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

Advocates in Washington of the Affordable Care Act have been fighting tooth and nail to preserve the president’s signature health-care law—and they’re fighting even harder to expand it in the states. Conservative lawmakers in our home states of Utah and Florida recently defeated a combined three proposals to expand Medicaid under ObamaCare. They were absolutely right to do so, as the fiscal messes in states that did expand Medicaid demonstrate.

When open enrollment began on the nation’s healthcare exchanges on November 1, many people who bought insurance for 2015 found that the 2016 plans they had to choose from have narrower networks of hospitals. In addition, premiums might be significantly higher. Insurers have asked the federal government for permission to increase premiums by as much as 40 percent or more. All of this is happening because health insurers say that people who have signed up for coverage under the Affordable Care Act have been sicker than expected.

After nearly two years in operation and millions of dollars spent in development, the small business health insurance exchange created by the Affordable Care Act is struggling to catch on. Nationally, about 85,000 people, from 11,000 small businesses, have coverage through the online marketplace known as the Small Business Health Options Program, or SHOP, according to the latest federal data released in May. Those totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015.

“Everyday people with good health insurance and ready access to medical care die of preventable diseases,” my friend John, a retired surgeon, wrote me recently. My friend was lamenting a recent article appearing in many Idaho newspapers about the tragic death of a woman with asthma. Her death was blamed on lawmakers who have refused to expand government-run programs like Medicaid to include able-bodied, childless adults.

“Everyday people with good health insurance and ready access to medical care die of preventable diseases,” my friend John, a retired surgeon, wrote me recently. My friend was lamenting a recent article appearing in many Idaho newspapers about the tragic death of a woman with asthma. Her death was blamed on lawmakers who have refused to expand government-run programs like Medicaid to include able-bodied, childless adults.

Government health officials worked diligently this year to improve consumer experience on Healthcare.gov and make sure people know what they are getting for their money when they pick health insurance. But one thing is out of the government’s control: whether doctors and hospitals will agree to accept patients who buy these plans. Surveys and data are limited, so it’s difficult to gauge the extent of the issue, but anecdotal evidence from patients and providers show it is a struggle. Some newly insured patients wonder whether it’s worth paying for coverage they can’t actually use. Even when they do find a provider, reports show they face crippling out-of-pocket costs they didn’t expect.

Republican Matt Bevin’s victory in the Kentucky governor’s race Tuesday highlighted the enduring power of public sentiment about the federal health law to energize GOP voters as the national parties prepare for the 2016 elections. The Affordable Care Act, also known as Obamacare, played a central role in the contest, which Mr. Bevin won resoundingly, 53% to 44%, against Democrat Jack Conway. The Republican pledged to dismantle the state’s health exchange—which earned praise for its relatively smooth launch—and to roll back or modify the expansion of Medicaid under the law.

The Democratic Party has prospered for decades by promising voters entitlements in return for Election Day loyalty. It worked with Social Security and Medicare, and so it was supposed to work for ObamaCare: Pass it and they will come. Instead the Affordable Care Act has become a recurring political catastrophe for Democrats, most recently on Tuesday in Kentucky.

When Congress was debating the Affordable Care Act (ACA), the debate largely revolved around how many people would gain insurance and how the law would impact the deficit, not about how the law would address existing government policies and programs that largely created the perverse incentives. The ACA created several new perverse incentives, unfortunately.

Regardless of whether there is a President Cruz or a President Rubio in January 2017, regardless of the existence or size of a Republican majority in Congress, the so-called Patient Protection and Affordable Care Act (ACA) has failed. The grand vision of an efficient pseudo-market in health insurance under enlightened federal management — the heart of Obamacare — is not coming to pass. Obamacare, meaning the operating model that undergirded the law that Congress passed and President Barack Obama signed with great fanfare — is dead, and it will not be revived. What remains is fitful chaos.