Mergers are sweeping health care, as insurers, hospitals and doctors seek economic shelter from Washington by linking up and getting big.

These merger trends were underway prior to Obamacare. But there’s little question that the law purposely hastened these developments.

Just a few weeks before the third Obamacare enrollment season begins, researchers are pointing out that millions of people are still uninsured, despite the law, and that there are real hurdles to convincing people to sign up.

The first two enrollment seasons made a sizable dent in the U.S. uninsured population, as about 17 million Americans have gained coverage through the Affordable Care Act’s various provisions, the Department of Health and Human Services estimated this week.

The New York State Department of Financial Services (NYDFS), the Centers for Medicare and Medicaid Services (CMS), and the New York State of Health (NYSOH) health plan marketplace today announced actions regarding the Health Republic Insurance of New York co-op. NYDFS is directing Health Republic to cease writing new health insurance policies and the co-op will commence an orderly wind down after the expiration of its existing policies.

A New York nonprofit health insurer with more than 200,000 patients is going out of business, becoming the fourth and, by far, the largest co-op created under the Affordable Care Act to collapse this year.

In its annual report on poverty and the uninsured, the U.S. Census Bureau reports that: “The percentage of people without health insurance coverage for the entire 2014 calendar year was 10.4 percent, down from 13.3 percent in 2013. The number of people without health insurance declined to 33.0 million from 41.8 million over the period.” (Our analysis shows that virtually all of the increase in the number of people with health insurance has come from Medicaid expansion.)

According to a Sept. 3 report by Anna Wilde Mathews of the Wall Street Journal, Pittsburgh-based Highmark Health announced it will cut back its range of plans offered through the ObamaCare marketplaces.

Insurers have asked for double-digit rate increases for nearly 1 out of every 3 Obamacare plans that will be sold on HealthCare.gov for 2016 coverage, according to a new analysis.

And in three states—Delaware, South Dakota and West Virginia—every plan sold on HealthCare.gov is asking for 10 percent or more hikes in the prices of their premiums for next year, AgileHealthInsurance.com said in its report.

Highmark Health said it would reduce its range of offerings on the Affordable Care Act marketplaces, becoming the latest insurer to retrench amid steep financial losses.

The big Pittsburgh-based nonprofit company said it would continue to sell plans related to the federal health overhaul in all of the areas it currently serves, which span Pennsylvania, Delaware and West Virginia. But “we will have less products in the market overall,” said David L. Holmberg, the company’s chief executive, who said Highmark had lost $318 million on its individual health-law plans in the first six months of 2015, after rolling out a very broad array of options that had attracted many consumers with chronic conditions who required costly care.

Most of the 275 million Americans with health benefits probably see the logo on the corner of their insurance card and think that’s who has them covered. But for almost 100 million of them—the majority of Americans who get coverage through work—the true insurer is noted somewhere else: on their business card. It’s called self-insurance, and the Obama administration seems interested in curtailing the practice to shore up the Affordable Care Act’s health-insurance exchanges.

According to preliminary data released by the Internal Revenue Service (IRS) in a letter to Congress on July 17, 2015, about 40 percent of households that received subsidies in 2014 are currently at risk of losing their subsidy eligibility because of complications with their 2014 tax returns. To date 1.8 million heads of households have not submitted the appropriate Affordable Care Act (ACA) related tax forms to reconcile the $5.5 billion in subsidies paid on behalf of these households.