“Despite Obamacare’s strong national enrollment numbers, several states are at risk for big premium hikes.

Each state is its own insurance market, and they had wildly different experiences during Obamacare’s first open-enrollment window. So although nationwide statistics are important for judging the law’s political success, the substantive tests for the law’s future mostly lie with the states—and some of them aren’t looking so hot.”

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“The first suggested Obamacare premium prices for 2015 don’t look so scary, but a few states could soon be in for some nasty sticker shock.

Health insurers that are still processing enrollments from Obamacare signups are at the same time setting their premiums for 2015 individual policies—and setting the stage for more debate about the Affordable Care Act.”

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“Massachusetts pioneered universal health care in 2006. Under then-Governor Mitt Romney, it was the first state to guarantee access to insurance — and drove its uninsured rate down to just 4 percent.

Which makes it baffling that Massachusetts did arguably the worst of any state in implementing Obamacare. Like a handful of ardent Obamacare supporters in other states, Massachusetts officials tried to pull off an ambitious launch — and failed badly.”

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“There’s been a dramatic turnaround in some Democrats’ thinking about Obamacare and the 2014 elections. Where lawmakers once sought to avoid blame for their national health care overhaul, they are now confident, energized and ready to rub the supposed success of Obamacare in their Republican opponents’ faces.”

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“A few months into Obamacare’s coverage expansion, there’s been plenty of debate about where the millions of newly insured have obtained coverage — whether through the law’s exchanges, directly from an insurer, through expanded Medicaid or through an employer. The health-care law’s immediate impact is a little more clear in hospitals, which are starting to report who’s coming through their doors during the first months of expanded coverage under the Affordable Care Act.”

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“An insurer in Washington state selling plans under the Affordable Care Act is proposing to lower customers’ health premiums next year in what appears to be one of the first such decreases proposed for 2015.”

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“In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.”

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“Whenever somebody says that an argument is settled, you can be sure that it is not. If it were settled, there would be no need to say so. No president will hold a press conference to announce that the argument over the prohibition of alcohol is settled, precisely because it truly is settled. So when President Obama declared the debate over his health-care law “settled” and “over,” as he did at an April 17 press conference, his performance was self-refuting.”

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“Kyle Cheney of Politico is a solid, straight news reporter. So I was a little surprised this morning to see his analysis of state Obamacare exchange spending features numbers much smaller than the ones I have been using, most notably a figure of $248 million for Oregon and just $57 million for Massachusetts. Total federal grant funding to Oregon’s failed exchange, according to CMS, is $305 million. Massachusetts, according to CMS, is at $179 million. These are huge disparities.”

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“Now, the Obama administration, saying that some rural hospitals have been receiving subsidies they weren’t meant to get, has proposed eliminating a further $2.1 billion in Medicare payments next fiscal year for hospitals designated as providing “crucial access.”

In addition, under the new federal health law, hospitals are losing government subsidies for providing care to the uninsured. The law envisioned that those who couldn’t afford insurance would be covered by an expansion of Medicaid, but two dozen states, including North Carolina, opted not to do so.”

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