While health care has not been central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.

Hillary Clinton and Donald Trump have laid out different approaches to addressing these and other health care issues. Central among these is their position on the future of the ACA. Hillary Clinton would maintain the ACA, and many of her policy proposals would build on provisions already in place. Donald Trump, in contrast, would fully repeal the ACA, and although his policy proposals and positions do not offer a full replacement plan, they do reflect an approach based on free market principles.

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About 27,000 Hoosiers will lose their Obamacare plans next year after Indiana University Health Plans announced it is withdrawing from the Indiana marketplace, citing big losses from the new enrollees. It had covered 15% of marketplace enrollees last year. Indiana Sen. Dan Coats, a Republican, said the announcement from IU Health Plans is evidence the healthcare law is “collapsing before our eyes.”  “Because of the broken Obamacare system, Hoosiers continue to face rising premiums and limited choices rather than reliable, affordable healthcare,” Coats said.

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Obamacare’s fourth open enrollment period will begin November 1. For the Internal Revenue Service, it will be open season on uninsured taxpayers. In an effort to maximize enrollment, the IRS is mining the personal tax information of people who have chosen not to buy Obamacare policies or claimed an exemption. CMS proclaims Obamacare policies are “a product consumers want and need” and plans an outreach campaign. The agency can’t understand why millions of people—many of them young and healthy—still don’t realize what they want and need it.

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Several RAND Corporation health economists have offered very rough estimates of the coverage and cost effects of the hazy health policy proposals by the two major presidential candidates, Hillary Clinton and Donald Trump. In choosing to fill Trump’s policy vacuum with their own void of limited health policy modeling, the RAND researchers conclude that Trump’s proposals would increase the number of uninsured individuals within a range of 16 to 25 million individuals (relative to current-law ACA arrangements), with disproportionate losses suffered by those with low incomes or in poor health. However, Trump doesn’t spend much more taxpayer money to achieve these results, and his plans in health policy would increase the federal deficit by somewhere between $0.5 billion to $41 billion.

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BlueCross BlueShield of Tennessee sent shock waves Monday across Tennessee with the company’s decision to exit the Obamacare exchange in Nashville, Memphis and Knoxville, a move that highlights persistent volatility in the young health insurance marketplace.

Three years into the Affordable Care Act exchange, the state’s largest insurer is grappling with hefty losses and ongoing uncertainty on the marketplace. BCBST is open to coming fully back into the market once uncertainties about policies and the membership wane.

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In yet another sign of instability in Obamacare’s health-insurance Exchanges, BlueCross BlueShield of Nebraska has announced it will leave that state’s Exchange entirely, while BlueCross BlueShield of Tennessee will exit the Exchange in all three of that state’s major metropolitan areas. The moves will leave 112,000 Tennesseans and tens of thousands of Nebraskans scrambling to find new coverage for 2017 from a dwindling number of carriers.

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