United States health spending is projected to rise 5.3 percent in 2018, reflecting rising prices of medical goods and services and higher Medicaid costs, a U.S. government health agency said on Wednesday, an upward trend it forecasts for the next decade.

The increase represents a sharp uptick from 2017 spending, which the U.S. Centers for Medicare and Medicaid Services (CMS) now estimates to have been a 4.6 percent climb to nearly $3.5 trillion. It had previously forecast a 2017 rise of 5.4 percent.

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Insurer participation and competition in Obamacare declined again in 2018 at both the state and county levels. In 2017, nearly one-third of counties (32.8 percent) had only one insurer offering exchange coverage. In 2018, more than half (51.3 percent) of all counties face that situation. Many insurers have exited the exchanges; ones that remain offer higher premiums and narrow network plans. The emerging norm appears to be one in which major metropolitan areas have two or three insurers offering exchange coverage, while less-populous areas have only one. A health insurance monopoly offering overly expensive coverage that pays for only a very limited set of providers is deeply unattractive, especially to customers who previously enjoyed choice in both their insurance and medical care. Not surprisingly, consumers are looking to Congress and the President for help in escaping the soaring costs and shrinking choices that characterize the ACA exchanges.

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House Republicans are in discussions about repealing or delaying ObamaCare’s employer mandate to offer health insurance, House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Tuesday.

Brady told reporters that he has discussed the idea with Health and Human Services Secretary Alex Azar, as well as other members of the Ways and Means Committee.

“We’ve discussed that with him as well as committee members, so yeah, there is that discussion, and I’d like to see us make progress there,” Brady said.

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New analysis from Avalere finds that plans with more restrictive networks, including health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), continue to dominate the exchange market, with 73% of the 2018 market comprised of restrictive network plans, up from 68% in 2017 and 54% in 2015. Avalere analysis also found that deductibles for the most popular type of plan on the exchange—silver plans—will climb in 2018, to an average of $3,937, up from $3,703 in 2015, and each following year they will increase.
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People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states. “Members have difficulty finding–and in many cases cannot find–medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.

“People signed up for insurance and they ‘discovered there were no doctors,”’said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.

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Idaho has a maverick plan to let insurers sell plans that don’t meet Obamacare coverage rules and patient protections to give more health insurance options to citizens who can’t afford the expensive Obamacare policies. Gov. Butch Otter issued an executive order to authorize a state-level version of the “Cruz amendment,” which Senator Ted Cruz (R-TX) offered to the Better Care Reconciliation Act during efforts to repeal the ACA last year. The amendment would have allowed insurers to offer non-ACA-compliant plans in the individual market so long as they also offered plans through the marketplace. Other conservative states are keeping a close eye on the option. HHS Secretary Alex Azar said he would closely scrutinize Idaho’s plan, but he said it was too early to know what action he might take.

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Two weeks into his new post, HHS Secretary Alex Azar on Wednesday took another step in the Trump administration’s move toward relaxing the Affordable Care Act’s moratorium on new physician-owned hospitals.

In the HHS budget hearing before the House Ways and Means Committee, Rep. Sam Johnson (R-Texas) asked for Azar to commit the administration to help repeal the ACA’s “ban” on physician-owned hospitals.

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Businesses are pushing back on the Internal Revenue Service’s decision to begin enforcing the Affordable Care Act’s employer insurance mandate, challenging penalties that run into the millions and asserting the agency is wrong to impose the fines.

The ACA imposes a penalty on employers with more than 50 workers who don’t provide qualifying coverage to employees, but the fines weren’t initially enforced. In November, the IRS said it would begin assessing penalties, starting with companies that failed to comply in 2015, when parts of the employer mandate first kicked in.

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Galen Institute Senior Fellow Doug Badger has written a paper, published by the Taxpayers’ Budget Office of the National Taxpayers Union Foundation, in which he analyzes CBO’s expectation that the Center for Medicare and Medicaid Innovation (CMMI) would reduce Medicare spending by $45 billion over ten years.  The forecast is flawed, Badger concludes, as CBO “ascribes unobserved and unobservable savings to projects that CMMI has not yet undertaken (and may never undertake).”  He says the CBO’s judgements “are in some cases questionable, in others mistaken and in still others rendered obsolete.”

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Nevada is taking steps toward leaving the federal healthcare.gov and setting up a separate exchange operated by the state.

The Nevada Appeal reports that the Legislative Interim Finance Committee on Friday authorized state officials to spend $1 million to prepare a request for proposals and find a private provider.

Heather Korbulic, executive director of the state system, says changes are needed because healthcare.gov is steadily raising the rates it charges states that link their front-end systems to the federal exchange.

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