The Obama administration cannot force a Missouri lawmaker and his family to carry health insurance that includes contraception coverage despite the Affordable Care Act’s requirement that insurers cover birth control, a federal judge ruled Thursday.

U.S. District Judge Jean C. Hamilton said Thursday that HHS may not compel Republican state lawmaker Paul Joseph Wieland, his wife Teresa Jane Wieland or their insurer to include contraception coverage in their health plan. The ACA’s contraception mandate otherwise requires group health plans and insurers to cover contraceptives and sterilization procedures.

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The Department of Health and Human Services’ (HHS) annual report on Medicaid’s finances contains a stunning update: the average cost of the Affordable Care Act’s Medicaid expansion enrollees was nearly 50% higher in fiscal year (FY) 2015 than HHS had projected just one year prior. Specifically, HHS found that the ACA’s Medicaid expansion enrollees cost an average of $6,366 in FY 2015—49% higher than the $4,281 amount that the agency projected in last year’s report.

The government’s chief financial experts appear not to have anticipated how states would respond to the federal government’s 100% financing of the cost of people made eligible for Medicaid by the ACA. It appears that the enhanced federal funding for the ACA expansion population has led states to set outrageously high capitation rates—the amount government pays insurers—for the ACA Medicaid expansion population. The rates are much higher than the amounts for previously eligible Medicaid adult enrollees and suggest that states are inappropriately funneling federal taxpayer money to insurers, hospitals, and other health care interests through the ACA Medicaid expansion.

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