Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.

The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.

Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.

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House Speaker Paul Ryan’s policy plan for health care, as expected, leans heavily on market forces, more so than the current system created by Obamacare. The proposal contains a host of previously proposed Republican ideas on health care, many of which are designed to drive people to private insurance markets.

Importantly for conservatives, as part of a full repeal of the Affordable Care Act, the current law’s mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage. The plan also would alter Medicaid by implementing either per capita caps or block grants, based on a state’s preference.

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Alaska, one of the reddest states in the country, is essentially bailing out its insurance market to prevent Obamacare from collapsing.

A bill passed by the heavily GOP state Legislature to shore up its lone surviving Obamacare insurer is awaiting the signature of Gov. Bill Walker, a Republican-turned-independent who was endorsed two years ago by former vice presidential candidate Sarah Palin. The legislation, originally proposed by Walker, sets up a $55 million fund — financed through an existing tax on all insurance companies — to subsidize enrollees’ costs as the state struggles with Obamacare price spikes and an exodus by all except one insurance company.

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The White House is urging states to be more aggressive against health insurance companies as it looks to prevent expected and widespread premium hikes of 10 percent or more this year.

The federal health department announced Wednesday that it will dole out about $22 million to boost state-level “rate reviews,” considered one of the strongest weapons against premium increases.

Under the system, health insurers are required to justify rate increases to state insurance departments, some of which have the power to reject “unreasonable” increases. With the new funding, federal health officials hope states can hire outside insurance experts to dig deeper into the proposed rates and prove the hikes are unjustified.

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Sen. Rob Portman (R-Ohio) released a letter to the Obama administration on Thursday asking what it will do to help Ohioans who received coverage from a failed Obamacare co-op.

Last month the nonprofit co-op InHealth announced that it would be liquidated and taken over by the state. It provided health coverage to about 22,000 state residents. In his letter, Portman said those enrollees now must choose between getting new insurance and starting over paying a new deductible, or paying the tax penalty for not having health insurance.

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Maryland’s health cooperative filed a lawsuit Monday seeking to block the federal government from requiring it to pay more than $22 million in fees for a program designed to cover insurance company shortfalls.

The lawsuit by Evergreen Health Cooperative Inc. is the latest twist in the saga of health insurance co-ops set up under the Affordable Care Act to compete against larger, established insurers.

The co-ops were supposed to help keep premiums down by injecting competition into the industry. Instead, 13 of 23 startups that launched successfully have since collapsed, forcing more than 700,000 consumers to seek new insurance. A number of co-op officials have said they were hurt by the federal program because of a formula it used to spread out risk, which they say hurts them while benefiting large, already established insurance companies.

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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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Insurance companies participating in Delaware’s health insurance exchange under the Affordable Care Act are seeking average rate increases of about 24 percent or more for next year, state officials revealed Thursday in acknowledging the potential sticker shock for consumers.

In a rate filing with the Delaware Department of Insurance, Highmark Blue Cross Blue Shield of Delaware is asking for an average rate increase of 32.5 percent for individual plans. Rate increases would vary by plan and would range from 24.1 percent to 35.8 percent.

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California is moving to become the first state to allow unauthorized immigrants to purchase insurance through the state exchange. The state Assembly voted Tuesday to open up Covered California to immigrants living in the U.S. illegally who want to purchase a health plan with their own funds.

SB 10, sponsored by Democratic state Sen. Ricardo Lara from southeast Los Angeles County, would authorize the state to apply for a federal waiver to make the change. The state Senate voted to pass the measure last June and an April staff report from Covered California also expressed support for the move.

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UnitedHealthcare will stop offering Affordable Care Act plans in Illinois in 2017, the Tribune confirmed Tuesday.

The departure of the insurance company will reduce the number of coverage options for consumers in 27 counties.

UnitedHealthcare announced in April that it would pull out of nearly all of the ACA exchanges because of heavier-than-expected losses from covering a population that turned out to be sicker than it expected. The ACA plans, which the company offered in 34 states this year, are a small share of UnitedHealthcare’s total business.

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