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A ruling by the Internal Revenue Service creates a significant obstacle to a new type of health care network that the Obama administration has promoted as a way to provide better care at lower cost, industry lawyers and providers say. ... In its recent ruling, the I.R.S. denied a tax exemption sought by an accountable care organization that coordinates care for people with commercial insurance. The tax agency said the organization did not meet the test for tax-exempt status because it was not operated exclusively for charitable purposes and it provided private benefits to some doctors in its network. (Pear, 5/29)

On Jan. 13, 2014, a team of Internal Revenue Service financial managers piled into government vans and headed to the Old Executive Office Building for what would turn out to be a very unusual meeting. Upon arrival, the I.R.S. officials, some of whom had expressed doubts that the Obama administration had the proper authority to spend billions of dollars on a crucial element of its health care law, were ushered into a conference room. There, they were presented with an Office of Management and Budget memo laying out the administration’s justification for spending $3.9 billion on consumer health insurance subsidies. (Hulse, 5/30)

Three years after the launch of the state's health insurance exchange under the Affordable Care Act, three in five of Maryland's eligible uninsured still lack coverage. Despite the state's outreach efforts — and penalties imposed on those who don't buy health plans — officials acknowledge that they are having a hard time reaching most residents without insurance. (McDaniels, 5/28)

Americans who live in the two biggest states that haven’t expanded Medicaid have more complaints about health care costs and quality, according to a new survey released by the Texas Medical Center Health Policy Institute in Houston. They’d also like their states to expand Medicaid. (Feibel, 27)

The industry has called it a difficult but necessary decision in a time when it's being hammered by losses in the individual market, especially during the "special enrollment periods" reserved for those who need new coverage because of a job loss or life change. Insurers allege many people are abusing the system by waiting until they are already sick to sign up. Not all are buying that explanation, however, calling it one more covert way the industry has found to impede access to higher-benefit coverage and skirt the health care law's mandate to cover everyone regardless of medical needs. (Deam, 5/28)