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

President Barack Obama was in Milwaukee Thursday to congratulate the city for winning a federal health insurance sign up contest during the latest open enrollment period under the Affordable Care Act.

Gov. Scott Walker said greater enrollment is good, but the complaints he says he hears about the law are bad.

“What we hear routinely from small business owners and farmers across the state is that it’s anything but affordable,” Walker said. “They’ve actually seen their health care costs go on up dramatically even with the so-called Affordable Care Act.”

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California politicians and interest groups have been working overtime to figure out a way to fix an illegal Medicaid provider tax—the subject of my recent Mercatus Center study. These taxes are problematic because they are generally accompanied with the guarantee of increased Medicaid payments to the providers paying the tax—payments largely financed with federal matching funds. As a result, provider taxes, which reek of government favoritism because of how the benefits often target select providers, raise Medicaid spending.

California’s tax is illegal under federal law because the state was holding numerous insurers harmless from the tax that should not have been. The state has recently come up with a revised tax plan that it is submitting for federal approval.

Unlike the last few election cycles, paid political advertising that features healthcare issues hasn’t played a starring role in the early primaries.

But once the Democratic and Republican nominees are selected, watch out.

The Affordable Care Act and other healthcare issues are going to get plenty of screen time, according to experts who track campaign advertising. Indeed, one analyst estimates healthcare messages, combining both pro- and anti-Obamacare ads, will account for nearly one-fifth of the more than $6 billion that will be spent in this year’s massive onslaught of television and digital advertising to voters in the presidential, congressional and gubernatorial campaigns.

Health Care Service Corp. improved its net loss in 2015, but the Blue Cross and Blue Shield conglomerate continues to hemorrhage money in the Affordable Care Act’s nascent marketplaces.

HCSC, which owns the Blue Cross and Blue Shield affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas, lost $1.5 billion on its individual ACA-compliant plans in 2015, according to financial filings. After factoring in a premium deficiency reserve, an accounting measure that predicts future losses, the insurer lost $866 million last year on its ACA plans, said Ken Avner, HCSC’s chief financial officer.

There may finally be one thing Republicans hate more than ObamaCare: TrumpCare.

The GOP front-runner, after weeks of talking in vague terms about his plans for the health care system, put out a seven-point proposal Wednesday night, just in time for the GOP debate in Detroit and four more primary contests this weekend.

But within hours, Republican opinion leaders in health care were already piling on.

“It has the look and feel of something that a 22-year-old congressional staffer would write for a backbencher based on a cursory review of Wikipedia,” wrote Avik Roy, the opinion editor at Forbes who has advised several GOP presidential candidates on health policy, including Mitt Romney in 2012.

Obamacare does not have a mandate. Wait: Has Marco Rubio proposed an individual mandate? The Cato Institute’s Michael Cannon and James Capretta of AEI have engaged in a spirited and informative point-counterpoint on that question here at NRO. Cannon writes that Rubio’s Obamacare-replacement plan is built “around an individual mandate.”  Capretta responds by noting that Rubio proposes to repeal all of Obamacare, including “the requirement that all Americans buy government-approved health insurance,” commonly known as the individual mandate.

Pulling Americans from Obamacare’s wreckage should be among the next president’s most urgent priorities. Costs are rising, choices contracting, and regulation metastasizing. Reform will not be easy to achieve. Replacing Obamacare will require open and robust discussion, a process that is more likely to succeed if we’re all speaking the same language and using words to inform, not inflame.

Last week at the Houston GOP presidential debate, Marco Rubio hammered Donald Trump on his ignorance of health care policy. “What is your plan, Mr. Trump?” asked Rubio. “The lines around the states,” Trump feebly responded. When Trump was asked if his plan had any other provisions, Trump said “no, there’s nothing to add.” That embarrassing performance has led the Trump campaign to put out what now purports to be the official Donald Trump health reform plan. And all you need to know to understand this plan is that it bears little relation to the things Trump has actually said on health care.

Donald Trump on Wednesday laid out for the first time how he will reform the U.S. health care system after repeatedly pledging to “repeal and replace Obamacare with something much better.”

Trump published a seven-point health care reform plan that calls for repealing Obamacare, breaking down state barriers that prevent the sale of health insurance across state lines and making individuals’ health insurance premium payments fully tax deductible.

The reforms, which Trump calls “simply a place to start,” are aimed at broadening access to health care, making health care more affordable and improving the quality of care, according to the plan published on Trump’s campaign website.

The vast majority of Americans have not benefited from Obamacare, according to a poll released by National Public Radio, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health Monday.

56 percent of Americans polled said they don’t believe the Affordable Care Act has directly impacted them. Of those surveyed who said it did have a direct impact, more said health care reform has been overall detrimental rather than positive — coming in at 25 percent and 15 percent respectively.

Senator Rubio is proposing to fix a longstanding problem in federal tax law. He wants to make sure that all Americans get a comparable tax break for health insurance, regardless of whether or not they get their insurance through their place of work. For many years, federal law conferred a generous tax break for health insurance only on employer-paid premiums, which are excluded from the taxable compensation of workers for both income- and payroll-tax purposes.

Obamacare’s defenders would say that Obamacare fixed this problem by giving households credits that they can use when they buy insurance through the law’s “exchanges.” But the Obamacare credits are not connected in any way with the value of the tax benefit for employer-provided coverage, they are income-tested and thus phase out for middle-income families, and they can be used only to purchase heavily regulated plans.

Rubio’s proposal would truly level the playing field by first getting rid of Obamacare and then giving Americans who buy insurance on their own, rather than through their place of work, a tax credit of roughly comparable value to the tax break conferred on an employer plan of average cost.