If policy makers want to instigate more competition in the ACA, they can start by broadening “credibility adjustments” to make it easier for new plans to get started. The exemptions should cover all new carriers that enter the exchanges. They should be deeper and apply for an extended period over which a new carrier faces high startup costs.

A far better alternative would be to scrap the caps on health plan operating margins altogether, and make it easier for new plans to channel revenue into startup costs and investors to turn profits off these investments. The law already provides some flexibility toward these ends. It states that the HHS Secretary can adjust the individual market cap if “the Secretary determines that the application of the 80% may destabilize the individual market in such State.” So long as consumers have transparency (and reliable metrics) on the value of the benefits that different plans offer, the exchanges would benefit from giving new health plans far more flexibility on how they allocate their capital.

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Medicaid expansion is a poor use of taxpayer dollars. Blase rebuts Dr. Aaron Carroll, a long-time supporter of the Affordable Care Act’s (ACA) Medicaid expansion, writing in The New York Times to encourage further expansion.  Carroll doesn’t not address new data showing government spending on Medicaid expansion enrollees is nearly 50% higher than the government projected, nor that Medicaid enrollees obtain only 20 to 40 cents of value for each dollar the government spends on their behalf.

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In yet another sign of instability in Obamacare’s health-insurance Exchanges, BlueCross BlueShield of Nebraska has announced it will leave that state’s Exchange entirely, while BlueCross BlueShield of Tennessee will exit the Exchange in all three of that state’s major metropolitan areas. The moves will leave 112,000 Tennesseans and tens of thousands of Nebraskans scrambling to find new coverage for 2017 from a dwindling number of carriers.

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President Obama has an opportunity to win a positive legacy in health care. Although his attempt at payment reform, Obamacare, has failed in public opinion, he is also encouraging important initiatives in medical innovation. The Cancer Moonshot and Precision Medicine Initiative represent investments in innovation that can bring big payoffs. However, they will not succeed fully unless the Food and Drug Administration allows patients access to new therapies. Legislation modernizing the FDA, the 21st Century Cures Act, is being fumbled inches away from the Congressional end zone. Presidential leadership is needed.

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Complications arising from the Affordable Care Act (ACA) premium tax credits (PTCs) are causing millions of people to effectively break the law. People who benefit from advance premium tax credits (APTCs) must file tax returns and include a form to reconcile the advanced amount to the actual end-of-year entitled amount. The failure of so many people to fulfill this new legal requirement has led the government to spend more than it should have as APTCs tend to be higher than legally entitled amounts.

The big news is that tax filers, as of April 28, 2016, reported $15.8 billion in total APTC payments. According to data released by HHS, I estimate the amount of APTCs paid in 2015 equaled $26.7 billion—nearly $11 billion more than the amount reported by tax filers. It appears that about 3 million households that received an APTC in 2015 had not filed the required paperwork with the Internal Revenue Service (IRS) by the end of April 2016.

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As many as 20 million Americans soon will be getting a letter from the Internal Revenue Service “suggesting” they sign up for ObamaCare insurance.

Getting a letter from the IRS can be a threatening and nerve-racking experience; it seldom is seen as a suggestion and more of a threat.  But at President Obama’s direction, the IRS is “reaching out” to people who paid the tax penalty for not buying mandatory health insurance or who claimed an exemption in hopes of “attracting” more people to sign up for ObamaCare insurance.  The government is particularly interested in compliance from healthy young people.

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Yahoo Finance’s Ethan Wolff-Mann, who may have the best name in journalism, writes it’s not true that ObamaCare has caused employers to reduce workers’ hours because the new Kaiser Family Foundation/Health Research Educational Trustsurvey found “a whopping 7% of employers with more than 50 employees actually gave part-timers full-time jobs since Obamacare was officially launched in 2013. Only 2% of employers cut full-timers to part-time.” Leaving aside the question of whether 7 percent is a whopping figure, the figures Wolff-Mann cites don’t necessarily support his claim.

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A new Urban Institute report claims premiums for plans sold in ObamaCare’s health-insurance Exchanges are lower than comparable premiums for employer-sponsored health plans. Unfortunately, Urban scholars used sleight of hand to hide the full premiums for ACA plans. Incorporating the full premiums shows Exchange plans are more expensive.

The study’s authors used the premiums that HealthCare.gov and state-run Exchange web sites quote prospective enrollees. Yet those quotes do not reflect the full premium for Exchange plans.

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New York has revolted against a critical component of the Affordable Care Act: RiskAdjustment.  If its revolt survives an almost certain legal challenge, a number of states are likely to double down on New York’s actions and remove one of the few remaining fingers holding Obamacare on to a cliff.

Acting under direction of its new Superintendant of Financial Services, Maria Vullo, New York has joined the chorus of those familiar with the program in contending that the federal Risk Adjustment program is backfiring. Critics say the program transfers too much money amongst insurers and is actually destabilizing the market.  New York is the first state, however, to put money behind the critique.

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In new research published by the Mercatus Center, I analyze the causes and impact of the much higher-than-expected enrollment and spending associated with the Affordable Care Act (ACA) Medicaid expansion. Though unpredicted by Washington experts, the results were predictable. The federal government’s 100% financing of state spending on expansion enrollees has led states to boost enrollment and create high payment rates. (See this 2-minute Mercatus video for additional information on this significant development.)

In states that have expanded, enrollment and per enrollee spending are nearly 50% higher than predicted. While interest groups within the states—particularly hospitals and insurers—benefit from the higher spending being charged to federal taxpayers, substantial evidence suggests much of this new spending is wasted or provides little value for its intended recipients.

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