HONOLULU (AP) — Hawaii officials are scrambling to provide information to the federal government to satisfy concerns about financial problems at the state’s health exchange.

All state-run insurance exchanges that are part of President Barack Obama’s Affordable Care Act are supposed to be financially sustainable this year. But without an infusion of cash, the Hawaii Health Connector won’t have enough money for its operations. The Legislature hasn’t yet approved the organization’s request to issue $28 million in bonds or loans.

Without a solid path to sustainability in place, the federal government is telling the state it may have to eventually move some technology functions to a federal system, said Jeff Kissel, CEO of the Hawaii Health Connector.

“This is a contingency that is being imposed on any state-based exchange that doesn’t have a funded sustainability plan in play,” Kissel said. “I don’t know of any other exchanges that are having to do this because it seems to me that everyone else is funded.”

The landmark 2006 Massachusetts health-care law that inspired the federal overhaul didn’t lead to a reduction in unnecessary and costly hospitalizations, and it didn’t make the health-care system more fair for minority groups, according to a new study that may hold warnings for the Affordable Care Act.

Massachusetts’ uninsured rate was cut by half to 6 percent in the years immediately following the health-care law signed by then-Gov. Mitt Romney. Blacks and Hispanics, who have a harder time accessing necessary medical care, experienced the largest gains in insurance coverage under the Massachusetts law, though they still were more likely to be uninsured than whites.

The new study, published in the BMJ policy journal, examined the rates of hospitalizations for 12 medical conditions that health-care researchers say wouldn’t normally require hospitalization if a patient has good access to primary care. These include hospitalizations for minor conditions like a urinary tract infection, or chronic conditions that would require repeat primary care visits over the course of a year.

“It’s thought to be a good measure and one of the few objective ways of looking at access [to health-care provider] in the community,” said Danny McCormick of Harvard Medical School, the study’s lead author.

The New York legislature voted down Gov. Andrew Cuomo’s proposal to tax health insurance policies to fund the state’s Obamacare exchange, calling the fees system used by the Obama administration and other states counterintuitive.

The shrinking number of state-run Obamacare exchanges are facing a new problem this year — how to fund their ongoing operations now that start-up grants from the federal government are running out.

In New York, like many other states, Cuomo proposed a tax on health insurance premiums to fund the state-run exchange’s operations. That tactic comes with its own concerns: some states, such as Hawaii, have smaller-than-expected enrollment and the per-policy fees aren’t bringing in enough money.

Rhode Island is considering adopting a tax itself, but due to small enrollment in the tiny state, fees per Obamacare enrollee would likely climb higher than $30 every month, according to Modern Healthcare. Even California, which boasted the highest enrollment of any state in 2014 (but has recently been dethroned by Florida), has had to raise its monthly premium tax.

But according to the New York Post, members of New York’s state legislature refused the extra tax on premiums because the plan would drive up the cost of health insurance for Obamacare customers, defeating the purpose of the exchange and its often-subsidized coverage.

Coping with ever-increasing medical bills is frustrating — and getting more so..

A recent survey by private health insurance exchange EHealth highlights the pressure Americans are feeling. It found that more than 6 in 10 people say they’re more worried about the financial effect of expensive medical emergencies and paying for healthcare than about funding retirement or covering their kids’ education.

People who get health insurance through work and on their own have seen their costs rise dramatically over the last decade.

According to the Commonwealth Fund, a New York think tank, annual increases in work-based health plan premiums rose three times faster than wages from 2003 to 2013. Out-of-pocket costs have also been climbing.

“More people have deductibles than ever before,” says Sara Collins, a Commonwealth Fund vice president. From 2003 to 2013, the size of deductibles has grown nearly 150%.

Whether a person is coping with a severe illness or trying to deal with everyday medical costs, the challenges are many.

(Reuters) – Arizona Republican Governor Doug Ducey signed a law on Monday that requires doctors to tell women that drug-induced abortions can be reversed and that blocks the purchase of insurance on the Obamacare health exchange that includes abortion coverage.

The requirement that patients be told that the effects of abortion pills may be undone by using high doses of a hormone was the most hotly contested provision during legislative debate.

Supporters said there was ample evidence the reversal was possible if acted upon quickly, although they provided no peer-reviewed studies in support of their position.

When the Supreme Court drops its big ObamaCare ruling this summer, Republican leaders say they will be fully ready to step in — even if it won’t be the party’s official replacement plan.

“We have to be prepared, by the time the ruling comes, to have something. Not months later,” House Ways and Means Committee Chairman Paul Ryan (R-Wis.) told reporters this week.

Ryan said he plans to have a bill ready — and priced by the Congressional Budget Office — by late June when a ruling for King v. Burwell is expected. The GOP-backed case, which threatens to erase people’s subsidies in about three-quarters of states, has tremendously high stakes.
“There are going to be 37 states immediately impacted, or presumably impacted, and that’s something that deserves an immediate response,” Ryan told reporters.

