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

The term “Cadillac tax” is evocative: It suggests that the health-insurance plans it would tax—through a provision in the Affordable Care Act—are to regular health insurance as a Cadillac is to a Kia. President Obama once described the levy as targeting “really fancy [health insurance] plans that end up driving up costs.”

But what many Americans may not realize is that “Cadillac tax” is in part a misnomer. While some plans that qualify for the tax may be high-end with extra benefits, or “really fancy,” not all of them are. Nor is every employee with an expensive plan a corporate executive. Over time, the number of Americans affected by the tax is expected to increase, as is the revenue the government expects to raise from their plans.

This week, we learned that ObamaCare enrollments are nearly 40% below the original projections—further proof that the American people want nothing to do with this flawed system.

Under the Obama administration, we are becoming a nation of rules—not laws—dictated by a president and a White House who are more concerned with pursuing a partisan political agenda than they are with serving the American people.

Nowhere is the disregard for the laws of our nation—and the failure of our bloated, inept, partisan government—more obvious than in the way the Democrats foisted ObamaCare on us. And the way in which it has utterly failed to help Americans get the quality, affordable health care we were promised.

Presidential candidate Carly Fiorina outlines her blueprint to repeal ObamaCare and promote the free market in health care.

This one weird trick can help even rich people buy ObamaCare at sharply reduced prices. Really.

A number of wealthy individuals, some of whom were “disgusted” with ObamaCare when it first went into effect, nonetheless are now taking advantage of federal financial aid available under that health-care law to help significantly reduce their monthly insurance premiums.

Carolyn McClanahan, a Jacksonville, Florida-based financial advisor and medical doctor, told CNBC that she’s steered at least five such clients, whose individual net worths range between $1 million and $3 million, toward buying ObamaCare health plans because of the federal subsidies available due to their taxable income levels.

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.