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Congressional Republicans are warning the Obama administration not to settle with insurers that have sued the government over an Affordable Care Act program to compensate them for losses under the law, saying such a move would bypass spending limits set by Congress. Forty-six House Republicans signed a letter sent Thursday to Health and Human Services Secretary Sylvia Mathews Burwell saying they oppose any settlements and could sue the administration to block them. (Armour, 9/22)

Democrats are beginning to talk about changing ObamaCare to fix what they acknowledge are growing problems in the law’s insurance marketplaces. Insurers have been dropping out of ObamaCare or hiking their premiums this year due to financial losses, fueling Republican criticism of the law ahead of the November elections. (Sullivan, 9/22)

As concerns about the survival of the Affordable Care Act’s markets intensify, the role of nonprofit “co-op” health insurers -- meant to broaden choices under the law -- has gained prominence. Most of the original 23 co-ops have failed, dumping more than 800,000 members back onto the ACA markets over the last two years. Many of those thousands of people were sicker and more expensive than the remaining insurers expected -- and they’re hurting results.  ... “These co-ops have attracted, we think, disproportionately high health-care utilizers,” Gary Taylor, an analyst with JPMorgan who follows the industry, said in a telephone interview. Their former members “are now enrolled in these for-profit health plans. That’s been a factor driving the deterioration in their profitability.” (Darie, 9/23)

Blue Cross Blue Shield of North Carolina will marketplace plans in every county in the state next year, the insurer said Thursday. The insurer will be the only one to offer plans in every county next year. BCBSNC had previously suggested it could withdraw from the marketplace before 2017, citing financial losses, which would have left most counties in the state without an insurer offering exchange plans. (McIntire, 9/22)

With major insurers retreating from the federal health law’s marketplaces, California’s insurance commissioner said he supports a public option at the state level that could bolster competition and potentially serve as a test for the controversial idea nationwide. “I think we should strongly consider a public option in California,” Insurance Commissioner Dave Jones said in a recent interview with California Healthline. “It will require a lot of careful thought and work, but I think it’s something that ought to be on the table because we continue to see this consolidation in an already consolidated health insurance market.” (Terhune, 9/22)