He declined to provide details about the plan that he and other GOP chairmen are drafting, but said it would offer “freedom” and “more choices” for any ObamaCare customers who loses their subsidies. Until the ruling, he said King v. Burwell will be one of his top three agenda items.

Breaking with normal tradition, we’re going to open this week’s update with national trends before moving into updates at the federal and state levels. This week there was an interesting report from the Kaiser Family Foundation that estimated that 50 percent of households receiving financial assistance to purchase private health insurance on the Marketplaces will have to return a portion of that subsidy when they file their tax returns as part of the tax credit reconciliation process. Repayments will, in most cases, be deducted from an enrollee’s refund check and the Kaiser report estimates that the average repayment will be $794. Roughly seven percent of enrollees could owe a repayment of between $2,000 and $5,000 and two percent could have to repay more than $5,000. A slightly smaller percentage of households, 45 percent, are estimated to receive additional money with their tax refund because they received underpayments in tax credits, with the average refund estimated to be $773. Kaiser’s report comes the same week as an unrelated but equally insightful analysis from Avalere found that for Open Enrollment 2 (OE2), ACA Marketplaces were primarily successful in enrolling lower-income persons eligible for subsidized coverage. The report found that as a person’s income went up, they were less likely to enroll in ACA coverage through a Marketplace, with only two percent of persons eligible for Marketplace coverage, but earning more than the amount to receive a subsidy, enrolled in a plan through a Marketplace.

With many Marketplaces and the Federally-facilitated Marketplace currently offering a Special Enrollment Period (SEP) for those currently uninsured who did not have health coverage in 2014 and are subject to the “shared responsibility payment” when they file their 2014 taxes, there have been few updates on how many eligible persons are taking advantage of this opportunity to gain coverage. However, over the weekend Mark Ciaramitaro, a vice president of health-care enrollment services at H&R Block, told the Wall Street Journal “that a significant percentage of taxpayers whose household members were not covered for at least a portion of 2014 are opting” to pay the penalty for not having coverage and not demonstrating an interest in signing up for 2015 coverage.

During a 2014 Valentine’s Day meet-up with House Democrats, President Obama thanked them for their unstinting support of the Patient Protection and Affordable Care Act. “I think,” he said, “10 years, five years from now, we’re going to look back and say this was a monumental achievement.”

Well, the president’s health care law marks its fifth anniversary this week. And most Americans are not, in fact, looking back and saying the law enacted in 2010 – with not one Republican vote in either the House or Senate – was a monumental achievement.

Indeed, in an NBC News/Wall Street Journal poll this month, a 44-34 plurality of respondents thought Obamacare a “bad idea.” And a 62-22 percent majority said that what they had seen, read or heard in recent weeks about the Affordable Care Act had made them “less confident” about the law.

Some suggest the public’s misgivings about Obamacare are almost entirely attributable to GOP opposition to the law. In a statement Monday, Democratic National Committee Chairwoman Debbie Wasserman Schultz noted that “Republicans have voted more than 50 times to repeal or undermine this critical law.”

The Affordable Care Act (ACA), like President Clinton’s health plan in the 1990s, made the mistake of trying to achieve coast-to-coast health care coverage with a system that essentially looks the same everywhere. That approach was always going to be a challenge. US health care is an enormous and complex economy in its own right. If the US health system were a separate national economy, for instance, it would be the fifth largest economy in the world – larger than the entire economy of France or of Britain. The idea that a single piece of legislation could successfully reorganize the world’s fifth largest economy was a fantasy, especially when the bill had to go through the congressional sausage-making machine.

It’s true that the ACA gave Americans a choice of plan on federal or state-run exchanges. But the ACA still sought a template for insurance rules, benefits and other structural features that would be the same from Vermont to Texas and Florida to Alaska. That was unwise. The continuous political warfare since the enactment of the legislation reflects the fact that different parts of the country have very different views of how health care should be organized.

ObamaCare is celebrating its fifth anniversary, but few Americas are cheering.

The Real Clear Politics average of the latest major opinion polls about the health law shows that 52.5% oppose it and only 42% approve. The 10.5% spread is identical to the average of polls taken when the law was signed five years ago. Approval numbers never have topped disapproval numbers since the law was enacted. It is not getting more popular and it is not settled law, as President Obama claims.

President Obama is touting the increased number of people who have health insurance as a result of the law. According to Gallup, the uninsured rate among U.S. adults averaged 12.9% in the fourth quarter of last year. The uninsured rate was 14.4% the year before the health law passed, also according to Gallup.

So our health sector has been thrown into turmoil, millions of people have lost their private health plans, $1 trillion in new and higher taxes have been imposed on individuals and businesses – and the uninsured rate has dropped a net of 1.5%.