States increased their spending in fiscal year 2015 by the biggest margin in more than 20 years, but most of the increase was thanks to huge leaps in Medicaid spending under the first full year of the Affordable Care Act. Spending increased last fiscal year, which ended on June 30 for most states, by 7.8 percent, according to new estimates from the National Association of State Budget Officers (NASBO).

Tax-advantaged healthcare Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are at risk of being gutted because of ObamaCare’s Cadillac tax, warns the Employers Council On Flexible Compensation. The employers are asking employees to call on Congress to repeal the Affordable Care Act’s Cadillac tax on benefit-rich health plans, or at the very least to exempt employees’ contributions to these accounts from the Cadillac tax calculation.

Whether it is the Centers for Medicare and Medicaid Services (CMS) determining which treatments and technologies are worth covering and how much they are willing to reimburse for them; the Agency for Healthcare Research and Quality (AHRQ) mandating quality and safety standards; or the new Affordable Care Act exchanges setting the standard for benefit packages throughout the health insurance market, it is clear that government agencies and their mandates play a powerful role in guiding the provision of health benefits and the overall construct of the market.

Land of Lincoln Health, an insurance co-op created under ObamaCare, is no longer taking new small-business customers. The health insurer announced in October that it would severely cap enrollment on the exchange, HealthCare.gov, and limited new small-business clients in particular to help the co-op survive long term. More than half of the co-ops nationwide have failed.

The CEO of UnitedHealth, the nation’s largest health insurer, said on Tuesday he regretted the decision to enter the ObamaCare marketplace last year, which the company says has resulted in millions of dollars in losses. “It was for us a bad decision,” CEO Stephen Hemsley said at an investor’s meeting in New York, according to Bloomberg Business. UnitedHealth announced last month that it would no longer advertise its ObamaCare plans over the next year and may pull out of the exchanges completely in 2016.