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State-based marketplaces survived startup problems with botched technology and political threats but continue to grapple with a fundamental challenge: financial sustainability. The 13 states that run their own exchanges face challenges in raising enough money, through user fees or state funding, to maintain their operations now that about $5 billion in early federal grants has largely run out. As states establish those budgets, they are testing decidedly disparate approaches to investments in priorities like marketing, technology and operations. (Mershon, 7/25)

Insurance premiums for Affordable Care Act individual policies may not be as expensive as presumed when compared to rates before the law took effect, a recent analysis suggests. The analysis, released last week by Health Affairs, argues that though premiums are increasing, they’re actually lower than they would have been before the Affordable Care Act was implemented in 2010. That’s because the “average premiums in the individual market actually dropped significantly upon implementation of the ACA,” the analysis says. (McIntire, 7/25)

One of Kansas’ largest health insurers is trying to reduce costs and improve the quality of care for at least some of its customers in the Topeka area. Blue Cross and Blue Shield of Kansas announced Monday that it had formed an accountable care organization, or ACO, with SCL Health, the parent company of St. Francis Health, which operates a hospital and more than 20 physician clinics in the region. (Hart, 7/25)