Sandy Dowland has been to the emergency room 10 times in the past year and was hospitalized during four of those visits. She has had a toe amputated and suffers from uncontrolled diabetes, high blood pressure, major depression, obesity and back pain.

But her health is not high on the 41-year-old woman’s priority list.

“I have a lot going on,” said the unemployed mother of five who lives in a homeless shelter. She said it’s a struggle just to get herself and children through each day.

. . .

The federal government doesn’t have to pay insurers billions of dollars under an Affordable Care Act program aimed at enticing them into the markets by helping cover their financial risks, a divided federal appeals court ruled Thursday.

In a case brought by Moda Health Plan Inc., the ruling is a blow to insurers hoping to recoup money they say they were owed under the 2010 health law.

. . .

Growth in state spending on the Medicaid program is expected to fall significantly in the short term, according to a new report by state budget officers.

The findings, published Thursday in a report from the National Association of State Budget Officers, or NASBO, show that state Medicaid spending is expected to carry a median growth rate of 4.5 percent in fiscal 2018, and then growth is projected to slow significantly in fiscal 2019, to a median growth rate of 1.5 percent. The organization uses governors’ budgets in making its assessments.

. . .

Democrats are seizing on the Trump administration’s push in court to overturn ObamaCare’s protections for people with pre-existing conditions, hoping to leverage the issue ahead of November’s midterm elections as some Republicans rush to distance themselves from the move.

The Department of Justice’s (DOJ) decision to join a legal battle arguing that one of the most popular parts of ObamaCare should be struck down is being viewed by Democrats as a political gift, with the party apparatus quickly using the issue to attack GOP candidates and rally their base.

. . .

ObamaCare enrollees should brace themselves for another year of double-digit premium hikes.

Average premiums for plans sold through the state and federal insurance exchanges will jump as much as 32% next year, according to a recent report from actuarial firm Milliman. Consumers in some markets could face 80% rate hikes, according to a separate analysis from Blue Cross Blue Shield.

Democrats have pounced on these projections to blame the GOP for “marketplace sabotage.” Senate Minority Leader Chuck Schumer, D-N.Y., remarked that “Republicans and the Trump administration own any and all increases in health care premiums for American consumers.”

. . .

The Affordable Care Act (ACA) established health insurance marketplaces where consumers can buy individual coverage. Leveraging novel credit card and bank account micro-data, we identify new enrollees in the California marketplace and measure their health spending and premium payments. Following enrollment, we observe dramatic spikes in individuals’ health care consumption. We also document widespread attrition, with more than half of all new enrollees dropping coverage before the end of the plan year. Enrollees who drop out re-time health spending to the months of insurance coverage. This drop-out behavior generates a new type of adverse selection: insurers face high costs relative to the premiums collected when they enroll strategic consumers. We show that the pattern of attrition undermines market stability and can drive insurers to exit, even absent differences in enrollees’ underlying health risks. Further, using data on plan price increases, we show that insurers largely shift the costs of attrition to non-drop-out enrollees, whose inertia generates low price sensitivity. Our results suggest that campaigns to improve use of social insurance may be more efficient when they jointly target take-up and attrition.

. . .

Republicans are in a predictable spot as they head to the midterm election: The party failed to repeal ObamaCare, and the press is waving around double-digit premium increases for 2019. Democrats are pinning the blame on Republicans, though the basic problem is still the structure of the Affordable Care Act.

. . .

Last week was an amazing and unusual week at the Department of Justice, and it went largely unnoticed by the mainstream media. Attorney General Jeff Sessions, with the approval of President Trump, submitted court filings in two lawsuits agreeing that Obamacare will be unconstitutional as of Jan. 1, 2019, and that DACA is and always has been unlawful. Thus, DOJ will not defend Obamacare nor will it defend DACA on the merits.

Not since the Obama administration flipped its position on DOMA has the DOJ declined to defend something this important. And unlike the DOMA case, in both the Obamacare case and the DACA case, DOJ is relying on existing rulings from the Supreme Court and the 5th Circuit, respectively, in formulating its positions.

. . .

Senate Majority Leader Mitch McConnell said “everybody” in the Senate wants to preserve consumer protections for people with pre-existing conditions, an Obamacare provision that the Trump administration last week said is unconstitutional and should be struck down in court.

“Everybody I know in the Senate — everybody — is in favor of maintaining coverage for pre-existing conditions,” McConnell told reporters in the Capitol. “There is no difference in opinion about that whatsoever.”

. . .

Health and Human Services Secretary Alex Azar told lawmakers Tuesday that he wants to preserve access to affordable insurance for Americans with preexisting medical conditions, but he declined to disclose his view of an administration move that could undercut such consumer protections.

Calling it “a constitutional position . . . not a policy position,” Azar sidestepped grilling on whether he agreed with a legal brief filed last week by Justice Department attorneys stating they would not defend the Affordable Care Act in a federal lawsuit by Texas and 19 other Republican-led states.

. . .