State Medicaid agencies say Congress’ decision to suspend the Affordable Care Act’s tax on health insurers for one year is a good first step, but they are pushing for its permanent repeal.

While most private health insurance plans have had to pay the tax themselves, states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates. Thirty-eight states and the District of Columbia contract with Medicaid managed-care plans.

Donald Trump had a complete meltdown Thursday night when he got locked in this exchange with Marco Rubio over health care. Rubio kept pressing him on what his plan for health care was, and Trump responded by incoherently talking about getting rid of “the lines around the states.” Essentially, Trump wants to increase competition by allowing insurers to sell plans across state lines without regard to the states’s own insurance regulations.

Setting aside the fact that Trump’s understanding of health care policy is woefully inadequate, his one idea on health care isn’t even a good one. Granted, this is an idea a lot of Republicans have floated and, in theory, increased insurance competition is needed and state insurance regulations are often an impediment to this. But in practice, the idea runs into the buzzsaw of federalism.

Six states filed a new lawsuit Wednesday against the Obama administration over the Affordable Care Act.

The complaint that Texas, Wisconsin, Kansas, Louisiana, Indiana and Nebraska filed in the Northern District of Texas takes issue with the Health Insurance Providers Fee assessed to health insurers to cover federal subsidies.

The lawsuit says nothing in the Affordable Care Act’s language provided clear notice that states would also have to pay the fee.

“This notice was not even provided by rule but was ultimately provided by a private entity wielding legislative authority,” the suit says.

Health Republic Insurance Company of Oregon, a Lake Oswego-based insurer that is phasing down its operations, on Wednesday filed a $5 billion class action lawsuit on behalf of insurers it says were shorted by the federal government under an ObamaCare program.

The lawsuit, filed in the United States Court of Federal Claims, focuses on a program that was intended to offset insurer losses in the early years of the implementation of the Patient Protection and Affordable Care Act.

Instead, payments to insurers under the “risk corridor” program amounted to 12.6 percent of the amount expected for 2014, and are expected to be similarly low for 2015.

Federal law and regulations “are unequivocal about the payments the Government must make,” according to the lawsuit. “The law is clear: the Government must abide by its statutory obligations.”

Funding a problem doesn’t solve a problem. There are ways to make health care more affordable and accessible with less government dependence. For starters, Congress should seriously reconsider the way the program is financially structured so states can be granted more flexibility to devise ways that can improve the value Medicaid brings to its beneficiaries.

The other component involves reducing regulation to make medical care more affordable, like repealing Certificate of Need, permitting mid-level providers to practice within their full scope of authority, exercising right-to-try laws, reducing the number of health insurance benefit mandates, or changing the federal tax code to allow the direct primary care market to expand.

The ObamaCare health exchange in Colorado faced “numerous weaknesses” and had “inadequate security settings,” leaving the personal information of enrollees vulnerable, according to a new audit.

The inspector general for the Department of Health and Human Services publicly released its review of Connect for Health Colorado on Wednesday, revealing the exchange had inadequate security measures in place for more than a year.

The report, which reviewed information security controls as of November 2014, did not go into specifics of Connect for Health Colorado’s vulnerabilities because of the “sensitive nature of the information.”

California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients.

Covered California is working on a proposal that would force the plans to pay commissions effective next year, said Executive Director Peter Lee. The proposed rules could apply to regular and special enrollment periods, and would leave the specific commission amount or percentage up to insurers, he said.

Regulators in other states have warned insurers about altering commissions in a way that discriminates against higher-cost consumers, but Lee said Covered California may be the first exchange to adopt specific rules.

The state’s Kynect health insurance exchange is a financially unsustainable boondoggle that has cost $330 million, Gov. Matt Bevin’s top health officials told lawmakers at the Capitol Tuesday. Additionally, state spending on Medicaid will jump by 20 percent in the next two-year budget, to $3.7 billion, as federal support declines, they said.

“The day of reckoning has come, and we’re going to have to pay the bills,” Health and Family Services Secretary Vickie Yates Brown Glisson told the House budget subcommittee for human services.

People are starting to get excited about another ObamaCare work-around: The section 1332 waiver. This refers to a section of ObamaCare that allows states great flexibility in how they deliver ObamaCare within their borders. The curious thing about section 1332 waivers is that they can only be issued as of January 1, 2017.

Why? Why not allow states to get section 1332 waivers as of October 2010, when ObamaCare’s first regulations took effect? Or January 2014, when the gushers of tax credits began to flow through the exchanges? Who knows? Maybe the administration just thought they needed a few years for the cement around ObamaCare to solidify.

Newt Gingrich and Tom Daschle have co-authored a report on how states can use section 1332 waivers to execute policy preferences either to the left or the right of ObamaCare. Anne Phelps of Deloitte & Touche LLP has also written a report describing the benefits of using a section 1332 waiver.

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.