Articles on the implementation of ObamaCare.

Texas — In rural Borden County, 12 people signed up for Obamacare this year. Livid over the government telling them they must buy something and loath to take anything that looks like a “handout,” the uninsured here are likely to stay that way. As Obamacare’s third open enrollment season began Sunday, this rock-solid conservative community of about 650 people offers a window into the challenges health law advocates face to expand coverage around the country.

When it passed Congress in 2010, the Affordable Care Act offered substantial financial support to create nonprofit health-insurance plans. Today 11 of the 23 such regional Consumer Operated and Oriented Plans have failed—seven since the beginning of October. They’ve collapsed despite federal startup loans totaling more than $1.1 billion. These loans will likely never be fully repaid, while insurers and consumers will be on the hook for any unpaid claims left behind by failed insurers.

Texas — In rural Borden County, 12 people signed up for Obamacare this year. Livid over the government telling them they must buy something and loath to take anything that looks like a “handout,” the uninsured here are likely to stay that way. As Obamacare’s third open enrollment season began Sunday, this rock-solid conservative community of about 650 people offers a window into the challenges health law advocates face to expand coverage around the country.

A low-cost health insurance co-op that covers about one in three Arizonans that have an Affordable Care Act marketplace plan won’t be allowed to sell health plans Sunday — the opening day consumers can purchase insurance — after the state of Arizona and the federal government took action against the entity. The Arizona Department of Insurance said Friday afternoon that Meritus Health Partners/Meritus Mutual Health Partners has been placed into “supervision” and only can continue to serve existing clients until the end of the year. The federal government also suspended Meritus from the Affordable Care Act’s federal marketplace, which means the company won’t be able to sell health plans via healthcare.gov when the health-care law’s three-month enrollment period begins Sunday.

When the open enrollment period for the New Mexico Health Insurance Exchange kicks off Sunday, one carrier with thousands of patients won’t be ready to offer plans through the state’s online portal. New Mexico Health Connections has announced that its insurance offerings on the exchange will be delayed by one or two weeks as some technical glitches are resolved. Dr. Martin Hickey, chief executive of the nonprofit insurance cooperative, said the plans should be available by Nov. 15. Hickey said the problem occurred as the co-op was uploading templates to the federal healthcare.gov website, where New Mexicans seeking individual coverage must go to enroll in a policy.

The Affordable Care Act (ACA) called for the establishment of non-profit “Consumer Operated and Oriented Plans” (CO-OP) to offer health insurance at lower prices and with patient, rather than corporate, interests at heart. Almost half the CO-OPs have failed in the first two years, with five failures announced just in the last month. Understanding the reasons why the CO-OPs were set up and why they failed can help us learn important lessons about the potential of government and private enterprise not just in the health care sector, but in all areas of the economy.

Insurance regulators said Friday the financial condition of Health Republic of New York, the largest of 23 health insurance co-ops established by a $2.4 billion Obamacare program, is “substantially worse than the company previously reported in its filings.” It is unclear if the co-op deliberately misled state regulators in its original filings, or if regulators found evidence of financial wrongdoing while they tried to close down the defunct non-profit. The co-op’s insolvency was announced September 25.

About 29 million people are still without health insurance, government estimates show — down more than a third since 2013. About half are eligible for subsidized coverage through the marketplaces or can enroll in Medicaid. Signing them up won’t be easy, Obamacare navigators and advocates say. Many don’t see the need for coverage, they believe it’s too expensive or they are unaware of financial assistance to lower the costs for insurance, surveys and interviews have found.

In sum, of the 24 Obamacare co-ops funded with federal tax dollars, one (Vermont’s) never got approval to sell coverage, a second (CoOportunity) has already been wound down, and nine more will terminate at the end of this year. So what is behind this, so far, 46% failure rate? To start with, the program was a Congressional exercise in not merely reinventing the wheel, but doing a bad job of it.

The clock is ticking on new rules under the Affordable Care Act that aim to ensure that hospitals devote more resources to charity care. But an article in the New England Journal of Medicine argues that the changes, known as Section 501(r) under the Internal Revenue Code, may not be yielding the desired effect. Section 501(r) mandates that not-for-profit hospitals must provide charity care to patients who need it—by actively ensuring that those who qualify for financial assistance get it, by charging reasonable rates to uninsured patients and by avoiding extraordinary collection practices. Hospitals also must perform a community needs assessment every three years.