The battle over Obamacare implementation

After seven years, Republicans have finally released their health care legislation. Now their bill can be compared side-by-side with the Affordable Care Act based on how it affects enrollees’ pocketbooks — including both premiums and out-of-pocket costs for care.

The bill does not measure up well: For all but the youngest individuals, it increases both overall costs and the risk of a financially devastating event.

A new Obama administration report found the health-care law forced health insurers to refund 6.8 million consumers more than $330 million in 2013, for an average of $80 per family. The report also estimates that the health-care law led to $9 billion in premium savings since 2011 in part by getting insurers to cut back on administrative costs and profits.

The savings and refunds come through what’s known as the medical loss ratio (MLR), which measures how much premium revenue goes to medical care or programs that improve health-care quality instead of, for example, administrative costs or profits.

The uninsured rate keeps on falling, the most recent round of Gallup poll data shows.

The downturn in the uninsured rate coincides with the start of the largest expansion of health insurance coverage in more than five decades, which is more commonly known as Obamacare.

The people who bought Obamacare during the law’s first open enrollment period are largely pretty satisfied customers, a big new study from the Commonwealth Fund shows.

Most adults with new coverage have used it to go to the doctor; and about 80 percent say they’re satisfied with their purchase.

One in 20 Americans report being newly insured in 2014, and more than half of the newly insured say they obtained health insurance through Obamacare’s exchanges, according to new data from Gallup.

Gallup previously found the nation’s uninsured rate remains at 13.4 percent after a peak of 18 percent last year. That finding, along with the new data, suggests that Obamacare helped millions of Americans gain health insurance after open enrollment began last October.

More than a dozen states decided to build new health insurance marketplaces under Obamacare. Now, they need to figure out how to pay the costs of running those massive websites.

The Affordable Care Act provided federal grant funding for states to get their new web portals up and running. The Obama administration doled out $4.6 billion in grants to states launching their own marketplaces.

The odds of Virginia expanding Medicaid in 2014 appear to be dwindling.

Democratic Gov. Terry McAuliffe has been an aggressive proponent of the Medicaid expansion since he took office in January. But despite his months long campaign to move forward, the Republican-controlled Virginia House has refused to put the Medicaid expansion in a budget.

If Georgia expanded Medicaid, Atlanta’s uninsured rate would fall by more than 56 percent under Obamacare.

But Georgia isn’t expanding Medicaid. That means, according to a new Urban Institute analysis, the city of 5.5 million people will only see its uninsured rate fall by nearly 25 percent instead.

A slim majority of Obamacare’s private insurance enrollees were uninsured when they signed up for coverage, a new survey from the Kaiser Family Foundation finds.

Obamacare opponents have regularly argued that most enrollees already had coverage, meaning that health reform wasn’t driving down the uninsured rate.

Kentucky Gov. Steve Beshear never planned on his state becoming an Obamacare stand-out.

“We were working hard to make sure that everything worked, but we had no idea that we would be one of the few whose website would actually work when we started,” Beshear says.

Subsidized shoppers on HealthCare.gov are paying, on average, $82 monthly premiums for health plans, new data from the US Department of Health and Human Services shows.

The report, published Wednesday, is the most in-depth look available so far at the prices that federal marketplace shoppers will pay for private health coverage. It shows the vast majority of shoppers will use federal subsidies to pay for insurance, significantly reducing their monthly price tag.

Louisiana Senator David Vitter, a Republican and 2015 gubernatorial candidate, said he’s open to expanding the public health-care program Medicaid through Obamacare, the Associated Press reports.

The announcement increases the chances that Louisiana will become one of the next Republican states to adopt the Medicaid expansion. Current Governor Bobby Jindal, who’s term-locked from running for re-election, is one of the expansion’s staunchest opponents in the ongoing battle over the Medicaid expansion.

SEATTLE - By nearly any metric, Washington had one of the most successful Obamacare launches. Unlike Healthcare.gov or neighboring Oregon’s failed marketplace, the state exchange ran smoothly within days of going live.

