New health-insurance legislation in Iowa will become the latest test of the ability of states to allow coverage that doesn’t comply with the federal Affordable Care Act.

Iowa Gov. Kim Reynolds is expected to soon sign into law a bill that would allow the Iowa Farm Bureau, a nonprofit, to offer health coverage that would fall outside the ACA’s rules. The new coverage, which the legislation calls “health benefit plans,” would be administered by the state’s largest insurer, Wellmark Blue Cross & Blue Shield . The product would officially not be considered health insurance, according to the legislation—leaving details of the coverage unclear.

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Health-insurance premiums are likely to jump right before the November elections, a result of Congress’s omission of federal money to shore up insurance exchanges from its new spending package.

Lawmakers from both parties had pushed to include the funding in the $1.3 trillion spending law signed Friday, but they couldn’t agree on details. A battle has already begun over how to cast the blame for the expected rate increases.

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Democrats revolted against this week’s spending package because the deal includes the 1970s Hyde Amendment, which bans federal funds from subsidizing abortion. The left claims this is some new GOP initiative. But Hyde protections have long applied to: Medicaid, Medicare, the Children’s Health Insurance Program, the Indian Health Service, the Federal Employees Health Benefits Program, the military health-care program Tricare, among others, as Republicans have pointed out. Such guarantees are standard for appropriations bills.

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When Republicans failed to repeal ObamaCare last year, it recalled the old line about snatching defeat from the jaws of victory. That loss, however, should not be allowed to overshadow an important Republican success on health care. Millions of Medicare beneficiaries now get their coverage through private plans under Medicare Advantage—a quiet step forward that brings real benefits. To ensure continued progress, Republicans must resist the temptation to choose short-term savings over long-term reform.

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The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it’s done for retail.

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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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We said Republicans would pay dearly for failing to replace ObamaCare, and the bill is already coming due this week in a political extortion fight with health insurers. The GOP may pad the omnibus spending bill with enough cash to preserve the law through the 2020 election.

Congress is debating how to handle cost-sharing reductions, which are payments to insurers for defraying out-of-pocket costs or deductibles for low-income individuals. The Trump Administration stopped these payments last year. Congress had declined to appropriate the money, and a federal judge said the Obama Administration wrote the checks illegally.

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The tax-reform provision repealing the penalty on those who refuse to participate in ObamaCare has freed millions of Americans to escape a system that exploits them. But while Americans can escape ObamaCare, they still can’t buy insurance in the individual market independent of ObamaCare because private insurers are prohibited from selling it. If this prohibition can be removed through the granting of state waivers by the Department of Health and Human Services, or by the passage of a new federal statute, ObamaCare will collapse into a high-risk insurance pool for the seriously ill rather than become a stepping stone to socialized medicine.

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Amazon, Berkshire Hathaway and J.P. Morgan have announced a nonprofit initiative to address excessive spending on health care, starting with their own million or so employees. They can expect many suggestions. Here’s one: The three CEOs— Jeff Bezos, Warren Buffett and Jamie Dimon, whom I’ll call “BB&D”—could do a huge service by describing the depth and nature of the cost problem, something politicians have long failed to do.

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Democratic and Republican states are moving in opposite directions on health policy, leaving Americans with starkly divergent options for care depending on where they live.

The Trump administration and congressional Republicans, by easing many of the Affordable Care Act’s nationwide requirements after failing last year to repeal the entire law, are effectively turning major components of health policy over to the states.

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