The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

The cost of expanding Medicaid under President Barack Obama’s health care overhaul is rising faster than expected in many states, causing budget anxieties and political misgivings.

Far more people than projected are signing up under the new, more relaxed eligibility requirements, and their health care costs are running higher than anticipated, in part because the new enrollees are apparently sicker than expected. Rising drug prices may also be a factor.

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For weeks, rumors have been flying that WikiLeaks would deliver an “October surprise” for Hillary Clinton’s campaign, a bombshell revelation that she would struggle to recover from in the short weeks remaining until the election. (So far, it’s a dud — surprise!)

But Clinton should be worried about a “November surprise” — the wave of policy cancellations and rate hikes that will attend the debut of Obamacare’s fourth open-enrollment period, on Nov. 1. Just a week before Election Day.

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Many variables remain up in the air as we contemplate what Obamacare would look like without functioning exchanges, but the failure of the exchanges in some states might provide an opportunity to amend and improve upon the ACA, and move the American health care system towards a freer market system where individuals are free to enroll in any health insurance plan that is for sale, and where insurers have the freedom to sell the plans that are the most appealing to potential buyers. Treating markets where the ACA has failed as opportunities rather than crises might be the first step in achieving sustainable health care reform.

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The Affordable Care Act hasn’t done much to change trends of low-income people seeing changes in their health insurance coverage, a new study finds.

About a quarter of low-income adults in three states have experienced a change in their health insurance coverage, known as “churning” under the Affordable Care Act, according to a study released today by the Harvard T.H. Chan School of Public Health in the journal Health Affairs. Maintaining insurance coverage over time can remain difficult under the law, the researchers found.

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A majority of American adults oppose a potential “bailout” of the insurance industry, according to a poll released today by Freedom Partners.

Of those surveyed, 55 percent of adults said they were opposed to the administration using taxpayer money to direct funds to insurance companies reporting losses on the Affordable Care Act markets.

President Obama says his signature domestic policy, the Affordable Care Act, needs some fixes.

“In my mind the [Affordable Care Act] has been a huge success, but it’s got real problems,” Obama said in an interview with New York Magazine published Sunday.

The Affordable Care Act, or Obamacare, created a new marketplace, known as the exchanges, which many insurers have struggled to adapt to. Several insurers have said they won’t offer marketplace plans next year, and the retreat of major insurers including UnitedHealth, Aetna and Humana in recent months have highlighted some of the shortfalls of the law.

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Vermont has received tentative approval from the Obama administration to establish an all-payer reimbursement system for healthcare providers in the state starting in January.

Maryland long has had an all-payer system, but it covers only hospitals. Vermont plans to use an accountable care organization-type structure that would cover all providers. All-payer systems require all insurers, whether private, Medicare or Medicaid, to pay similar rates for services.

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Republican senators are pressing the Obama administration for information on what they say could be a “bailout” of insurance companies under ObamaCare.

Sens. Marco Rubio (Fla.), Mike Lee (Utah), Ben Sasse (Neb.) and John Barrasso (Wyo.) wrote a letter to the administration warning against financial settlements with insurance companies. Those companies have sued over a shortfall in an ObamaCare program known as risk corridors.

“We write to express our grave concerns regarding the potential participation of your departments in a multibillion dollar bailout of select health insurance companies through the Affordable Care Act’s Risk Corridors Program,” the senators wrote.

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President Obama would veto a House bill that would provide an exemption from the individual mandate if someone’s insurance coverage ended mid-year because of a co-op closure, the White House said Tuesday.

The House is debating H.R. 954, the CO-OP Consumer Protection Act, and is slated to vote on the measure later today. The bill responds to the closures of three co-ops, nonprofit insurers that were created under the Affordable Care Act, during the past year. Republicans have pointed to the failures of 16 out of 23 original co-ops as a sign of the 2010 health care law’s weakness.

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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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