With Donald Trump’s presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals.
Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. A key element, conservative experts say, would be for a Clinton administration to make it easier for states to obtain Section 1332 waivers under the Affordable Care Act. Those waivers allow states to replace the law’s insurance exchange structure with their own innovative models.
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Last year, healthcare leaders had their eyes trained on one big case – King v. Burwell – and they celebrated when the justices voted to uphold a key provision of the Affordable Care Act.
This year wasn’t nearly so straightforward for healthcare leaders watching the Supreme Court, which wrapped up its latest term last week. At least half a dozen notable cases fragmented healthcare wonks’ attention. The outcomes of those cases left some in the industry cheering and others wringing their hands.
Healthcare-related cases focused on abortion, the ACA’s contraception mandate, patents, unions, claims data and the False Claims Act, among other topics. And the mid-term death of Justice Antonin Scalia looks to have affected the outcomes of some of those cases.
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The ObamaCare program for small business in Illinois—known as SHOP—has been troubled from the start. Only two insurers sold health plans on the online marketplace to Chicago small businesses: startup Land of Lincoln Health and Blue Cross & Blue Shield of Illinois. Now there’s just one. Facing massive financial losses, Chicago-based Land of Lincoln has stopped signing up new small-business customers.
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.