As Congress works to repeal President Barack Obama’s signature health law, Kentucky Republican Gov. Matt Bevin is already at work unwinding some of its provisions in his state.

Mr. Bevin has dismantled the state’s health-insurance exchange, moving patients to the federal website last year. He has proposed introducing new conditions for recipients of Medicaid, the federal-state health program for the poor, that would require patients to pay premiums of up to $15 a month and perform employment-related or community-service activities, among other provisions

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Blue Cross and Blue Shield of Kansas City announced yesterday it has decided to exit the Obamacare exchange next year. The decision affects about 67,000 Blue KC customers in 30 counties in western Missouri as well as Wyandotte and Johnson counties in Kansas. Danette Wilson, Blue KC’s president and CEO, said that the company has lost more than $100 million total on its exchange plans since the ACA rolled out in 2014.

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The Department of Health and Human Services on Tuesday released a checklist for states that choose to seek waivers from certain Obamacare requirements.

Through the waivers, commonly known as “innovation waivers” or 1332 waivers, states can ask the federal government to allow them to set up high-risk pools, reinsurance programs or another proposal that would reduce costs for customers or allow for more people to be covered.

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Republicans finally hit a home run with a 217-213 vote Thursday to pass a health care bill that will help millions of struggling Americans. They proved they can govern. Yet one of Republicans’ most notable successes is so far getting too little recognition. GOP negotiators embraced the only model that can ultimately see this bill successfully to President Trump’s desk: states’ rights. The compromise is far from perfect—concocted, as it was, under pressure, and with dozens of competing interests in the room. The Senate offers Republicans an opportunity to do much better by building on the idea’s model of states’ rights.
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The MacArthur amendment focuses on an idea that’s core to Republicans’ DNA: federalism.  That’s a positive step forward.  But what still seems to be lacking is a strategic roadmap for what Congress and the Administration should be trying to achieve.  By laying out this roadmap, the Administration can bridge the gap between Republican moderates and conservatives, and possibly open up a much-needed dialogue with centrist Democrats.

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The Trump administration appears to have scrapped one of the key tools the Obama administration used to encourage states to expand Medicaid under the Affordable Care Act.

The shift involves funding that the federal government provides to help hospitals defray the cost of caring for low-income people who are uninsured. Under a deal with Florida, the federal government has tentatively agreed to provide additional money for the state’s “low-income pool,” in a reversal of the previous administration’s policy.

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Congressional Republicans have called for restructuring Medicaid, reviving a debate that has largely remained dormant for two decades. During the mid-1990s, Congress and President Clinton advanced competing Medicaid reform proposals. Republicans urged that the federal government issue Medicaid block grants to states. The White House and congressional Democrats proposed instead to place per capita limits on federal Medicaid payments to states. The most salient difference between these approaches is that per capita allotments retain the individual entitlement to Medicaid while block grants generally do not. Today, Republicans who once resisted Medicaid per capita allotments support them, and Democrats who backed such allotments oppose them. Given this legislative history, policymakers seeking common ground might look to Medicaid per capita allotments as a point of departure.

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As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients, a move that industry analysts say is critical to keeping premiums affordable for plans sold on the law’s online marketplaces in 2018.

This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums.

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It looks like House Republicans have been trying over the past few days to coalesce around a revised version of the AHCA. One key revision has involved a more assertive temporary federal reinsurance scheme to quickly lower premiums and stabilize the transition period to a new system. But maybe the most significant, and least familiar, new proposal has involved allowing states to obtain waivers from some Title I regulations in Obamacare.   The devil will be in the details, and they will matter enormously here, but the general concept of returning regulatory power to the states through waivers that are connected to the bill’s spending measures is an interesting way to deal with the constraints Republicans confront and could have real promise.

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Now that House Republicans have squandered their shot at reordering Medicaid, governors who want conservative changes in the health program for ­low-income Americans must get special permission from the Trump administration.

Near the front of the line is Wisconsin Gov. Scott Walker, a Republican who not only supports work requirements and premium payments but also a new additional condition: to make applicants undergo a drug test if they’re suspected of substance abuse.

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