Iowa on Tuesday submitted to the federal government a final request to make changes to try to shore up its struggling ObamaCare insurance marketplace.

The plan from the Iowa Insurance Division is intended to be a short-term market stabilization solution to entice more insurers into the marketplace. The state is facing what it calls a “collapse” of its ObamaCare marketplace after all but one insurer declined to offer plans for 2018.

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Ohio Gov. John Kasich said he and Colorado Gov. John Hickenlooper are planning to release proposals as early as next week on how to repair Obamacare’s exchanges.

“We’re getting very close,” Kasich, a Republican, said in a joint interview with Hickenlooper on Colorado Public Radio on Monday. “I just talked to my guys today, men and women who are working on this with John’s people, and we think we’ll have some specifics here … I think we could have it within a week.”

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Senators looking for ways to stabilize the individual health insurance market will hear from governors and state health insurance commissioners at their first bipartisan hearings next month.

The hearings, set for Sept. 6-7, will focus on stabilizing premiums and helping people in the individual market in light of Congress’ failure to repeal and replace the Affordable Care Act, or Obamacare.

“Eighteen million Americans, including 350,000 Tennesseans – songwriters, farmers, and the self-employed – do not get their health insurance from the government or on the job, which means they must buy insurance in the individual market,” said Sen. Lamar Alexander, the Tennessee Republican who chairs the Senate Health, Education, Labor and Pensions Committee.

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Between “80 to 85 percent of Americans are already covered by health insurance, and most of them are happy with what they’ve got.” It’s true that single payer would help extend coverage to those who are currently uninsured. But policy makers could already do that by simply expanding Medicaid or providing larger subsidies to low-income Americans.
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For all the attention on various ways to improve Medicaid’s finances and sustainability in recent months, another key area of Medicaid policy that deserves focus is improving the state waiver process. With all the recent calls for bipartisanship, this should be an area where Democrats and Republicans can work together to improve the program.

Medicaid is a state-federal partnership and a critically-important safety net for millions of our nation’s most vulnerable patients. The program dates back to the Great Society era and will cover up to 98 million people and cost taxpayers more than $600 billion this year alone.

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In Part 1, we learned that real per capita health spending saw a 25-fold increase the 8 decades starting in 1929 even as real per capita GDP grew only 5-fold during the same period.

In Part 2, we learned that annual excess growth in inflation-adjusted health spending above and beyond general economic growth has been a persistent phenomenon: from 1929 to 2015, the average rate of growth in real per capita health spending (4.1%) was slightly more than double the rate experienced in the rest of the economy (2%).

Today we will examine the consequences of this outsized growth in health spending: health spending–which includes both spending on health services (“health care”) as well as health insurance–absorbs an ever-growing fraction of the economy and government spending (in this post, my term “health spending” is equivalent to the official government term used by actuaries at the Centers for Medicare and Medicaid Services: National Health Expenditures or NHE: it includes both spending for medical care services/supplies/medications as well as health insurance and the attendant administrative costs borne by health care providers and health insurers; in short, it includes everything).

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A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.

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In Iowa, the state’s sole remaining insurer announced on Thursday that it wants to boost ObamaCare premiums by 57%. This isn’t exactly the vibrant, competitive, low-cost market that Democrats promised. But it is the inevitable outcome of ObamaCare’s government-knows-best approach to health care.

Earlier this year, Aetna and Wellmark Blue Cross & Blue Shield announced that they were pulling out of Iowa’s ObamaCare exchange, leaving only Medica, which was also threatening to leave. Not surprisingly, Medica has used its newfound monopoly status to push for increasingly higher rates, while trying to pin the blame President Trump for the increases.
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A majority of the public (57 percent) want to see Republicans in Congress work with Democrats to make improvements to the 2010 health care law, while smaller shares say they want to see Republicans in Congress continue working on their own plan to repeal and replace the ACA (21 percent) or move on from health care to work on other priorities (21 percent). However, about half of Republicans and Trump supporters would like to see Republicans in Congress keep working on a plan to repeal the ACA.
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The mere existence of ACA insurance policies can’t be the only metric for measuring the success of a major federal program. Another sensible measure of ACA success is the affordability of the policies being sold. For a broad spectrum of middle-aged persons in the middle class, premiums for even the cheapest bronze policy today are, in a majority of rating areas examined, so expensive that people are formally exempt from the individual mandate.

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