Meg and Robert Holub were surprised to receive a letter last week welcoming them to a new health insurance plan and telling them to pay $3,483 by Jan. 8.

“We have received your application for individual and family coverage effective 1/1/2018,” the letter said. The only problem: They never applied for the coverage, did not want it and could not afford it.

“I worried, did someone hack my account to sign me up for this?” Mr. Holub said. “And I wondered, what are the implications if I don’t pay for this plan? Will I be hounded by a credit agency?”

. . .

Anne Cornwell considered two drastic strategies in her quest to get affordable health insurance premiums last year for herself and her retired husband.

One was divorce. Another was taking a 30 percent pay cut. She chose the latter.

That maneuver slashed the premiums for the couple, who live in Chattanooga, Tenn., from exorbitant to economical. Instead of $2,100 a month — the amount she had been quoted for 2017 — their premiums are just $87 monthly, her lost income more than compensated for by qualifying for insurance subsides.

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Consumers here at first did not believe the health insurance premiums they saw when they went shopping for coverage this month on HealthCare.gov. Only five plans were available, and for a family of four with parents in their mid-30s, the cheapest plan went typically for more than $2,400 a month, nearly $30,000 a year.

With the deadline for a decision less than a month away, consumers are desperately weighing their options, dismayed at the choices they have under the Affordable Care Act and convinced that political forces in Washington are toying with their health and well-being.

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As Republicans and the Trump administration continue trying to chip away at the Affordable Care Act, the Internal Revenue Service has begun, for the first time, to enforce one of the law’s most polarizing provisions: the employer mandate.

Thousands of businesses — many of them small or midsize — will soon receive a letter saying that they owe the government money because they failed to offer their workers qualifying health insurance. The first round of notices, which the I.R.S. began sending late last month, are being mailed to companies that have at least 100 full-time employees and ran afoul of the law in 2015, the year that the mandate took effect.

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More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Trump’s assertion that the marketplace was collapsing.

In a report on the first four days of open enrollment, the Trump administration said Thursday, 601,462 people selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.

. . .

Voters in Maine approved a ballot measure on Tuesday to allow many more low-income residents to qualify for Medicaid coverage under the Affordable Care Act, The Associated Press said. The vote was a rebuke of Gov. Paul LePage, a Republican who has repeatedly vetoed legislation to expand Medicaid.

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Republicans should focus on revisions and improvements to the state-innovation-waiver provision in the A.C.A. As part of that provision, Section 1332 allows states to receive federal financial support in a lump sum and to waive or revise many of Obamacare’s most noteworthy provisions, including its mandates, the structure and administration of subsidies provided by it, and covered benefits. In return for this flexibility, states must certify that the changes will still result in coverage that is as comprehensive, affordable and widespread as that provided for under the law.

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A bipartisan Senate proposal to stabilize health insurance markets and continue paying subsidies to insurance companies would produce a modest reduction in federal budget deficits but would not substantially change the number of people with coverage, the Congressional Budget Office said on Wednesday.
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The Trump administration is poised to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections.

The new rules, which could be issued as soon as Friday, fulfill a campaign promise by President Trump and are sure to touch off a round of lawsuits on the issue.

More than 55 million women have access to birth control without co-payments because of the contraceptive coverage mandate, according to a study commissioned by the Obama administration. Under the new regulations, hundreds of thousands of women could lose birth control benefits they now receive at no cost under the Affordable Care Act.

. . .

With time running short, the authors of the latest plan to repeal and replace the Affordable Care Act shifted money in the bill to Alaska and Maine, which are represented by Republican senators who appear reluctant to support it.

The revised version of the bill, written by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would provide extra money for an unnamed “high-spending low-density state,” a last-minute change seemingly aimed at Alaska and its holdout Republican senator, Lisa Murkowski, who has yet to say how she will vote. It would also send money toward Maine, whose Republican senator, Susan Collins, had said earlier on Sunday that she would almost certainly vote no.
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