Washington has enrolled 32 percent of residents eligible for private coverage through the exchange, putting it among the top ten states in terms of reach. The state has done a good enough job to convince an additional four health insurers to join the marketplace in 2015, increasing the total number of plans to 12.

The Senate on Thursday overwhelmingly approved Sylvia Burwell to replace Kathleen Sebelius as the head of the US Department of Health and Human Services.

Burwell, who acted as the White House’s budget director over the past year, will now oversee a massive government bureaucracy that deals with issues ranging from medical marijuana research to the Centers of Disease Control and Prevention. Burwell’s biggest focus, however, will almost certainly fall on the continued implementation of Obamacare.

Support for killing Obamacare’s employer mandate is growing.

The employer mandate is meant to be an incentive for employers to offer coverage to their workers by fining companies $2,000 for every full-time worker not given the chance to enroll.

Since the health-care law’s inception, Obamacare’s political supporters have been completely outspent by the law’s opponents.

A new report from Kantar Media shows that political spending for and against Obamacare has been very lopsided since it was signed into law, with the opposition spending 15 times more on ads than supporters.

Indiana Gov. Mike Pence really hates Obamacare. He refused to set up an insurance exchange and, while serving in Congress, voted repeatedly for repeal. But Pence — alongside 10 other Republican governors — has found something Obamacare is good for: forcing the Obama administration to agree to conservative Medicaid reforms they might not otherwise consider.

Governors have the final say over whether their states expand Medicaid to millions of Americans — and haven’t been shy about using that leverage with the Obama administration. Pence demanded that, if he were to sign onto the Medicaid expansion, it would only happen if he could use Indiana’s controversial, Bush-era Medicaid experiment as a vehicle.

Obamacare isn’t only about its insurance exchanges.

There’s actually another half to the health-care law: it reforms payments to doctors. And these reforms could play a big role in reshaping the US health-care system. They are, in short, what the Obama administration hopes will drive down the US’s high health-care spending over time.

Summer is upon us. For most Americans, this means bathing suits and beaches. For America’s health wonks, hot weather signals something completely different: it’s the start of health insurance rate filing season.

Health insurance plans are just now starting to turn in the prices they want to set for coverage next year. These filings are the first glimpse at how expensive Obamacare will be in 2015.

Early data shows health insurance premiums will generally go up in 2015, but most of the hikes won’t be the double-digit increases some Obamacare opponents previously predicted.

Some of the first publicly available data, from Virginia, shows rate increases ranging from 3.3 percent to 14.9 percent, the Wall Street Journal reported Monday. WellPoint, for instance, filed rate increases averaging around 8.5 percent across the state.

Obamacare’s state-run exchanges were better at enrolling people than the federal exchanges — and that success came with a higher price tag.

The exchanges cost $7.4 billion in federal dollars to set up. About $3.9 billion of that went to 15 marketplaces run by states and the District of Columbia, which all spent a lot more on outreach per enrollee than HealthCare.gov.

About 80 to 90 percent of Obamacare enrollees are paying their insurance premiums, major health insurers testified before Congress on Wednesday.

House Republicans’ report, insurers explained, got that metric wrong. It counted potentially millions of enrollees’ premiums as unpaid when they still had several weeks left to pay their bills. Insurers, in fact, said they had warned the committee that the data was preliminary before it was published online on April 30.

Obamacare is a story of 50 states. It doesn’t really matter how the entire nation does in terms of enrollment; success or failure instead comes down to how each state’s exchange fares.

Looking at the health-care law through that framework, however, is a lot more nuanced: the success of the exchanges varied significantly from state to state, according to the Urban Instute’s analysis of new federal data.

Just over 8 million people have signed up private insurance on the health law’s exchanges, the Obama administration’s final tally for the first year of open enrollment shows.

The report, published Thursday, also includes the federal government’s first estimate of how many exchange enrollees lacked health insurance coverage prior to picking a plan on the marketplace.

Insurance companies seem to be doing okay under Obamacare.

If the health-care law fell flat, health insurance companies would likely be the first to panic. Their whole business model, after all, relies on selling health policies.