Last week, the Centers for Medicare and Medicaid Services released its official estimates of the uninsured population and of health spending. In 2014, ObamaCare’s coverage expansion fell between 6 and 12 million short of expectations, while driving the growth of health spending to its highest rate in 7 years. ObamaCare has only reduced the percentage of U.S. residents without health insurance by about 2%: a remarkably small number, and far lower than what the law was supposed to achieve.

Democrats like to talk a lot about being the party of choice, but under Obamacare, individuals are finding their choices increasingly limited. At its core, Obamacare forces individuals to purchase government-approved insurance policies and precludes them from buying plans that might be more in line with their healthcare needs. Though Obamacare’s defenders argue that the requirements imposed on health insurance plans only serve to guarantee that individuals have better coverage, in reality, what’s happening is that the law is driving insurers to limit choices.

Cassandra Gekas, operations director for Vermont Health Connect, said staff members are working on a problem in which hundreds of people who paid their monthly premiums on time were canceled for nonpayment. Apparently, the cancellations were related to a five- to seven-day period it takes for the system to process end of the month payments. Vermont Health Connect was plagued with technical glitches and security problems after its launch Oct. 1, 2013.

Land of Lincoln Health, an insurance co-op created under ObamaCare, is no longer taking new small-business customers. The health insurer announced in October that it would severely cap enrollment on the exchange, HealthCare.gov, and limited new small-business clients in particular to help the co-op survive long term. More than half of the co-ops nationwide have failed.

A Kaiser Health News analysis of costs in the three-dozen states selling policies through the federal healthcare.gov website found a sharp difference in premium prices between plans that offer out-of-network care and those that do not. The analysis compared the monthly premiums for the least expensive silver-level plans — the category that are the most popular purchases — for a 40-year-old in each county. While the average premium for the least expensive closed network silver plan—principally HMOs—rose from $274 to $299, a 9 percent increase, the average premium for the least expensive PPO or other silver-level open access plan grew from $291 to $339, an 17 percent jump, KHN found. The cost variations hold true for any age.

The latest turmoil in health insurance marketplaces created by the Affordable Care Act has emboldened both conservatives who want to shrink the federal role and liberals who want to expand it. UnitedHealth Group announced last week that it may pull out of the marketplaces in 2017 after losing money this year. This followed the collapse of 12 of the 23 nonprofit insurance cooperatives created with federal loans under the health law. In addition, insurance markets in many states are unstable. Premiums are volatile and insurers say their new customers have been sicker than expected.

Michael Cannon of the Cato Institute, Tarren Bragdon of the Foundation for Government Accountability, and Daniel Landon of the Missouri Hospital Association joined former Secretary of the Department of Health & Human Services (HHS) Kathleen Sebelius to discuss Medicaid expansion under the Affordable Care Act.

Complete footage of the debate is available here: Part 1Part 2Part 3Part 4Part 5, and Part 6.

The sudden collapse of the largest nonprofit insurance cooperative created under the Affordable Care Act is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan’s patients. Hospitals, doctors, and other clinicians are legally obligated to continue treating Health Republic patients through the end of the month but have been given no assurances they will ever be paid for that care.

Executives with Arizona’s nonprofit health insurance co-op said Tuesday that they have failed to come up with additional financial backing and the insurer plans to shut down all operations December 31, 2015. The announcement by Meritus Health Partners means 59,000 Arizonans it now covers need to find a new insurer by December 15 if they want coverage on January 1, 2016.

“Taxpayers should not be forced to throw good money after bad,” Grace-Marie Turner said in an interview with LifeZette. Turner is president of the Galen Institute, a not-for-profit health and tax policy research organization. “Congress would be well advised to exercise its oversight function to ensure no additional federal dollars are wasted on the program, as well as investigate how the taxpayer loans have been spent and who will pay it back,” she said.