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State-run health insurance markets that offer coverage under President Barack Obama's health law are struggling with high costs and disappointing enrollment. These challenges could lead more of them to turn over operations to the federal government or join forces with other states. Hawaii's marketplace, the latest cautionary tale, was awarded $205 million in federal startup grants. It has spent about $139 million and enrolled 8,200 customers for individual coverage in 2015. Unable to sustain itself, the state marketplace is turning over sign-ups to the federal HealthCare.gov for 2016. (Alonso-Zaldivar, 7/26)

Two new health insurers are poised to join California's market for Obamacare coverage — industry giant UnitedHealth and a New York start-up named Oscar. Many consumers may welcome the new choices starting next year and the prospect that increased competition helps hold down premiums. The lack of more health plans to choose from has been a sore point for some Covered California customers during the rollout of the Affordable Care Act. (Terhune, 7/24)

California on Monday will announce 2016 premium rates for individual health plans sold on the state's insurance exchange, an important gauge of affordability amid growing concern that some insurers around the country are seeking double-digit price increases. Last year, state officials declared victory when they announced premiums rose by an average of 4.2 percent, which was about half the increase the industry saw over a three-year period. But this year a number of health plans around the country have requested increases above 10 percent for 2016, saying their new customers turned out to be sicker than expected. (Lin, 7/27)

Iowans who buy their own health insurance pleaded with the state's top regulator Saturday to reject big premium increases, but several expressed doubt their words would have much effect. Insurance Commissioner Nick Gerhart held a hearing on rate increases from Wellmark Blue Cross & Blue Shield and Coventry Health Care. Wellmark, the state's largest health insurance carrier, is proposing premium increases averaging 21 percent to 26 percent for 140,000 Iowans. Coventry, the largest Iowa carrier selling policies that qualify for Affordable Care Act subsidies, is proposing average increases of 17 percent for about 30,000 Iowans. (Leys, 7/25)

The number of Minnesotans struggling to pay their medical bills is rising sharply, despite an increase in the number of residents who have health insurance. In the past year, Minnesota’s main hospital and clinic groups filed nearly 9,000 lawsuits against people with large or long-standing medical debts — a sharp increase since 2005, according to a Star Tribune analysis of court records. (Howatt, 7/26)

Thought you had seen the end of major controversy over the Affordable Care Act? Think again. One of the last pieces to take effect promises to soon reignite the fierce debate on President Barack Obama’s landmark health overhaul. It’s known as the “Cadillac tax” — a hefty surcharge on relatively generous employer-sponsored health insurance. The tax won’t take effect until 2018, but many businesses are already bracing for it. (Shapiro, 7/25)

Kaiser Health News staff writer Jay Hancock reports: "A $57 million experiment to deliver better, more efficient care at federally funded health centers struggled to meet its goals and is unlikely to save money, says a new government report. The test to coordinate treatment for high-risk Medicare patients in hundreds of communities was one of many demonstrations run by the Department of Health and Human Services’ innovation center." (Hancock, 7/27)