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

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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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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Insurers have announced that they are sharply raising prices or pulling out of the Obamacare markets entirely. Many consumers will have fewer choices of insurance plans, and many insurance plans will include fewer doctors and hospitals. Many of the most important problems can be understood if you think of an Obamacare marketplace as a particular kind of restaurant: an all-you-can-eat buffet. It can be a solid business, but it’s hard to get the pricing right. For example, you can be in deep trouble if your buffet suddenly becomes the favorite hangout of the high school football team.  Unless you make major adjustments, you will quickly lose money. That may be what has happened to some of the companies selling health insurance.

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ObamaCare is plainly unaffordable for many young Americans. We’re at the start of our careers—and the bottom of the income ladder—so paying so much for something we likely won’t use makes little sense. The IRS penalty of $695 or 2.5% of our income is often cheap by comparison. We may be young, but we can do the math.

Young Americans aren’t looking for “outreach” and “engagement” from President Obama. We’re looking for affordable health-insurance plans—and ObamaCare doesn’t offer them.

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