The Iowa Senate gave final approval Tuesday to controversial legislation that would exempt certain health plans from Affordable Care Act mandates.

The legislation combines two proposals backers say would reduce health insurance costs, but critics worry could undermine consumer protections.

Senate File 2349 was approved 37-11, sending it to Gov. Kim Reynolds, whose spokeswoman said she was “eager” to sign it. The measure passed the House last week.

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California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.

In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.

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California Assembly Speaker Anthony Rendon is refusing to advance this year a controversial single-payer health care bill that would dramatically reshape the state’s health care financing and delivery system. Instead, he’s orchestrating an alternative, narrower approach that seeks to achieve universal coverage and make Obamacare more affordable.

Rendon this year gave lawmakers in his house “autonomy to come up with a package” of health care bills, he said in a recent interview. Now, without engaging the other side in the Senate, the Assembly has unveiled a major legislative push on health care that would expand coverage and lower consumer costs while laying the groundwork for a future system financed by taxpayers.

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As the debate continues in Virginia over whether to expand Medicaid, it is crucial to look at what the outcome has been for other states that have already expanded their programs. Thirty-one states have taken this step under the provisions laid out in the Affordable Care Act. The ACA expanded Medicaid eligibility to able-bodied adults below 138 percent of the federal poverty level, and covered 100 percent of the cost of the expansion enrollees for the initial period. That percentage declines, and by the year 2020 the federal government will only cover 90 percent of the cost of expansion enrollees. With funding after that unclear, residents of Virginia will face an unknown future of Medicaid. Given the facts staring back at us, why would any Virginian support expanded coverage?

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Arkansas recently became the third state to receive approval from the U.S. Department of Health and Human Services (HHS) to implement a work requirement for Medicaid adults. The hand-delivered approval follows the department’s endorsement of work requirements submitted by Kentucky and Indiana and comes ahead of action on similar requests from a host of other states, including Arizona, Maine, New Hampshire, Utah, and Wisconsin. Arkansas’s request was among several proposed amendments to the state’s Section 1115 demonstration waiver for its Arkansas Works program, including a proposed income eligibility cap at 100 percent of the federal poverty level (FPL) for the expansion population, which HHS did not approve at this time.

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What does “substantially” mean?

That could be the pivotal question for Idaho, whose chief executives now must justify their plan to let Idahoans buy health insurance in defiance of the Affordable Care Act.

Gov. Butch Otter, Lt. Gov. Brad Little and Idaho Department of Insurance Director Dean Cameron said earlier this year that insurers would be allowed to sell plans that don’t comply with the ACA, also known as Obamacare. They called the plans “state-based” insurance.

Those state officials — relying on legal opinions including those written by lawyers for Blue Cross of Idaho — believe they are “substantially enforcing” the law.

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Promising to build on the Affordable Care Act, a coalition of influential interest groups announced a new legislative push Thursday for a patchwork of measures that aim to make healthcare in California cheaper and more accessible.

Advocates touted a slate of proposals, including expanding Medi-Cal access to adults without legal status and increasing subsidies to those buying insurance on the Covered California exchange, as priorities for this legislative session.

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The only consistent characteristic of the Affordable Care Act (ACA) is its ability to generate litigation. The gift that keeps on giving for Obamacare opponents seems to defy common law doctrines curbing the practices of champerty and maintenance (frivolous lawsuits).

Last month 20 state attorneys general and two governors launched the latest lawsuit in federal district court in Texas, arguing that the upcoming repeal of tax penalties for the ACA’s individual mandate, as of January 2019, means that the entire law has become unconstitutional (or at least a number of its related insurance regulation provisions).

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The Trump administration rejected on Thursday Idaho’s plan to allow the sale of stripped-down, low-cost health insurance violates the ACA. The 2010 statute “remains the law, and we have a duty to enforce and uphold the law,” Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, said in a letter to the governor of Idaho, C.L. Otter. While rejecting Idaho’s plan in its current form, Ms. Verma encouraged the state to keep trying, and she suggested that, “with certain modifications,” its proposal might be acceptable.

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A state Senate panel Monday backed legislation that requires New Jerseyans to buy insurance or pay a fee — a mandate the Trump administration will end in 2019.

The move is a step toward protecting the health insurance marketplace created by the Affordable Care Act, also known as Obamacare.

The federal landmark health care law requires individuals to buy a policy if they do not have one or face a fine at tax time. The law was meant to ensure younger and healthier people who might otherwise forgo insurance will participate in the insurance market and share costs.

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