King vs. Burwell is on the horizon. If the plaintiffs are successful, so goes the theory, subsidies end in 37 exchanges operated by the Department of Health and Human Services and serviced by HealthCare.gov. Coverage gets more expensive, and people won’t be able to afford their policies.

But, this outcome was foretold all the way back in the Senate mark-up of the proposed ACA legislation. Purposely requiring subsidies in state-run exchanges remains the incentive for states to set them up. The administration did not expect so many states elected not to set up their own exchanges, and it is now a big problem. As was noted in 2009 by critics of the bill, if states don’t hand out subsidies, people won’t be able to afford to buy coverage.

In the health savings account industry, the problem is compounded. The ACA law also created a perpetual rule change engine.

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The fight over ObamaCare’s Medicaid expansion escalated Monday, as Texas’s Republican governor backed a lawsuit from Florida fighting the expansion effort.

Last week, Florida’s Republican Gov. Rick Scott announced he would sue the Obama administration over what he calls an effort to force the state to expand Medicaid under ObamaCare.

Texas’s Republican Gov. Greg Abbott on Monday announced his support for the lawsuit.

“When the federal government exceeds its constitutional authority, the States must take action,” Abbott said in a statement. “[I] commend Governor Rick Scott’s decision to take legal action to protect these important constitutional principles.”

At issue is the Obama administration move to link Florida’s rejection of a Medicaid expansion to separate federal funding that helps hospitals in the state care for the uninsured.

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During the 2008 financial crisis, “too big to fail” became a familiar phrase in the U.S. financial system. Now the U.S. health-care system is heading down the same path with a record number of hospital mergers and acquisitions—95 last year—some creating regional monopolies that, as in all monopolies, will likely result in higher prices from decreased competition.

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(Reuters) – If the U.S. Supreme Court blows up the tax subsidies at the heart of Obamacare in June, Republicans hope to deliver on their promise to offer an alternative healthcare plan.

But key parts of it may resemble the one President Barack Obama delivered five years ago in the Affordable Care Act, partly reflecting Republican concerns that they could pay a political price if insurance subsidies are yanked from millions of Americans later this year.

Two front-running Republican options at an early stage in Congress include a refundable tax credit that experts say is virtually the same thing as the Obamacare tax subsidy being challenged before the Supreme Court. Republicans deny that their ideas are tantamount to “Obamacare Lite” but acknowledge they will need bipartisan support for their plans to stand any chance of avoiding an Obama veto.

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Today the Competitive Enterprise Institute (CEI) released a report by finance expert Scot Vorse that shows many states knew as early as 2011 that they might not receive tax credits if they opted out of establishing a state-based health insurance exchange. Whether nonparticipating states had adequate knowledge that they were putting their Obamacare subsidies at risk is a critical question in CEI’s Supreme Court case, King v. Burwell.

Vorse obtained emails related to a January 2012 letter sent by seven states to the U.S. Department of Health and Human Services (HHS). While Obamacare supporters have dismissed this letter as a “spoof,” these state emails show the letter was a carefully crafted and coordinated effort by the states to get detailed information about the exchanges from HHS.

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Normally, market competition is good for consumers. More competition generally means competitors are battling each other to lower their prices and/or raise the quality of their goods. But when it comes to Obamacare, the market is working backwards, at least for people receiving health insurance subsidies through the exchanges. The more competitive the marketplace, often the more people have to pay for insurance.

How did this happen?

The Affordable Care Act, aka Obamacare, created a series of exchanges where people can shop for health insurance if they don’t already receive it from the government (e.g. Medicare or Medicaid) or from their employer. The exchanges are a pro-market approach to healthcare reform. But they aren’t a simple market, by any means. In part, they are complicated because most people purchasing insurance through the exchanges receive subsidies. If you earn less than 400% of the federal poverty limit, you’ll probably qualify.

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California’s health insurance exchange, established under the Affordable Care Act, has been held out as a national model for Obamacare. In some ways—not all of them good—it is. Whether it’s falling far short of 2015 enrollment goals or sending out 100,000 inaccurate tax forms, Covered California is struggling with its share of challenges.

Now, several senior-level officials integral to the launch of Covered California—who enthusiastically support the Affordable Care Act—are speaking about what they view as gross incompetence and mismanagement involving some of the $1 billion federal tax dollars poured into the state effort.

‘Somebody Must Have Been Smoking Something’

Consultant Aiden Hill became a “foxhole convert” to Obamacare in July of 2010 when he lost his insurance, had a serious medical issue and couldn’t get a new policy.

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WASHINGTON — Republican or Democrat, the next president will have the chance to remake the nation’s health care overhaul without fighting Congress.

The law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own health care systems.

States could not repeal some things, such as the requirement that insurance companies cover people with health problems. But they could replace the law’s unpopular mandate that virtually everyone in the country has health insurance, provided the alternative worked reasonably well.

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It has been five years since the Affordable Care Act, better known as ObamaCare, was signed into law. The disastrous rollout of the federal marketplace website, Healthcare.gov, is well-known. According to a Bloomberg Government analysis released in September 2014, the cost of Healthcare.gov was more than $2 billion, more than twice the Obama administration’s estimates. Appropriately, the federal marketplace has been a subject of numerous congressional hearings.

But state-run websites have also squandered hundreds of millions of federal tax dollars. While the House Committee on Oversight and Government Reform has been investigating some of the problems with state-run websites, much more can and should be done. Every House and Senate committee that oversees healthcare issues should carefully examine the roles played by the Centers for Medicare and Medicaid Services (CMS), state officials and contractors in the design and implementation of the websites.

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Florida Gov. Rick Scott (R) announced Thursday he is suing the Obama administration as part of an escalating dispute over whether the state will expand Medicaid under ObamaCare.

“It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into ObamaCare,” Scott said in a statement Thursday announcing the lawsuit.

Scott is objecting to the Obama administration linking the extension of separate federal money to help hospitals in the state care for the uninsured, known as the Low Income Pool (LIP), to the state’s decision on whether to expand Medicaid under the Affordable Care Act.

The Obama administration says the LIP funding will not be renewed in its current form after June. It says that the future of the program is “linked” to the decision to expand Medicaid, though it stops short of saying it is entirely dependent on it.

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