Every week, I get an email from the Maryland Health Connection––the state run health insurance exchange. Maryland is one of a minority of states that are building their own Affordable Care Act ("ObamaCare") exchange. You can go to their site and sign up for these weekly updates. Let me suggest that Maryland is an example of what an on-track and well organized effort looks like for any exchange

The Society of Actuaries is out with another estimate of health insurance rate increases as a result of implementation of the Affordable Care Act ("Obamacare"). While there is a great deal of difference between states, they are estimating an average increase of 31.5% on account of the new underwriting reform and benefit expansion requirements of the health law: These rate increase

As the Obama administration continues its top secret effort to build federal insurance exchanges in about 34 states while 16 states are doing it on their own, that continues to be the big question. HHS is using IT consulting firm CGI for much of the work on the exchanges and the federal data hub. CGI has their plate full since they are not only working on the federal exchange but also doing work

So far California has received $910 million in federal grants to launch its new health insurance exchange under the Affordable Care Act ("Obamacare"). The California exchange, "Covered California," has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years. The state will also

The New Jersey Governor became the eighth Republican to take the Medicaid expansion deal. What I found notable is that he essentially mimicked Florida Republican Governor Rick Scott in reserving the right to back out in future years if the feds dont keep their funding promises. While the feds are paying 100% of the cost of expansion in the first three years, that support ultimately drops to 90%

Anyone who has ever read this blog and noticed its upper right hand corner has known that Dr. Koop and I were friends––for more than 20 years. One of my more amazing experiences with Dr. Koop centers on a walk we took from the White House to my office up Connecticut Avenue. In the length of about a mile, I dont know how many people stopped him and thanked him for his service. Just regular

A million Floridians will now be eligible for Medicaid––the Obama administration is happy about that. Republican Rick Scott gets to do it his way––in an almost entirely private market. This from todays Tampa Bay Times: His [Scotts] endorsement of the expansion came hours after the federal government agreed to grant Florida a conditional waiver to privatize Medicaid statewide for the states

Paul Ryans Medicaid block grant proposals have always made sense to me. Give the states their Medicaid allotment and real flexibility over how they spend what will inevitably be less federal money. But as I have thought about the impact of implementing the Medicaid expansion under the Affordable Care Act ("Obamacare"), Medicaid block granting is looking more and more problematic. Under the new

Last weeks deal to avert the "fiscal cliff" settled very little. For those in the health care market, I will suggest the big takeaway is that we should expect very little will be settled in the coming months and we will continue to face a great deal of uncertainty for years to come. Without an agreement to alter the course we are on, it is estimated that we will add more than $10 trillion to

Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act ("Obamacare"). Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine. From Bloomberg: Health insurance premiums may as much as double for some small businesses and individual

Should states build their own health insurance exchanges under the Affordable Care Act (ACA) ("Obamacare")? Should states expand their Medicaid programs under the ACA? These are the tough questions many, particularly conservative, states are now wrestling with. While it is too late for a state to now decide to build an exchange before the fast approaching launch date, it is still possible to

What will health insurance cost in 2014? Will the new health insurance exchanges be ready on time or will the law have to be delayed? There Will Be Sticker Shock! First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates. In a November 2009 report, the CBO estimated that premiums in the individual

The Obama administration just released another set of regulations, the "Draft Notice of Benefit and Payment Parameters for 2014." Among many other things in the 373 pages, they have announced their proposed assessments to cover the cost of running the federal exchange. In order for the feds to administer the new insurance exchanges, they have proposed a fee of 3.5% of premium on each insurance

The Affordable Care Act ("Obamacare") is now settled law. It will be implemented. It will also have to be changed but not until after it is implemented and the required changes become obvious and unavoidable. We can all debate what those things will be (cost containment is on top of my list) but it doesnt matter what we think will happen––time will tell.  There are and will be more lawsuits. I

Private health insurance exchanges will save employers money but not make health insurance cheaper. Because private health insurance will save employers money, they will grow. Will Private Insurance Exchanges Reduce Health Insurance Costs? Theres lots of buzz these days about private insurance exchanges. The idea is to give employees more choice in purchasing their own individual coverage

Not surprisingly, only about 10% of firms with fewer than 200 workers take advantage of self-insurance––and almost no very small groups (fewer than 50 workers) use the product. It just isnt worth it for these small employer groups to take the risk that they will either have too many claims or very big claims from their workers––that is what insurance companies are for. Already, 96% of workers

Indiana, New Mexico, and Wisconsin are asking the federal government to exempt people making between 100% and 133% of the poverty level from the upcoming Medicaid expansion. These Republican governors need to put up or shut up. Ever since the passage of the Affordable Care Act (ACA), Republican governors have been clamoring for block granting Medicaid. The Supreme Court ruled that a state

Romney says he will repeal “Obamacare” if he is elected. Given that this has been part of his platform from the beginning of the campaign he is entitled to do that if he wins. I did not support passage of the Affordable Care Act (ACA) in 2010 because I saw it as an unaffordable entitlement expansion with no real hope of containing costs. But the practical reality of killing the Affordable Care

Let’s take a look at Mitt Romney’s Health Care plan using his own outline ("Mitt’s Plan") on his website. Romneys approach to health care reform summarized: "Kill Obamacare" - There seems to be no chance Romney would try to fix the Affordable Care Act––he would repeal all of it. No new federal health insurance reform law - There is no indication from his policy outline that he would try to

They both are and they both aren’t. I’ve never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare. As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for the press to try

Republican Vice Presidential pick Paul Ryan isn’t the only one Democrats are piling on this week. The knives have come out for Senator Ron Wyden, the Oregon Democrat. I guess that isn’t a surprise. If Ron Wyden is right on Medicare then so are Paul Ryan and Mitt Romney. The fundamental problem here is that the Democrats have decided that their best path to victory in the November elections is

by Brian Klepper Like most health law watchers, I was surprised by the recent Supreme Court decision. Im sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle. I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the

I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out. I also expected the four liberal justices to support both the individual mandate as well as the entire law. About everyone expected Roberts and Kennedy to vote alike. If Roberts had gone with

Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable. Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income

In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts vote saved the ACA."On to the elections.