Congress is bickering over health care again as they race toward a March 23 deadline to pass a government spending bill and avoid another government shutdown. The final budget may include funding for reinsurance and cost-sharing reductions intended to stabilize the individual insurance market. Negotiations continue with mixed messages from the White House, Republicans pushing for abortion restrictions and Democrats refusing to budge. The outcome is anyone’s guess.

In the meantime, a new single payer proposal is getting traction. The Center for American Progress recently released their proposal for a single payer program, Medicare Extra for All. The plan would allow people to keep their employer-based health insurance coverage or enroll in the Medicare Extra program, a comprehensive coverage program with income-based premiums.

Twenty conservative states filed a lawsuit in late February claiming that the recent individual mandate repeal renders the Affordable Care Act (ACA) unconstitutional. There have been many lawsuits challenging provisions of the ACA; whether this one will be one to watch remains to be seen. At the state level, Arkansas became the third state approved to impose Medicaid work requirements and the Administration passed on Idaho’s proposal for new health plans lacking many ACA consumer protections, encouraging them to instead pursue short-term plans.

Washington’s Insurance Commissioner, Mike Kreidler is encouraging Premera Blue Cross to spend the bulk of their $390 million tax windfall for the benefit of its enrollees. Premera has so far committed to $250 million of improvements. Included in this figure is a mandatory rebate to enrollees of a portion of their 2018 premiums because the percentage of premium dollars that the company spent on clinical services and quality improvement was lower than the ACA requires. Kreidler also announced last week his intention to initiate rulemaking on short-term health insurance plans that recent federal regulations now permit, and which threaten to undermine the stability of the insurance marketplace.