Iowa Insurance Commissioner Nick Gerhart can hardly believe he’s giving some consumers this advice: If you can’t find an affordable, full-fledged health insurance policy, he tells them, maybe you should consider going without one.

The Affordable Care Act started requiring most Americans to have health insurance in 2014. But the law offers an exemption for people who can’t find policies that would cost them less than about 8 percent of their household incomes.

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Massachusetts will be responsible for at least $162 million in new costs over the next decade to fund the federal expansion of health insurance coverage, according to a new report.

The paper from the Pioneer Institute, a free-market-oriented Boston think tank, said that additional spending will squeeze the state budget and divert money from other priorities such as education and transportation.

The costs come in the form of a fee that is part of the Affordable Care Act, which extended insurance coverage to millions of people. The law makes more Americans eligible for Medicaid and provides subsidies to many people on private insurance plans, depending on their level of income. Pioneer said it is the first organization to calculate the long-term costs of the fee.

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As insurers push large premium increases for 2017 Obamacare plans, some of the steepest hikes have been requested by insurers in crucial swing states that could determine control of the Senate.

In nine of 11 states with competitive Senate races, at least one insurer seeks to hike rates for Obamacare customers by at least 30 percent next year: Highmark Blue Cross Blue Shield in Pennsylvania wants to jack up average premiums by more than 40 percent. In Wisconsin, three insurers have asked for rate hikes of more than 30 percent. In New Hampshire, two of the five carriers want to sell plans with rate increase above 30 percent.

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The Affordable Care Act enrollment period doesn’t begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums.

But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services.

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State insurance officials say they are feeling pressure to approve large ObamaCare premium increases to prevent more insurers losing money from dropping out of the market altogether.

Tennessee’s insurance commissioner, Julie Mix McPeak, this week announced the approval of premium hikes of 62 percent, 46 percent and 44 percent, respectively, for the three insurers on the state’s marketplace.

She said her department’s actuaries had found the rate increases to be justified.

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Tennessee’s insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.

The rate approvals, while a tough decision, were necessary to ensure that consumers around the state had options when open enrollment begins in November, said Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance. BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.

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Aetna’s retreat from most ObamaCare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona.

The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year.

State regulators still have until Aug. 23 to try to lure other companies into the marketplace, but it could be a tough sell after one of the nation’s largest insurers decided to pull back because of costs.

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Late Monday evening, health insurer Aetna confirmed a major pullback from Obamacare’s exchanges for 2017. The carrier, which this spring said it was looking to increase its Obamacare involvement, instead decided to participate in only four state marketplaces next year, down from 15 in 2016. Aetna will offer plans in a total of 242 counties next year — less than one-third its current 778. Coupled with earlier decisions by major insurers Humana and UnitedHealthGroup to reduce their exchange involvement, Aetna’s move has major political and policy implications

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There are a lot of people in the U.S. who dream of single-payer health care. And what a dream it is! Government as the only entity paying for care, able to drive down costs while ensuring universal coverage. There are not a lot such dreamers who think that the transition to such a system is imminent here.

Politically, it may be easier to get a single-payer system on the ballot in a blue state than it is to get it onto the floor of the U.S. Congress. But practically, it’s even harder to implement one that doesn’t bankrupt the government and enrage the citizenry. Such an experiment would certainly have effects on health-care policy for the rest of the nation — presumably a swing away from single payer.

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After last year’s 4% rate increase, California’s Obamacare insurance exchange rates appear to be catching up to the rest of the country.

The two biggest carriers are raising rates by much more than the average 13.2% increase. Blue Shield said its average increase was 19.9% and Anthem said it would increase rates an average of 17.2%

According to the LA Times, Covered California officials blamed the big increase on the “rising costs of medical care, including specialty drugs, and the end of the mechanism that held down rates for the first three years of Obamacare.”

Well, once again when it comes to Covered California’s explanations, not exactly.

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