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

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.

Yesterday’s post discussed what we know about Obamacare as its third open enrollment season commences. Here are four major questions about the future of Obamacare that remain unanswered.

Douglas Holtz-Eakin is the president of the American Action Forum and a former director of the Congressional Budget Office. He also served on President George W. Bush’s Council of Economic Advisers. With the Affordable Care Act’s insurance marketplaces beginning their third open enrollment this week, RealClearHealth talked to Holtz-Eakin about what’s working, what’s not working, what can be done today to address problems with the law, and what should be on the agenda of a new administration in 2017.

The financial failure of more than half the nonprofit health insurance companies created under the Affordable Care Act has handed Republicans a new weapon in their campaign against the health law, thrown the Obama administration on the defensive once again and left more than a half-million consumers in the cold.

Some observers might question the usefulness of ongoing policy discussion about health insurance coverage for pre-existing conditions. After all, as of January 2014, insurers are barred from excluding such conditions from their policies, even for short periods, by the Patient Protection and Affordable Care Act (ACA). Moreover, insurers are no longer allowed to charge higher-than-average premiums to consumers with higher-than-average expected health costs. In short, many would say the ACA has solved the problem, so there’s nothing more that needs to be discussed.

Douglas Holtz-Eakin is the president of the American Action Forum and a former director of the Congressional Budget Office. He also served on President George W. Bush’s Council of Economic Advisers. With the Affordable Care Act’s insurance marketplaces beginning their third open enrollment this week, Real Clear Health talked to Holtz-Eakin about what’s working, what’s not working, what can be done today to address problems with the law, and what should be on the agenda of a new administration in 2017.