Congress should enact waiver legislation that clarifies the availability of federal subsidies for the purposes of evaluating waivers’ deficit neutrality, including all potential federal spending that could be offset by a waiver, and evaluates its impact over a long (8-10 year) time period after an initial pilot period. Federal “guardrails” to prevent unintended consequences on patient outcomes and the deficit should focus on collecting data on costs and impact on vulnerable populations, while expanding consumer choices around affordable, high quality plan options.
Congress should also instruct HHS to create a set of standardized, expedited waivers that could be quickly approved, to enhance confidence in the process. Congress should also allow states to form multi-state compacts to share costs and develop the necessary implementation infrastructure.
. . .

Conspicuously absent from most commentary arguing that Kansas should expand Medicaid under the Affordable Care Act is any discussion about the program actually improving the health of recipients. Instead, we are left with terribly materialistic arguments about forgone federal money. Why is it that on the biggest policy questions facing Kansas, such as Medicaid or education, we hear lots about money spent and little about health outcomes or student achievement?
. . .

The idea of turning more power over to the states has long been advocated by conservatives, but there are compelling reasons for liberals to get behind devolving power from the federal government.

When Congress passed the Affordable Care Act in 2010, it left many of the details to the discretion of the Department of Health and Human Services, giving vast powers to the secretary to determine everything from fast-food menu labeling requirements to when individuals could purchase insurance. During the Obama years, the administration used its regulatory discretion — pushing and arguably exceeding the limits of the law — to prop up the president’s signature legislative accomplishment as the program ran into implementation problems.

. . .

It’s worth reading the Graham-Cassidy bill. It would repeal the individual and employer mandates of the Affordable Care Act, impose per capita caps on Medicaid, increase contributions to health-savings accounts, allow states to waive regulations on private insurance providers, and provide those states with block grants so they can design their own health-care systems.

If the bill became law, it would therefore be a genuine federalist triumph. A large portion of the federal money now set to fund the Medicaid expansion and subsidies of the Affordable Care Act would be instead distributed to individual states. Each state would have the freedom and means to develop its own health-care system. Reasonable people disagree over how best to design a health-care system, and under Graham-Cassidy, their ideas could be tested without causing a nationwide catastrophe and the disruption of a vital service.
. . .

Anthem announced Friday that it would fill Virginia’s 63 counties that were slated to have no ObamaCare insurers on the exchange next year.

Anthem initially announced it wouldn’t sell plans in Virginia in 2018, but backtracked Friday to cover the so-called bare counties.

“Since learning that 63 counties and cities in Virginia would not have access to Individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in the state,” Anthem said in a statement Friday.

. . .

Half of Virginia’s counties now are on track to have no health insurers offering Obamacare plans in 2018 after an insurer reversed a decision to sell individual health coverage in much of the state.

The pullback by Optima Health in Virginia ends a brief, two-week period in which every county in the United States was projected to have at least one Obamacare insurer next year.

. . .

Ohio Gov. John Kasich on Friday said that some of the essential health benefits that had been set up under Obamacare were too limiting to customers, proposing that someone have the option to buy a plan that excludes maternity coverage while explaining his decision to mandate autism coverage in his state.

Kasich, a Republican, was appearing in a panel in Washington alongside Colorado Gov. John Hickenlooper, a Democrat with whom he has been working on an Obamacare stabilization plan to lower the costs of premiums and give customers more choices for health insurance plans.

. . .

California and several other states will exempt themselves this year from a new Trump administration rule that cuts in half the amount of time consumers have to buy individual health insurance under the Affordable Care Act.

In California, lawmakers are contemplating legislation that would circumvent the rule in future years, too.

The Trump administration’s rule gives people shopping for 2018 coverage on the federal exchange 45 days to sign up, from Nov. 1 through Dec. 15.

. . .

A group of 11 states and the District of Columbia running their own Obamacare exchanges want more federal funding to stabilize exchanges facing higher premiums and insurer defections.

The states wrote to leaders of the Senate Health, Education, Labor and Pensions Committee with their ideas on Tuesday. Those include guaranteeing insurer payments and establishing a permanent reinsurance fund to help insurers.

. . .

Govs. John Kasich of Ohio (R) and John Hickenlooper of Colorado (D) announced Monday that they have reached an agreement on a bipartisan proposal to stabilize ObamaCare markets.

The governors, who have been calling for bipartisanship on healthcare in a series of recent interviews, are not yet releasing the details of their stabilization plan.

. . .