Health care is fast becoming an unsustainable expense for American families. This year the total cost of insurance for the typical family of four eclipsed $28,000, according to the Milliman Medical Index. Rising insurance premiums are also eroding worker compensation, as companies shift increased costs to employees.

Health care in the U.S. suffers symptoms of what Justice Louis Brandeis once termed the problem of “Other People’s Money.” Often a patient ordering and receiving medical care mistakenly believes he is not the one paying for it. This misconception is due in large part to the employer tax exemption for health insurance, which conceals the true cost of coverage from most workers.

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Michigan Gov. Rick Snyder (R) on Friday signed a bill to impose controversial work requirements on Medicaid recipients.

If the plan is approved by the Trump administration, Michigan would become the fifth state to add work mandates to its program.

In January, Trump officials released their guidelines for work requirements on Medicaid, a move that has drawn a sharp outcry from Democrats, who say the change will lead to people losing health coverage.

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Small-business owners and their employees often struggle to find affordable health-care options. A major reason is that ObamaCare, among other laws, makes coverage more expensive for small businesses than large companies. That’s why the Trump administration is expanding access to association health plans, or AHPs, beginning Tuesday.

ObamaCare imposes starkly different rules on large companies and small businesses. Companies with 50 or fewer employees are subject to the law’s benefit mandates and rating restrictions, while large companies are not. This is backward. Small businesses should face the same regulatory burden as large companies, if not a lighter one. AHPs will help level the playing field.

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One perverse effect of the Affordable Care Act is that corporate America escaped some of the onerous mandates that hurt small enterprises. The Trump Administration is now trying to mitigate that inequity with a rule on association health plans, or AHPs, and perhaps the result will be a durable and popular alternative to ObamaCare coverage.

On Tuesday the Labor Department rolled out a final rule on AHPs. The point is to allow more small businesses to join forces to offer health insurance, using economies of scale to reduce costs and diversify risk. This is how corporations and unions manage health insurance in the large group market, either by paying an outside issuer or self-insuring.

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Sandy Dowland has been to the emergency room 10 times in the past year and was hospitalized during four of those visits. She has had a toe amputated and suffers from uncontrolled diabetes, high blood pressure, major depression, obesity and back pain.

But her health is not high on the 41-year-old woman’s priority list.

“I have a lot going on,” said the unemployed mother of five who lives in a homeless shelter. She said it’s a struggle just to get herself and children through each day.

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The Republican-led Michigan Legislature on Thursday gave final approval to a bill requiring able-bodied adults in the state’s Medicaid expansion program to meet work or job-related requirements, sending it to Gov. Rick Snyder for his expected signature.

Starting in 2020, adults age 18 to 62 would have to show workforce engagement averaging 80 hours a month — through work, school, job or vocational training, an internship, substance abuse treatment or community service. Michigan would first seek a federal waiver to implement such requirements that have been embraced by President Trump’s administration.

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Remember Obamacare? The fight is far from over on the future of the Obama-era health insurance overhaul. Republicans are making a list-ditch effort this year to turn the program and the money over to the state. This isn’t full Obamacare repeal, but would make a world of sense because states would be free to experiment and find ways to reduce costs and provide better services.

Democrats are adopting a new political spin, which is that everything is fine with Obamacare. They claim that the only reason premium and deductible costs keep exploding is because President Trump repealed the individual mandate tax — which was nothing more than an unfair penalty on low-income families that can’t afford the high cost of the health law’s mandates. But if Mr. Trump is to blame, why were the costs skyrocketing two years before Mr. Trump even entered the Oval Office?

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States that have expanded Medicaid have seen strong gains in coverage and better access to care without having to sacrifice other social programs, new research has found.

But that may not last long.

An analysis by the Kaiser Family Foundation found the 33 states that expanded their Medicaid program to 133% of the poverty line saw a 7.4% decrease in the uninsured rate from 2013 to 2017 compared to a 2.7% drop to those that didn’t.

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The most significant federal entitlement reform in our lifetime was a little noticed provision that Democrats included in the Affordable Care Act (Obamacare). The provision garnered almost no attention from the mainstream media or even from most conservative commentators. Yet according to the Medicare Trustees report that followed, this one provision eliminated $52 trillion of unfunded federal government liability – an amount that was more than three times the size of the US economy.

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Kentucky Gov. Matt Bevin (R) is countersuing to stop a lawsuit filed by critics of the state’s plan to institute Medicaid work requirements.

The administration filed a lawsuit in federal district court in Kentucky on Monday seeking a ruling that the state’s Medicaid waiver fully complies with federal law.

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