The fate of the Obama administration’s significant investments in biomedical research will end up in the hands of either a candidate with a long, wonky track record on health and medicine — with mixed results — or the candidate whose views are an almost complete mystery.

Clinton “really knows what’s going on and is a policy wonk on medical research as well as health care,” said Mary Woolley, president of Research!America, a coalition of groups that promote medical research. Trump, however, has such an “in the moment” approach to medical research — almost never raising the issue unless someone asks him about it — that it will be impossible to know what he’d do until people ask him more questions, she said.

. . .

Maryland’s health cooperative filed a lawsuit Monday seeking to block the federal government from requiring it to pay more than $22 million in fees for a program designed to cover insurance company shortfalls.

The lawsuit by Evergreen Health Cooperative Inc. is the latest twist in the saga of health insurance co-ops set up under the Affordable Care Act to compete against larger, established insurers.

The co-ops were supposed to help keep premiums down by injecting competition into the industry. Instead, 13 of 23 startups that launched successfully have since collapsed, forcing more than 700,000 consumers to seek new insurance. A number of co-op officials have said they were hurt by the federal program because of a formula it used to spread out risk, which they say hurts them while benefiting large, already established insurance companies.

. . .

About 1,000 health care economists from around the country descend on Philadelphia this week for the biennial conference of the American Society of Health Economists.

Think of it as Woodstock for health geeks who will, over several days, present nearly 550 papers covering insurance, hospital mergers and a host of other issues.

Of all those, Obamacare will be the jam that gets played over and over with 78 papers focused on some aspect of the law.

. . .

California Governor Jerry Brown signed a bill into law allowing unauthorized immigrants to buy health insurance on a state exchange created under the U.S. Affordable Care Act, making the state the first in the country to offer that kind of coverage.

The law lets the state request a waiver from the federal government that will be needed to allow unauthorized immigrants to purchase unsubsidized insurance through Covered California, the state’s healthcare exchange.

. . .

Republican Obamacare replacement plans released so far would change the federal tax code to mitigate the cost of health insurance for individuals and families.

The Sessions-Cassidy legislation would provide a universal health insurance tax credit (UHITC) of $2,500 for individuals and $5,000 for married couples filing jointly, plus $1,500 per qualifying dependent.

A plan Price released in May 2015 would award tax credits for health insurance based on the ages of taxpayers and their dependents, ranging from $900 per year for individuals under age 18 to $3,000 for individuals aged 50 and older, according to the text of the Empowering Patients First Act of 2015.

Instead of a credit, the Republican Study Committee (RSC) has recommended a standard federal income tax deduction for health insurance of $7,500 per individual and $20,500 per family, as proposed in the American Health Care Reform Act of 2015 (AHCRA), sponsored by Rep. David Roe (R-TN) and 98 cosponsors.

All three plans also promote the use of health savings accounts and include provisions for giving states block grants to fund and reform their Medicaid programs according to their particular needs.

. . .

Many people contend that we should not worry about the premium rate shock because the ACA insulates most people from gross premiums. The oft-repeated idea is that the ACA basically requires only that people pay a percentage of their income in premiums. So, unless income goes up, a person’s net premium stays the same.

Reporters, pundits and bloggers should stop accepting or repeating this contention. Gross premium increases can matter a lot.

It is true that if you earn less than 400% of the applicable federal poverty level AND you purchased the second lowest silver plan the year before AND you continue to purchase the second lowest silver plan the following year, then your net premiums don’t go up even if the gross premium rises astronomically.

. . .

The U.S. Department of Health and Human Services on Thursday trotted out insurance executives who have found success selling health plans to individuals via the online insurance exchanges, a key part of the Affordable Care Act.

The conference, held in Washington and live-streamed to journalists and others, gave industry executives an opportunity to outline their strategies and challenges at a time when some major insurers are questioning the viability of plans sold on HealthCare.gov and the state-run exchanges.

In April, UnitedHealth Group Inc. announced it would stop offering exchange plans in many states next year, including Missouri and Illinois. The nation’s largest health insurer said it couldn’t make money on plans because of lower-than-expected enrollment and sicker people buying its plans.

. . .

Millions of people who pay the full cost of their health insurance will face the sting of rising premiums next year, with no financial help from government subsidies.

Renewal notices bearing the bad news will go out this fall, just as the presidential election is in the homestretch.

“I don’t know if I could swallow another 30 or 40 percent without severely cutting into other things I’m trying to do, like retirement savings or reducing debt,” said Bob Byrnes, of Blaine, Minnesota, a Twin Cities suburb. His monthly premium of $524 is already about 50 percent more than he was paying in 2015, and he has a higher deductible.

. . .

The number of part-time workers in jobs for economic reasons shot up by 468,000, apart from the 458,000 that left the workforce altogether.  Slack work or business conditions accounted for 181,000 of these jobs, while another 77,000 could only find part-time work.

Analysts at Goldman Sachs have noticed this trend for some time, and put the blame on Obamacare.

“The evidence suggests that the [Affordable Care Act] has at least modestly elevated involuntary part-time employment,” Goldman Sachs economist Alec Philips wrote in a research note published on Wednesday. Obamacare had the greatest impact on industries that traditionally do not offer strong health insurance coverage, such as retail stores and the hospitality industry. Phillips noted that these have the highest levels of involuntary part-time workers, and believes that the ACA has forced “a few hundred thousand” to take cuts in hours or accept part-time work as a result.

. . .

The Geisinger Health Plan foresees health costs rising 7.5% next year, but requested a 40% rate increase. The plan, which is run by one of the nation’s top-rated health organizations, underestimated the cost of covering the newly insured under ObamaCare. “Our rates for Medicare, Medicaid and employer-sponsored insurance have been relatively stable, but those products have to bear the cost of our losses on exchange business,” Kurt Wrobel, Geisinger’s chief actuary, said. Many insurers are struggling to find the best ways of providing care to their new customers as they prepare for the fourth year of coverage under ObamaCare.