Articles on the implementation of ObamaCare.

Earlier this month, the Trump administration shot down a plan from Idaho to sell health insurance that doesn’t comply with Affordable Care Act (ACA) regulations.

“If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,” wrote CMS Administrator Seema Verma in her rejection letter.

Three weeks later, another state — Iowa — is on the verge of making a similar move.

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The Iowa Senate gave final approval Tuesday to controversial legislation that would exempt certain health plans from Affordable Care Act mandates.

The legislation combines two proposals backers say would reduce health insurance costs, but critics worry could undermine consumer protections.

Senate File 2349 was approved 37-11, sending it to Gov. Kim Reynolds, whose spokeswoman said she was “eager” to sign it. The measure passed the House last week.

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California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.

In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.

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Everybody on Capitol Hill agreed: If anyone could break the deep-rooted partisan logjam over Obamacare in Congress, it was that deal-making duo Patty and Lamar. But in the end, it was Obamacare that broke their alliance.

Just seven months after Sens. Patty Murray (D-Wash.) and Lamar Alexander (R-Tenn.) heralded the beginning of a new bipartisan era on health care following the collapse of Obamacare repeal efforts, their lofty ambitions ended in much the same way as every Obamacare-related negotiation over the last eight years — with claims of betrayal, warnings of political fallout and no progress toward bridging the deep divide over the nation’s health care system.

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Of the $88 billion HHS appropriation announced Wednesday night, not a penny is going toward Obamacare. Congress is however extending oversight requirements on HHS regarding its administration of the health exchanges.

Congressional leaders released the long-awaited $1.3 trillion, two-year spending omnibus after days of wrangling behind closed doors over contentious policies that included an embattled stabilization package for the individual market that would fund cost-sharing reduction payments and a $30 billion reinsurance pool.

The bill was passed late Thursday night.

Lawmakers hustled Monday to resolve policy disputes holding up an agreement on a sweeping spending bill needed to keep the government funded beyond Friday, but negotiations stretched into early Tuesday morning.

Disagreements over health-care policy, immigration and funding for a New York rail tunnel project persisted as Democrats, Republicans and the White House negotiated the measure that would keep the government open until October and prevent a partial shutdown when its current funding expires at 12:01 a.m. Saturday.

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As the debate continues in Virginia over whether to expand Medicaid, it is crucial to look at what the outcome has been for other states that have already expanded their programs. Thirty-one states have taken this step under the provisions laid out in the Affordable Care Act. The ACA expanded Medicaid eligibility to able-bodied adults below 138 percent of the federal poverty level, and covered 100 percent of the cost of the expansion enrollees for the initial period. That percentage declines, and by the year 2020 the federal government will only cover 90 percent of the cost of expansion enrollees. With funding after that unclear, residents of Virginia will face an unknown future of Medicaid. Given the facts staring back at us, why would any Virginian support expanded coverage?

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Arkansas recently became the third state to receive approval from the U.S. Department of Health and Human Services (HHS) to implement a work requirement for Medicaid adults. The hand-delivered approval follows the department’s endorsement of work requirements submitted by Kentucky and Indiana and comes ahead of action on similar requests from a host of other states, including Arizona, Maine, New Hampshire, Utah, and Wisconsin. Arkansas’s request was among several proposed amendments to the state’s Section 1115 demonstration waiver for its Arkansas Works program, including a proposed income eligibility cap at 100 percent of the federal poverty level (FPL) for the expansion population, which HHS did not approve at this time.

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What does “substantially” mean?

That could be the pivotal question for Idaho, whose chief executives now must justify their plan to let Idahoans buy health insurance in defiance of the Affordable Care Act.

Gov. Butch Otter, Lt. Gov. Brad Little and Idaho Department of Insurance Director Dean Cameron said earlier this year that insurers would be allowed to sell plans that don’t comply with the ACA, also known as Obamacare. They called the plans “state-based” insurance.

Those state officials — relying on legal opinions including those written by lawyers for Blue Cross of Idaho — believe they are “substantially enforcing” the law.

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Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include funding for the Affordable Care Act’s cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for “copper” plans.

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