July 2017

Medicaid expansion and Covered California’s $100 million-a-year marketing budget have pushed the uninsured rate into the single digits, but enrollment has plateaued.
Jan Greene
The ACA made a dent, but Texas continues to lead the country in the percentage of people without insurance. Now it has also grabbed the top spot in high-deductible insurance.
Charlotte Huff
The ACA drove down the uninsured rate despite the lack of Medicaid expansion, but major insurers have left the market. In some rural areas, Florida Blue is the only insurer in the individual market.
Conservatives say Tennessee’s experience shows the ACA’s fatal weaknesses. But one expert believes that, properly nurtured, the state’s individual market could thrive.
Put the emphasis on ‘slowly.’ Still, those who make policy and those who sell policies will take any sign of hope they can get.
The Bay State can boast of the lowest uninsured rate, but the high costs give even proponents pause.
Maine has a rich history of health care policy innovation, although it was the ACA that finally brought down the uninsured rate. An older, rural population means no guarantees.
Joseph Burns
The Democratic governor and the Republican legislature have moved to shore up the individual market, but Minnesotans are leaving it in droves.

Managing Editor’s Memo
Frank Diamond
Legislation & Regulation
House salvages 2005 bill that’s gone nowhere three times in 12 years.
Richard Mark Kirkner
Medication Management
Price and physician reluctance to swap it into complicated regimens for heart failure could explain tepid sales.
Thomas Reinke
Value-Based Tools
University of Utah’s Value-Driven Outcomes program encourages attention to process. It’s a maligned concept in health care quality these days, but one Utah has refined to drive better outcomes.