The Patient Protection and Affordable Care Act is the law of the land and will likely continue to be for some time, despite opponents’ best efforts to get it thrown out in court.

But what the law will look like a few years down the line is anybody’s guess. In fact, the landmark legislation has already been changed significantly since it was originally enacted more than five years ago.

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Mercy will be the 58th rural hospital to close in the United States since 2010, according to one research program, and many more could soon join the list because of declining reimbursements, growing regulatory burdens and shrinking rural populations that result in an older, sicker pool of patients. The closings have accelerated over the last few years and have hit more midsize hospitals like Mercy, which was licensed for 75 beds, than smaller “critical access” hospitals, which are reimbursed at a higher rate by Medicare.

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A new breed of health insurers created under the Affordable Care Act — representing one of the government’s most innovative attempts in decades to foster better coverage — is on shaky financial ground in many of the 23 states where the plans began.

The nonprofit health plans were envisioned as a consumer-friendly counterweight to for-profit insurers, a way to provide more competition, greater consumer choice and better coverage in markets typically dominated by big commercial carriers. The government allocated billions of dollars in loans for them.

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Health insurers that lost millions of dollars last year under the Affordable Care Act may wait years for the government to deliver the aid it promised them.

Companies, including Downtown-based insurer Highmark, want about $2.87 billion to help cover their first-year losses from online insurance marketplaces — a centerpiece of the landmark health care law. But a federal relief program meant to limit their risk is more than $2 billion short, leaving the companies to collect only 12.6 percent of those requests late this year, the Centers for Medicare & Medicaid Services said this month.

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In 2009 and 2010 President Barack Obama and Health and Human Services Secretary Kathleen Sebelius designed and championed the largest expansion of the welfare state since the New Deal with little more than political force and broken promises. While the American people are forced to accept Obamacare until it can be repealed, the Supreme Court empowered states to accept or reject Obamacare’s Medicaid expansion. So far 20 states have said no.

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President Obama signed a small but significant bill this week that rolls back a requirement in his signature health law, the Affordable Care Act. Last week, Congress voted on bipartisan lines to repeal a small group insurance markets rule that was slated to go into effect in 2016. Many business groups said that without the change, premiums would have gone up for millions of workers.

Enactment of the bill was a small victory for Obamacare critics, but it could also pave the way for new, piecemeal approach to repealing Obamacare.

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The state approved a 27.3 percent rate hike for Hawaii Medical Service Association members and 34.4 percent increase for Kaiser members in Obamacare plans for 2016.

HMSA, the state’s largest health insurer, had proposed an average 49.1 percent rate hike — the highest it has ever requested — for 20,935 members in Obamacare plans next year. Kaiser proposed to raise rates 8.7 percent for 13,000 Obamacare plan members in 2016.

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A Daily Caller News Foundation analysis found multiple factors contributed to the Nevada co-op’s termination, including political cronyism, insider dealing and the lavish lifestyles of key executives. The Las Vegas Review-Journal called it a “toxic mix.”

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Consumers shopping on the government’s health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document.

A slide presentation dated Sept. 29 says HealthCare.gov’s window-shopping feature is getting a major upgrade. Window shopping is a popular part of the website that allows consumers to browse for taxpayer-subsidized health insurance plans. A copy of the document from the CMS was provided to the Associated Press.

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President Obama signed a bill Wednesday night making an important change to Obamacare that will prevent health insurance premiums for 3 million people from going up next year.

The Protecting Affordable Coverage for Employees Act seems like an unlikely Washington success story: A bipartisan health care bill passed by both chambers without a single no vote and signed by the president with no controversy or fanfare.

Except it’s actually not that unusual. For all the raucous debate over repealing Obamacare, such technical fixes can happen. Since the Affordable Care Act was first passed along party lines in 2010, President Obama has signed at least 14 bills making substantive changes in his signature legislation of his presidency, according to an analysis by the Congressional Research Service. Eight of those have been Republican bills.

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