“Few states have embraced the ideas behind the Affordable Care Act (ACA) with more enthusiasm than Maryland and Massachusetts, which adopted many of them years before the passage of the federal law. But the two now find themselves trying to fix their malfunctioning health insurance exchanges and seeking federal approval to spend more money to do so. When states first applied for what are called Establishment Grants to build their online marketplaces, they had to predict the costs. Going over those costs requires them to resubmit plans to spend money that would have either returned to the federal government or gone to future changes.”
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