadline Wednesday for initial filings to participate in the health law’s exchanges next year.

Oscar, which has been under a spotlight partly because of its tie to the Trump administration, said it aims to begin selling ACA plans in Tennessee for the first time in 2018, and re-enter the exchange in New Jersey, where it sat out this year. The insurer also will expand the regions where it sells ACA plans in California and Texas, and will continue selling plans in its home market of New York. Last week, Oscar announced that it will begin selling marketplace plans in Ohio next year, working with the Cleveland Clinic.

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The Trump administration has made critical ObamaCare payments to insurers for the month of June but won’t provide any certainty about whether they’ll continue in the future.

The payments, known as cost sharing reduction subsidies, reimburse insurers for providing discounts to low-income patients.

Insurers have been threatening to raise premiums — or leave the ObamaCare markets — if they don’t receive certainty about the payments from Congress or the White House.

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Obamacare’s second biggest flaw is that even as it upended the half-century long consensus over who should be in Medicaid, the law inexplicably left intact a feature of Medicaid that we have known for decades fuels excess spending: its open-ended matching rate.

So long as states put up a dollar to fund Medicaid, Uncle Sam is obliged to match it with anywhere from $1 to $3 federal dollars depending on that state’s unique matching rate. It has been proven empirically that this formula fuels higher spending. An analysis by Thad Kousser at UC Berkeley showed that all other things being equal, shifting a state from the lowest to highest federal matching rate increases discretionary Medicaid expenditures by 22 percent.

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It’s been just over seven years since President Obama declared: “It is not sufficient for us simply to add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform. Another way of putting it is we can’t simply put more people into a broken system that doesn’t work” [emphasis added].

Regrettably, the law he signed less than 10 months later fell far short of the president’s own benchmark as it relates to Medicaid. Not only did the ACA fail to impose any cost controls on Medicaid, it likewise contained no reforms to reverse or even corral the perverse incentives that for decades had simultaneously led to indefensible levels of Medicaid overspending even while creating enormous problems of access to the very people the program aimed to help. Instead, it amplified those incentives, making an already-bad situation even worse.

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Health care has been central to U.S. political debate for nearly a decade as Democrats created a new entitlement with little public support.

Compared to that effort, the Senate this time has been a model of deliberative democracy. On Dec. 19, 2009, a Saturday, then Majority Leader Harry Reid tossed the 2,100-page bill the Senate had spent that fall debating and offered a new bill drafted in an invitation-only back room. Democrats didn’t even pretend to care what was in it while passing it in the dead of night on Dec. 24, amid a snowstorm, in the first Christmas Eve vote since 1895.

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The House passed legislation Tuesday to ensure that immigrants in the country illegally can’t access tax credits for health insurance premiums.

Rep. Lou Barletta’s (R-Pa.) bill, approved in a largely party-line vote of 238-184, would require the Treasury Department to confirm that people applying for the tax credits are verified as U.S. citizens or legal residents by the Commissioner of Social Security or the Secretary of Homeland Security.

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One of the nation’s biggest health insurers says it will not return to Ohio’s public insurance exchanges next year, a decision that could open more holes in the Affordable Care Act’s increasingly thin system for helping people buy coverage.

The move announced Tuesday by Anthem could leave shoppers in 20 counties without an option for buying individual coverage on the exchange unless another insurer steps in.

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Blue Cross and Blue Shield of Kansas City announced yesterday it has decided to exit the Obamacare exchange next year. The decision affects about 67,000 Blue KC customers in 30 counties in western Missouri as well as Wyandotte and Johnson counties in Kansas. Danette Wilson, Blue KC’s president and CEO, said that the company has lost more than $100 million total on its exchange plans since the ACA rolled out in 2014.

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