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

The fed­er­al gov­ern­ment is poised to start mak­ing state-based ex­changes pay for us­ing Health­Care.gov’s tech­no­logy, and that has some states mulling the pos­sib­il­ity of shar­ing ser­vices with oth­ers to con­trol costs.

The Cen­ters for Medi­care and Medi­caid Ser­vices pro­posed a rule last year re­quir­ing that cer­tain states es­sen­tially “lease”Health­Care.gov through a user-fee rate of 3 per­cent of the monthly premi­um the is­suer charges for each policy plan—mean­ing that, for the first time, us­ing the fed­er­al plat­form for state-based mar­ket­places won’t be free.

Last month, mar­ket­place of­fi­cials from sev­er­al states gathered in Port­land, Ore­gon to dis­cuss the rule, in­creased col­lab­or­a­tion, and long-term mar­ket­place af­ford­ab­il­ity and sus­tain­ab­il­ity.

The law being implemented today is in many ways quite different than the law passed by a very temporary super-majority of Democrats back in 2010. It is highly likely that the ACA-as-implemented could not possibly have secured enough votes for passage in March 2010.

Likewise, we already know that neither the ACA-as-enacted nor ACA-as-implemented could possibly secure majority support in today’s Congress. Not only do all Republican presidential candidates want the law repealed and replaced, but so does the current front-runner in the New Hampshire Democratic primary.

Too many in the general public do not realize that five provisions of Obamacare have already been repealed.

The Affordable Care Act was signed into law nearly six years ago. Since that time, 106 regulations have been finalized to implement the ACA. These regulations will cost businesses and individuals more than $45 billion and will require approximately 165 million hours of paperwork in order to comply.

In addition to these regulations, hundreds of guidance documents regarding the ACA have been published by various federal agencies during this time as well. However, more regulations—and additional costs—are still to come.

Despite the ongoing debate between Republican lawmakers and President Obama on the future of the 2010 health care law, the January Kaiser Health Tracking Poll finds the Affordable Care Act is only one of many issues that may impact voting decisions, with nearly a quarter (23%) saying it’s extremely important.

When asked specifically about how some health care issues may impact their vote for president, at this point in the campaign, there’s not a single health care issue that voters coalesce around with more than 4 in 10 saying a number of different health care issues may be important to their vote.

Six out of 10 registered voters support “low income subsidies for health insurance.”

A smaller proportion (45%) believe states should expand Medicaid to people who work but are too poor to buy insurance.

Even fewer voters (41%) approve of President Obama’s idea to extend “start-up” benefits to states that haven’t yet expanded Medicaid.

In her confrontation with Bernie Sanders, Hillary Clinton always promises to “build on the successes” of ObamaCare, so allow us to recommend a follow-up question: What would those be, precisely? The entitlement is becoming less stable and less entrenched, not more, as it gets older.

The latest jolt is the $475 million loss UnitedHealth Group booked on the insurance exchanges in 2015, which the largest U.S. mega-insurer by membership expects to rise this year to another $500 million.

In 2015, the U.S. federal government spent more on healthcare than on Social Security for the first time. The Affordable Care Act’s expansion of Medicaid and the growing availability of subsidies for exchange plans are driving much of the higher spending.

Enrollment in the ACA’s insurance exchanges will hover around 13 million in 2016, the Congressional Budget Office said in an expanded economic report Monday, down from its previous estimate of 21 million but still above HHS’ most optimistic projection.

Federal spending on major health care programs will jump by $104 billion, or 11.1%, this year, according to Congressional Budget Office estimates published on Monday.

Those figures include a $24 billion increase stemming from a shift in the timing of certain Medicare payments from 2017 into 2016. Today’s CBO figures are a detailed version of the broader estimates published last week.

The nonpartisan CBO projected in its 2016-2026 Budget and Economic Outlook that spending on federal health programs will make up 5.5% of the country’s gross domestic product this year, and reach 6.6% by the end of 2026.

The Congressional Budget Office (CBO) issued a new budget forecast last week. It should be a wake-up call to policymakers, and to the candidates running for president. It is also a clear indictment of fiscal policy during the Obama presidency.

The forecast shows annual federal budget deficits rising throughout the coming decade, pushing total federal debt to levels well above the historical norm. CBO projects the federal budget deficit will be $544 billion in 2016, or 2.9 percent of GDP. By 2026, the annual deficit will be nearly $1.4 trillion, or 4.9 percent of GDP. Over the period 2016 to 2025, CBO expects the federal government will need to borrow an additional $9.4 trillion, pushing total federal debt up to $23.8 trillion, or 86 percent of GDP.

The deficits projected in CBO’s forecast, and the level of debt they would cause, are almost unprecedented in the nation’s history.

The House GOP emerged from its retreat earlier this month united in its goal to come up with an alternative to Obamacare. But the deeper into health policy the members dig, the more difficult finding consensus will become.

Republicans have determined that they will select pieces of different GOP proposals rather than simply put forth one of the party’s old plans as its main health proposal. The older conservative health plans are unworkable in a post-ACA world.