California Governor Jerry Brown signed a bill into law allowing unauthorized immigrants to buy health insurance on a state exchange created under the U.S. Affordable Care Act, making the state the first in the country to offer that kind of coverage.

The law lets the state request a waiver from the federal government that will be needed to allow unauthorized immigrants to purchase unsubsidized insurance through Covered California, the state’s healthcare exchange.

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Many people contend that we should not worry about the premium rate shock because the ACA insulates most people from gross premiums. The oft-repeated idea is that the ACA basically requires only that people pay a percentage of their income in premiums. So, unless income goes up, a person’s net premium stays the same.

Reporters, pundits and bloggers should stop accepting or repeating this contention. Gross premium increases can matter a lot.

It is true that if you earn less than 400% of the applicable federal poverty level AND you purchased the second lowest silver plan the year before AND you continue to purchase the second lowest silver plan the following year, then your net premiums don’t go up even if the gross premium rises astronomically.

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Millions of people who pay the full cost of their health insurance will face the sting of rising premiums next year, with no financial help from government subsidies.

Renewal notices bearing the bad news will go out this fall, just as the presidential election is in the homestretch.

“I don’t know if I could swallow another 30 or 40 percent without severely cutting into other things I’m trying to do, like retirement savings or reducing debt,” said Bob Byrnes, of Blaine, Minnesota, a Twin Cities suburb. His monthly premium of $524 is already about 50 percent more than he was paying in 2015, and he has a higher deductible.

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The Geisinger Health Plan foresees health costs rising 7.5% next year, but requested a 40% rate increase. The plan, which is run by one of the nation’s top-rated health organizations, underestimated the cost of covering the newly insured under ObamaCare. “Our rates for Medicare, Medicaid and employer-sponsored insurance have been relatively stable, but those products have to bear the cost of our losses on exchange business,” Kurt Wrobel, Geisinger’s chief actuary, said. Many insurers are struggling to find the best ways of providing care to their new customers as they prepare for the fourth year of coverage under ObamaCare.

Last month, the Kaiser Family Foundation released the results of its 2016 survey of 671 people who purchased individual market plans compliant with the new mandates and rules established by the Affordable Care Act (ACA). As many insurers announce large premium hikes for next year and others announce they are withdrawing from the market, the survey reveals that enrollees are increasingly unhappy with their coverage. Given that these enrollees are one of the primary groups that the ACA is supposed to be helping, their declining satisfaction is particularly concerning and suggests a change of direction in federal policy is warranted.

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The Affordable Care Act’s employer mandate has at least modestly led to a rise in involuntary part-time employment, according to a Goldman Sachs study released Wednesday.

“We would estimate that a few hundred thousand workers might be working part-time involuntarily as a result of the Affordable Care Act,” said Alec Phillips, an economist at the investment bank, in a research note.

This is only a fraction of the 6.4 million workers employed part-time for economic reasons, he said, but would be a significant share of the “underemployment gap.”

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Kentucky Governor Matt Bevin is making good on his campaign promise to close the doors on Kynect, the state’s Obamacare exchange. While Democratic former Governor Steve Beshear and a handful of Obamacare supporters have made waves about that decision, it has raised a bigger question: Does it make sense to run a state-based exchange?

Kynect is causing higher premiums for most residents of Kentucky, is not fiscally sustainable, and serves almost exclusively as a channel for Medicaid enrollment — Gov. Bevin is prudent to push to switch to the federal exchange.

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Obamacare supporters will say that increasing premiums don’t matter because anyone getting a subsidy has their premium share capped and they are therefore insulated from these prices and the follow-on big rate increases. The worst that can happen to them is that they will have to shop for a lower cost plan.

Those shoppers may well have to settle for plans with bigger deductibles and narrower networks to keep their premiums flat.

But the bigger thing this argument is missing is that half of the individual market does not get a subsidy in order to buy Obamacare health plans. The CBO has estimated that in 2017 both on and off the exchanges 12 million will get subsidies and 12 million won’t.

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The Senate spending bill to fund the Department of Health and Human Services and the Labor Department in 2017 will maintain Affordable Care Act funding, according to a senior GOP aide.

“We will fund all of the things we need to fund to try to keep it bipartisan,” the aide told Morning Consult, adding that this means some Republicans, specifically Sen. Ted Cruz (R-Texas), will accuse appropriators of funding Obamacare.

The Senate’s Appropriations subcommittee on labor and health will vote on the proposal Tuesday. The full committee is slated to advance the bill on Thursday.

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Blue Cross and Blue Shield of North Carolina sued the federal government, becoming the latest health insurer to claim it is owed money under the Affordable Care Act.

The suit, filed on Thursday in the U.S. Court of Federal Claims in Washington, D.C., says the U.S. failed to live up to obligation to pay the insurer more than $147 million owed under an ACA program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets.

The suit argues that the federal government violated the language of the health law, as well as a contractual obligation to the North Carolina insurer.

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