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Sixteen states and the District of Columbia manage their own health insurance marketplaces under the Affordable Care Act. These states, which were broadly supportive of health reform, chose to run their marketplaces to exert greater control over their insurance markets and tailor the portals to suit local needs. ...Respondents unanimously suggested that federal administrative actions and repeal efforts have created confusion and uncertainty that have negatively affected their markets. The state-run marketplaces used their broader authority to reduce consumer confusion and promote stable insurer participation. However, their capacity to deal with federal uncertainty has limits and respondents stated that long-term stability requires a reliable federal partner. (Giovannelli and Curran, 3/21)

Certain forms of individual health coverage are not required to comply with the consumer protections of the Affordable Care Act (ACA). These “alternative coverage arrangements” — including transitional policies, short-term plans, health care sharing ministries, and association health plans — tend to have lower upfront costs and offer far fewer benefits than ACA-compliant insurance. While appealing to some healthy individuals, they are often unattractive, or unavailable, to people in less-than-perfect health. By leveraging their regulatory advantages to enroll healthy individuals, these alternatives to marketplace coverage may contribute to a smaller, sicker, and less stable ACA-compliant market. The Trump administration recently has acted to reduce federal barriers to these arrangements. (Lucia, Giovannelli, Corlette et al, 3/29)

There have been widespread reports of very large premium ACA marketplace premium increases in most states in 2018. This analysis provides national estimats for changes in the lowest silver and gold plan premiums between 2017 and 2018. The national average increase was 32.0 perecnt for the lowest-priced silver plans and 19.1 percent for gold plans, but the increases varied by states. Several reasons are behind these large increases. The premium increases reflect significant policy changes and policy debates specifically affecting insurer decisions for the 2018 plan year as well as more typical annual considerations such as trend and healthcare costs. (Holahan, Blumberg and Wengle, 3/21)

In this cohort study of 11 215 older veterans with kidney failure, receipt of nephrology care in Medicare was associated with a 28 percentage point higher frequency of dialysis initiation, and a 5 percentage point higher frequency of death. The Veterans Affairs health care system appears to favor lower intensity treatment of kidney failure without an associated increase in mortality. ...eterans who receive pre-ESRD nephrology care in Medicare receive dialysis more often yet are also more likely to die within 2 years compared with those in VA. The VA’s integrated health care system and financing appear to favor lower-intensity treatment for kidney failure in older patients without a concomitant increase in mortality. (Tamura, Thomas, Montez-Rath et al, 4/9)