KEY FINDINGS

  • At least 70% of the recent slowdown in health care spending per capita—and possibly as much as 98%—can likely be explained by long-standing patterns known to affect health care spending trends, not by new, unexplained conditions in the medical sector.
  • Breaking down those figures, roughly 41% of the slowdown probably resulted from the decline in real per capita income because of the Great Recession.
  • Other factors known to affect health care spending growth—such as changes in the number of physicians and hospital beds per capita and in the percentage of the population with insurance coverage—account for somewhere between 32% and 57% of the slower health care spending growth.
  • The projected expansion of Medicaid coverage owing to the ACA will likely raise national health care spending in 2019 to about 1% higher than it would have been without the expansion.

The fed­er­al gov­ern­ment is poised to start mak­ing state-based ex­changes pay for us­ing Health­Care.gov’s tech­no­logy, and that has some states mulling the pos­sib­il­ity of shar­ing ser­vices with oth­ers to con­trol costs.

The Cen­ters for Medi­care and Medi­caid Ser­vices pro­posed a rule last year re­quir­ing that cer­tain states es­sen­tially “lease”Health­Care.gov through a user-fee rate of 3 per­cent of the monthly premi­um the is­suer charges for each policy plan—mean­ing that, for the first time, us­ing the fed­er­al plat­form for state-based mar­ket­places won’t be free.

Last month, mar­ket­place of­fi­cials from sev­er­al states gathered in Port­land, Ore­gon to dis­cuss the rule, in­creased col­lab­or­a­tion, and long-term mar­ket­place af­ford­ab­il­ity and sus­tain­ab­il­ity.

After the passage of the Affordable Care Act, the federal government gave Oregon $300 million to build an online health insurance exchange. The state then hired Oracle, the world’s second-largest software company, with profits of nearly $10 billion last year, to build the website.

The website never worked. In May 2014, then-Gov. John Kitzhaber, who was running for re-election and getting a lot of heat for Cover Oregon’s failure—asked Attorney General Ellen Rosenblum to sue Oracle.

For nearly two years, Oracle has been in a bruising, $5.5 billion legal battle with the state of Oregon over who is at fault for Cover Oregon, the failed $300 million health insurance website.

The decision states face of whether to expand Medicaid to non-disabled, working-age, childless adults—the Affordable Care Act primary expansion population—involves tradeoffs. These tradeoffs include higher taxes, reduced spending on items like education, transportation, or infrastructure, or reduced spending on other Medicaid populations such as the disabled, children, or the elderly. The ACA funding formula allows states to pass a much greater share of the costs of covering non-disabled childless adults to federal taxpayers, but the tradeoffs still exist.

Kentucky’s new Republican governor, Matt Bevin, has notified the Obama administration that he plans to dismantle the state’s ObamaCare marketplace. Bevin, who was sworn in last month, promised to scrap the marketplace, called Kynect, as part of his campaign, but he is now making it official. Bevin’s office said in a statement to WFPL News in Kentucky that having the state run the marketplace is a “redundancy.”

A recent about-face by the Obama administration on so-called “state innovation waivers” may be the most important change to ObamaCare that no one is paying attention to. These waivers, which will begin in 2017, allow states to take a block grant of funding and waive nearly every major component of the law. A major change, however, is now set to make these experiments mostly impossible. In recent guidance, stealthily released at the close of business on a Friday last month, the Department of Health and Human Services announced that the rules are changing.

Wyoming Gov. Matt Mead announced last month that he would spend the next few months advocating for ObamaCare’s Medicaid expansion in next year’s budget. But so far, Wyoming legislators have taken a thoughtful approach, carefully reviewing all of the evidence and ultimately rejecting ObamaCare expansion. Just 26 out of 90 lawmakers supported the issue during the last legislative session. With expansion costs exploding in other states and federal funding now on the chopping block, it’s clear that their decision was the right one.

In most states, health insurance premiums on the individual marketplace are rising by double digits under Obamacare. 17 states will face average premium increases of 20% or more. Iowans, for instance, will see their premiums spike by 22% this year. In Minnesota, Alaska, Tennessee, and Hawaii, rates will rise by 30% or more.

Want to know where your state ranks? FreedomWorks has calculated the average rate hike and the range of premium changes individuals purchasing insurance on the individual market will face. Click below to read more.

UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for ObamaCare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.

In states like New York, health insurers participating in ObamaCare negotiate annually with regulators to set prices for coverage. UnitedHealth’s rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company’s northeast region chief executive officer, said Wednesday. If the loss of a participant reduces the funds available to UnitedHealth, the company’s rates in New York’s ObamaCare market may be insufficient, he said.

Are New Yorkers looking at a health insurance tax to pay for the more than $200 million in unpaid doctor and hospital bills remaining after the collapse of the state’s consumer-run nonprofit insurance co-op? Or could that money come from the billions in bank settlements that have flowed to state coffers in recent years?

Those are among the questions that lawmakers and Gov. Andrew Cuomo will likely be debating in the upcoming legislative session. Also unclear is the future status of the approximately 215,000 New Yorkers who had low-cost health insurance policies through the short-lived Health Republic co-op.