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

The Patient Protection and Affordable Care Act, better known as Obamacare, may have gone into effect with the flip of the calendar on Jan. 1, 2014, but it remains a work in progress for much of America, which is still acquainting itself with the new health law.

According to preliminary data released by the Internal Revenue Service (IRS) in a letter to Congress on July 17, 2015, about 40 percent of households that received subsidies in 2014 are currently at risk of losing their subsidy eligibility because of complications with their 2014 tax returns. To date 1.8 million heads of households have not submitted the appropriate Affordable Care Act (ACA) related tax forms to reconcile the $5.5 billion in subsidies paid on behalf of these households.

Legislation overturning the Affordable Care Act’s expansion of the small-group insurance market is likely to get a look this fall, according to multiple sources on and off Capitol Hill, and it may be the Obamacare “fix” with the best chance of becoming law.

All the usual caveats apply: Republicans would have to convince the rank-and-file to accept a smaller-scale change to the law while waiting for full repeal. Democrats must be willing to agree to any change at all. Nothing involving Obamacare comes easy.

Back in 2009, President Obama spoke to the American Medical Association and said, “We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead paid well for how you treat the overall disease.” That’s a great idea, and it could really improve health care. Unfortunately, the president’s signature reform did nothing to move in that direction. Now, as before, almost no one in the health care fields is actually paid to keep people healthy.

At a July town hall in Nashville, Tenn., President Barack Obama played down fears of a spike in health insurance premiums in his signature health law’s third year.

“My expectation is that they’ll come in significantly lower than what’s being requested,” he said, saying Tennesseans had to work to ensure the state’s insurance commissioner “does their job in not just passively reviewing the rates, but really asking, ‘OK, what is it that you are looking for here? Why would you need very high premiums?’”

That commissioner, Julie Mix McPeak, answered on Friday by greenlighting the full 36.3% increase sought by the biggest health plan in the state, BlueCross BlueShield of Tennessee. She said the insurer demonstrated the hefty increase for 2016 was needed to cover higher-than-expected claims from sick people who signed up for individual policies in the first two years of the Affordable Care Act.

After talking about it endlessly, Republican presidential candidates are finally starting to get specific about how they intend to replace the Affordable Care Act. Wisconsin Governor Scott Walker released his plan last week. As the reaction to it shows, Republicans have to be ready with answers to a lot of hard questions.

As fall approaches, we can expect to hear more about how employers are adapting their health plans for 2016 open enrollments. One topic likely to garner a good deal of attention is how the Affordable Care Act’s high-cost plan tax (HCPT), sometimes called the “Cadillac plan” tax, is affecting employer decisions about their health benefits. The tax takes effect in 2018.

If you like your flexible spending account … you might not be able to keep your flexible spending account.

Obamacare’s looming “Cadillac tax” on high-cost health plans threatens to hit 1 in 4 U.S. employers when it takes effect in 2018—and will impact 42 percent of all employers by a decade later, according to a new analysis.

Republican presidential candidates are starting to roll on health reform. I mean that in a good way, like when the pilot accelerates down the runway and says “Let’s roll.” Governor Scott Walker (WI) just released his 15-page “Day One Patient Freedom Plan.” U.S. Senator Marco Rubio (FL) has written an op-ed in Politico that needs more detail, but contains a significant reform similar to Governor Walker’s.

Just in time for the next presidential election, health care spending is starting to take off again. Through 2024, health care spending is projected to grow by 5.8% annually, on average, according to CMS. While this isn’t unexpected—health economists across the political spectrum expected health care costs to start growing again (and growth rates are expected to still be lower than the long-run average)—the window for addressing health care costs in a less painful way is closing. Without better cost controls in the private sector, and without immediate reforms to Medicare, the health care sector is set to gobble up a full fifth of the U.S. economy in just 10 years.