State Republican leaders are ratcheting up the pressure on Congress to overhaul the Affordable Care Act if the Supreme Court this month rules that subsidies on the federal exchange are invalid.

Republicans from 33 states have written to Congress as part of a coordinated message urging federal legislators to develop a plan that would free states from the pressure of setting up their own exchanges to salvage subsidies, according to the Foundation for Government Accountability, a conservative think tank.

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America’s biggest health insurers are about to get even bigger, driven into a wave of consolidation by Obamacare’s new regulations and markets.
Anthem’s disclosure Saturday that it’s offered about $47 billion for Cigna Corp. is the first public confirmation the deal-making is in full swing. Cigna rejected the offer on Sunday, despite Anthem’s attempt to pressure Cigna’s board by taking the offer public. Anthem, Aetna Inc. and UnitedHealth Group Inc. all are poised to emerge as buyers or sellers when the dust settles.

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The five largest commercial health insurers in the U.S. have contracted merger fever, or maybe typhoid. UnitedHealth is chasing Cigna and even Aetna; Humana has put itself on the block; and Anthem is trying to pair off with Cigna, which is thinking about buying Humana. If the logic of ObamaCare prevails, this exercise will conclude with all five fusing into one monster conglomerate.

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In early June, the federal government released data on the premium increases that health insurers in 45 states and the District of Columbia are requesting for 2016. The numbers were eye-popping, with many requests exceeding 20 percent and a few even exceeding 50 percent. They were definitely “death spiral” inducing premium hikes. Yet, some pundits on the Left dismissed them as no big deal.

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Their industry already upended with the passage of the federal health care law, insurance companies are facing another upheaval if the Supreme Court rules that millions of Americans are not eligible for subsidies to help defray the cost of their coverage.

The court is expected to decide by the end of June or in early July whether it agrees with the plaintiffs in King v. Burwell that the language in the Affordable Care Act allows the government to offer subsidies only in those states that have established their own insurance marketplaces.

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Today, the Congressional Budget Office (CBO) issued an analysis of the budgetary and economic effects of repealing the Affordable Care Act (ACA), the first such estimate to factor the law’s impact on the economy into the price tag for repealing it, a type of analysis also known as dynamic scoring. Though much of the report is predictable and consistent with past analyses by the CBO of the ACA, it is novel in the comprehensiveness of its scope, and offers three important lessons for observers and policymakers.

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Many American conservatives oppose universal health insurance because they see it as fundamentally antithetical to a free society. “If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price,” wrote a guest editorialist in the ]Wall Street Journal in 2009. But according to the Heritage Foundation, a leading conservative think tank, ten nations freer than the United States have achieved universal health coverage. It turns out that the right kind of health reform could cover more Americans while increasing economic freedom.

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The strange, twisted journey to the Supreme Court of a case that threatens to unravel President Barack Obama’s namesake heath care legislation began five years ago in the quiet of a Greenville, S.C., law office.

It was summer 2010. The Patient Protection and Affordable Care Act had been signed into law a few months before on March 23. Tom Christina had been asked by his firm to study it and assess its implications for clients.

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Jonathan Gruber, the Massachusetts Institute of Technology economist whose comments about the health-care law touched off a political furor, worked more closely than previously known with the White House and top federal officials to shape the law, previously unreleased emails show.

The emails, provided by the House Oversight Committee to The Wall Street Journal, cover messages Mr. Gruber sent from January 2009 through March 2010. Committee staffers said they worked with MIT to obtain the 20,000 pages of emails.

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The fiscal year 2016 budget resolution passed by Congress in May requires the Congressional Budget Office and the Joint Committee on Taxation to include the macroeconomic feedback effects of changes in policy on the budget when evaluating major legislation (CBO and JCT are the official number crunchers of Congress).

Specifically, Section 3112 of the resolution requires CBO and JCT to “incorporate the budgetary effects of changes in economic output, employment, capital stock, and other macroeconomic variables resulting from such major legislation.”

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