Articles on the implementation of ObamaCare.

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.

A 10th co-op created under Obamacare has collapsed. Combined, the failed nonprofit insurance companies have received more than $1 billion in loans, with more than 600,000 consumers affected. The latest casualty, the Utah Insurance Department, announced yesterday that Arches Health Plan, a consumer-oriented and operated plan, or co-op, will not sell insurance in 2016. The co-op received $89.7 million in loans from the federal government.

Arches Health Plan, a membership cooperative that was born out of the Affordable Care Act and insures 66,000 Utahns, has been ordered out of the insurance market for 2016. Arches insures more low-income Utahns on the federal exchange, healthcare.gov, than any other company besides Select Health. But it also has customers who get their insurance on their jobs and individuals who buy plans through insurance agents or brokers.

In Part I, I showed that the administration’s new estimate of next year’s exchange enrollment is only about half of what prominent groups projected in 2010, and I discussed evidence that exchange plans are not attracting many young, healthy people. This piece shows that the groups also projected far too many unsubsidized enrollees and discusses reasons to be skeptical that the individual mandate will lead as many people to purchase coverage as assumed.

Consumers browsing HealthCare.gov for health insurance ahead of next week’s open-enrollment period will immediately notice a couple of items: a quicker window-shopping experience and many more high-deductible health plan options. The federal government’s exchange website launched its window-shopping feature Sunday, a week before the Affordable Care Act’s third open-enrollment period starts Nov. 1. The CMS touted the retooled site last week, although highly anticipated features such as finding in-network providers and covered prescription drugs won’t immediately be available.

The toll of failed co-op insurers, which were intended to challenge dominant companies that wield considerable power to dictate prices, has left about 500,000 customers scrambling to find health insurance for next year. A ninth co-op, which served Iowa and Nebraska, closed in February.