The Trump administration this week issued the rules governing next year’s Affordable Care Act insurance marketplaces, and they make some potentially large changes that could result in higher premiums and fewer benefits.

Meanwhile, states are going different ways in addressing the health insurance markets in their states in response to the federal activity. And House Speaker Paul Ryan announced his retirement — leaving an intellectual void among House Republicans when it comes to health care.

This week’s panelists for KHN’s “What the Health?” are:

• Julie Rovner of Kaiser Health News
• Stephanie Armour of The Wall Street Journal
• Sarah Kliff of Vox.com
• Paige Winfield Cunningham of The Washington Post

Among the takeaways from this week’s podcast:

• The federal rules for the ACA’s marketplaces could dramatically alter how state regulators determine what plan benefits must be covered.
• Those rules also change some conditions allowing people to qualify for exemptions to the requirement to have coverage — and they make those exemptions retroactive to 2017. So, some people who opted not to buy insurance and paid a penalty for 2017 may be able to file for refunds from the government.
• Insurance companies are concerned about a number of the new provisions, including those that might drive healthy consumers away from the marketplaces and alter how insurers are compensated for having unusually high numbers of expensive customers.
• An announcement from the White House this week said the administration is hoping to extend the work requirements that some states are seeking for Medicaid to other safety-net programs.
• California and Maryland are among the states looking at ways to shore up their individual insurance markets in light of the changes being made at the federal level.

‘Bill of the Month’

This month, NPR’s Alison Kodjak talks about a case of two CT scans — identical, except one cost 33 times more than the other.

If you want to submit a bill for the Bill of the Month series, here is the form.

And if you have an emergency room bill you’d like to share for this Vox.com project, here’s that form.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Vox.com, “Toe Ointment, a $937 Bill, and a Hard Truth About American Health Care,” by Sarah Kliff.

Stephanie Armour: Axios.com, “The Drug Pricing Contract Express Scripts Doesn’t Want You to See,” by Bob Herman.

Sarah Kliff: Vox.com, “Why Scott Gottlieb Is the One Trump Official Everybody Seems to Like,” by Julia Belluz, German Lopez and Dylan Scott.

Paige Winfield Cunningham: Kaiser Health News, “How A Drugmaker Turned The Abortion Pill Into A Rare-Disease Profit Machine,” by Sarah Jane Tribble.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher or Google Play.