What’s behind the huge premium increases on the Obamacare exchanges?

Supporters and opponents offer wildly different explanations and theories. They all pore over the data and get into the details of who is signing up, what the risk pools look like, and other things actuaries find exciting.

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The flurry of announced and rumored mergers in the health insurance sector has focused attention on how the Antitrust Division of the Department of Justice (DOJ) might assess the combination of some (or all) of the big five players (in order of size by revenues: UnitedHealth, Anthem, Aetna, Humana, Cigna).

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Americans who purchase health insurance on the Affordable Care Act’s exchanges should buckle up. Within the month, state regulators will begin approving premium hikes for plans sold in every state. The Centers for Medicare and Medicaid Services (CMS) has already released the premium increases that health insurers have requested for their 2016 plans. By law, insurers must receive regulatory approval for any increase more than 10%—and more than 10% is what many of them want.

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California lawmakers and activists are spearheading a first-in-the-nation plan to let undocumented immigrants buy Obamacare health insurance.
Supporters say the California proposal, which would need federal approval and couldn’t start until 2017, is the next logical step in expanding health insurance to a population that was intentionally excluded from the president’s health-care law. But uniting the two highly combustible issues of Obamacare and immigration could reignite a fierce health-care reform controversy.

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After failing to persuade his Legislature to expand Medicaid, Gov. Bill Walker of Alaska said Thursday that he planned to unilaterally accept the federal funds available to cover more low-income residents under the program.

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Less than three months ago, House and Senate Republicans passed a budget-conference agreement that said, “The conference agreement affirms the use of reconciliation for the sole purpose of repealing the President’s job-killing health care law.” Despite this seemingly clear language, House and Senate leadership have yet to commit to using reconciliation for the purpose of sending to President Obama’s desk a bill that would repeal all or most of Obamacare. But using reconciliation for that purpose would be useful — not because it would actually repeal Obamacare (Obama would simply veto the legislation) but because it would help pave the way to repeal in 2017, by serving as a trial run and helping to confirm Republicans’ resolve.

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The number of individuals on Medicaid, the joint state-federal health care program for low-income families and individuals, is projected to increase by about 14 million as a result of expanded eligibility under the Affordable Care Act (ACA). Since the inception of the Medicaid program, each state has covered roughly one-quarter to half of the cost of its own Medicaid enrollees. Under the ACA, the federal government will bear 100 percent of the cost of expansion through 2016, working down to 90% by 2020 and thereafter. But in reality, a loophole known as the Medicaid provider tax, which allows states to artificially inflate Medicaid costs, will let states milk the federal government for up to 106 percent of the cost of new enrollees. This tax gimmick should be repealed.

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Republican officials, after battling for years with Washington over ObamaCare’s Medicaid expansion, are testing a middle ground that could reshape the program – by making recipients pay for part of their health care.

Indiana has gone the furthest with this plan, but other states are enacting or debating similar measures.

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About 6.6 million U.S. taxpayers paid a penalty imposed for the first time this year for not having health insurance, about 10 percent more than the Obama administration had estimated — though a portion didn’t need to.
The penalty of as much as 1 percent of income was implemented under the Patient Protection and Affordable Care Act, or Obamacare, and was meant to encourage people to sign up for health insurance. The Treasury Department had said in January that as many as 6 million taxpayers would pay the fine.

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Companies are shifting their attention to health coverage for their pre-65 retiree population and exploring the opportunities public exchanges provide this population, now that the Supreme Court has upheld subsides on the federally-facilitated health insurance marketplace.

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