As I listened to the Town Hall where Democratic Presidential candidate Bernie Sanders proclaimed his dream of Medicare for All, I realized that he was speaking in vague generalities that were void of realism. Medical care would be “free at the point of service with no co-pays.” Would there be any brakes on the over-utilization of services? He had no answer. He thus needs to understand that the demand for medical services is limitless when other people are paying the bill. The suggestion that “Medicare for all” would save money is surely an example of a pipe dream.

As several states consider expanding Medicaid eligibility to able-bodied individuals above the poverty level, Virginia state officials have announced huge, unexpected Medicaid costs are threatening to siphon funding from programs such as education.

Although Virginia lawmakers insist the new cost burden is not related to Medicaid expansion, they acknowledge the program’s share of the budget has been growing for years and has led to $460 million in unforeseen Medicaid costs.

The Trump administration issued a proposed rule that would allow workers in large companies to use employee-provided tax-exempt health reimbursement arrangements (HRAs) to help pay premiums for individual health insurance.

The goal, according to administration officials, is to empower employees to make their own decisions regarding the health care they choose to purchase. Rules imposed under President Barack Obama prevented employers from covering medical costs tax-free via HRAs, declaring they would not meet the federal government’s mandate requiring companies with more than 50 full-time employees to provide health insurance covering all items the Obama administration deemed “essential.”

Doug Badger, a senior fellow at the Galen Institute, says young adults will be the group most adversely affected by the ban on short-term plans.

“Ages 26 to 34, in particular, have the highest uninsured rates in the country,” Badger said. “The reason for that is the ACA regulations charge them unfairly high premiums to subsidize, essentially, their parents. People in their twenties and thirties are asked to pay unfairly high premiums to subsidize those in the fifties and sixties, who purchase plans for unfairly low rates.” Skyrocketing premiums have reduced the number of young adults purchasing insurance, Badger says, and the short-term plans could help remedy that.

The Trump administration handed the decision about whether to offer short-term, limited duration health care plans over to the states. California immediately passed legislation to ban the sale of these plans, which the Trump administration had expanded access to by allowing for a longer renewal period and carrying time. Doug Badger, an expert on these plans, talks about why California’s decision is bad news for people seeking affordable alternatives to Obamacare Exchange plans and how, despite this, the move to let states decide is the intent of a federalist system.

On July 24, 2018, liberal activists announced they collected enough signatures to place Medicaid expansion on Idaho’s November 2018 ballot. If voters approve this initiative, Idaho will expand the program to able-bodied adults that earn up to 138 percent of the federal poverty line.

Supporters of Medicaid expansion claim the program will generate millions of dollars in new revenue and save money, citing a recent report from the consulting firm Milliman. However, an earlier 2016 report from Milliman determined Medicaid expansion would cost Idaho almost $3 billion more than its new estimates. The firm argues its 2018 estimates are more accurate because Medicaid expansion has cost other states less than previously thought, but this claim is completely without merit.