Articles on the implementation of ObamaCare.

A couple of years ago, the health insurance exchange in Minnesota – MNsure – was in deep trouble. Health insurance premiums for individual policies had shot up by as much as 67 percent, among the steepest increases in the country.  Insurers were abandoning the market, leaving 116,000 Minnesotans with scant choices.

The Minnesota Legislature offered a solution: a $271 million, publicly funded reinsurance pool that would help health insurance companies pay the most expensive medical claims, thereby lowering overall insurance premiums. The hope was that backstopping the insurers would stabilize the market and halt the rocket-like rise in premiums.

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Congress in 2017 failed to “repeal and replace” the Affordable Care Act. But the health law has been changed in many other ways over the past year and a half. Some changes were made by Congress, some by President Donald Trump and his administration and some by state officials. Here is a timeline of the most consequential events that have shaped the health law:

On his first day in office, Trump issues an executive order to “minimize the unwarranted economic and regulatory burdens” of the health law. It includes instructions to agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden.”

The same day, officials at the Department of Health and Human Services begin removing information on how to sign up for coverage from the healthcare.gov website, even though enrollment for 2017 policies lasts until the end of the month.

Maryland lawmakers on Wednesday finalized a bipartisan measure to collect $380 million in taxes from health insurers next year to help curtail surging premiums for 150,000 Marylanders and prevent the state’s Obamacare marketplace from a potential collapse.

The legislation was a quiet, one-year compromise between the Democratic-controlled General Assembly and Republican Gov. Larry Hogan, who is expected to sign the measures.

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The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.

New health-insurance legislation in Iowa will become the latest test of the ability of states to allow coverage that doesn’t comply with the federal Affordable Care Act.

Iowa Gov. Kim Reynolds is expected to soon sign into law a bill that would allow the Iowa Farm Bureau, a nonprofit, to offer health coverage that would fall outside the ACA’s rules. The new coverage, which the legislation calls “health benefit plans,” would be administered by the state’s largest insurer, Wellmark Blue Cross & Blue Shield . The product would officially not be considered health insurance, according to the legislation—leaving details of the coverage unclear.

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Earlier this month, the Trump administration shot down a plan from Idaho to sell health insurance that doesn’t comply with Affordable Care Act (ACA) regulations.

“If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,” wrote CMS Administrator Seema Verma in her rejection letter.

Three weeks later, another state — Iowa — is on the verge of making a similar move.

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The Iowa Senate gave final approval Tuesday to controversial legislation that would exempt certain health plans from Affordable Care Act mandates.

The legislation combines two proposals backers say would reduce health insurance costs, but critics worry could undermine consumer protections.

Senate File 2349 was approved 37-11, sending it to Gov. Kim Reynolds, whose spokeswoman said she was “eager” to sign it. The measure passed the House last week.

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California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.

In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.

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Everybody on Capitol Hill agreed: If anyone could break the deep-rooted partisan logjam over Obamacare in Congress, it was that deal-making duo Patty and Lamar. But in the end, it was Obamacare that broke their alliance.

Just seven months after Sens. Patty Murray (D-Wash.) and Lamar Alexander (R-Tenn.) heralded the beginning of a new bipartisan era on health care following the collapse of Obamacare repeal efforts, their lofty ambitions ended in much the same way as every Obamacare-related negotiation over the last eight years — with claims of betrayal, warnings of political fallout and no progress toward bridging the deep divide over the nation’s health care system.

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Of the $88 billion HHS appropriation announced Wednesday night, not a penny is going toward Obamacare. Congress is however extending oversight requirements on HHS regarding its administration of the health exchanges.

Congressional leaders released the long-awaited $1.3 trillion, two-year spending omnibus after days of wrangling behind closed doors over contentious policies that included an embattled stabilization package for the individual market that would fund cost-sharing reduction payments and a $30 billion reinsurance pool.

The bill was passed late Thursday night.