Monday Short Cuts

MAYAGÜEZ, P.R. — The first visible sign that the health care system in Puerto Rico was seriously in trouble was when a steady stream of doctors — more than 3,000 in five years — began to leave the island for more lucrative, less stressful jobs on the mainland.

Now, as Puerto Rico faces another hefty cut to a popular Medicareprogram and grapples with an alarming shortage of Medicaid funds, its health care system is headed for an all-out crisis, which could further undermine the island’s gutted economy.

Now that Congress and the courts have failed to overhaul Obamacare, states are eyeing the only current remaining opportunity to modify the healthcare law — this time from the inside out.

Policy and lawmakers are shifting their attention to a section of the Affordable Care Act allowing for state innovation waivers, known as "1332 waivers." Starting in 2017, the waivers can give states wider latitude in how they run their insurance marketplaces and regulate health plans, as long as they meet the law's major goals of providing affordable coverage to lots of people.

The Hawaii Health Connector insurance exchange has issued a request for proposals for an IT vendor to archive its data and dismantle its system as it winds down operations.

After spending approximately $130 million on the Connector system build-out, the state has opted to move to the federal exchange, instead of the Hawaii Health Connector, which was established as a nonprofit entity in 2011.

ST. PAUL, Minn. (AP) - Gov. Mark Dayton has made 11 picks to a health care task force that will study MNsure and MinnesotaCare and make recommendations for their future direction.

Dayton’s selections Friday will serve on a panel along with picks made by legislative leaders. The task force will begin meeting in August and must submit a report in January.

California and Texas are different in many ways—including in their levels of enthusiasm about Obamacare—but the two huge states are seeing similar effects from the Affordable Care Act.

Two new studies show sharp declines in the number of people without health insurance in California and Texas after implementation of Obamacare.

But those separate studies are also underscoring the challenges that health-care reform advocates will face in getting the remaining uninsured people—who are disproportionately Hispanic in both states—health coverage in coming years.

Vermont's troubled health exchange could add a new insurance carrier. But doing so is listed as one of the biggest open risks to functionality ahead of a critical deadline.

Administrators say the new dental insurer is likely to be approved. But that is not expected to happen until after open enrollment this fall as staff members scramble to meet a tight, self-imposed deadline for missing functionality. Not everyone's convinced they'll make it.

For the first time, last month Vermont Health Connect staff made changes to policies faster than new requests came in, bringing the number of backlogged changes down to 7,300 by July 6. That's according to a recently released monthly report, mandated by the Legislature after difficulties with the state's health insurance marketplace still haunt users more than a year-and-a-half after its initial launch.

In the absence of the Hawaii Health Connector, The Hawaii Department of Labor and Industrial Relations will issue tax credit eligibility for businesses signing up for health insurance plans, state officials said this week.

As the Hawaii Health Connector winds down its operations this fall, the state will adopt the federal platform to distribute health insurance plans.

The Hawaii Health Connector closed its Small-business Health Options Program (SHOP) enrollment on June 15, saying it will no longer offer employer eligibility determinations for plans or tax credits after July.

A first-in-the-nation program aimed at controlling costs and improving health care for some of Massachusetts’ poorest and sickest residents has sustained deep financial losses since its launch in 2013, dealing a setback to the state’s efforts to control rising medical spending through more coordinated care.

The three insurers in the pilot program lost a combined $54 million in 18 months,according to a recent report from the Executive Office of Health and Human Services. And as losses mount, insurers and state officials say it is too early to tell whether the program is improving the health of its members.