Articles on the implementation of ObamaCare.

The Affordable Care Act transformed the medical system, expanding coverage to millions, injecting billions in tax revenue, changing insurance rules and launching ambitious experiments in quality and efficiency.

Less of that might disappear under President-elect Donald Trump’s pledge to “repeal and replace Obamacare” than many believe, say policy analysts. Republicans promising change might not quickly admit it, but in some respects Obamacare’s replacement may look something like the original.

“It gets into a questions of semantics,” said Mark Rouck, an insurance analyst for Fitch Ratings. “Are they really repealing the act if they replace it with new legislation that has some of the same characteristics?”

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For the past six years, Republicans — across Washington, and across the country — have virtually to a person run against Obamacare. Their campaign has helped them win numerous House and Senate seats, a majority of governorships, and now has given them unified control of Washington for the first time in 15 years. Like the dog that finally caught the proverbial car, Republicans will wake up Wednesday morning asking themselves — on Obamacare, as on many other issues — “What now?”

The answer might be less obvious than it first appears. Democrats used the decade and a half between the defeat of Hillary Clinton’s health plan in 1993–94 and the 2008 election to develop a consensus architecture about what their ideal health-care plan would look like. In the Democratic primaries that year, Senators Clinton and Obama disagreed strongly on the necessity of an individual mandate to purchase coverage — a difference they litigated very publicly, and at great length, during the primary campaign — but agreed on virtually everything else.

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While Obamacare is currently making headlines for (much) higher than predicted costs, the Centers for Medicare & Medicaid Services (CMS) want to create a national database of highly sensitive personal health information for the 30 million Americans with individual and small group coverage. Under Section 153.610 of a new Health and Human Services (HHS) rule for Obamacare, this proposal would require health plans to send CMS data on enrollees on an unprecedented scale, including:

  • Amount paid
  • Diagnoses received
  • Drugs prescribed
  • Procedures received
  • Health care providers seen
  • Out-of-pocket liabilities assumed
  • Individual demographics
  • Social Security Number

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The health insurer Cigna is planning for a loss on the Obamacare market next year, its CEO said Thursday.

“We are going to expect to see some revenue growth but we are continuing to plan for a loss,” CEO David Cordani said on the company’s third quarter earnings call.

The insurer’s strategy to slowly expand into the new marketplace created by the Affordable Care Act has “proven to be more right than wrong,” he said, noting that was unfortunate.

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This may seem like same-old, same-old at this point. After all, lots of health insurers are threatening to leave the exchanges. You could be forgiven for yawning at the news that yet another company might pull back.

But in fact, this is huge news, because Anthem runs the Blue Cross/Blue Shield organizations in 14 states. And though Anthem doesn’t appear to be the sole company offering exchange coverage in any of those states, the Blues are generally the backbone of the exchanges. Where others have quailed, the Blues have by and large stuck with Obamacare. If they pull out, then it’s likely that we’ll see more counties, and possibly entire states, with no Obamacare policies on offer.

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The fourth open enrollment for health coverage under the Affordable Care Act opened Tuesday, a critical 90 days that the Obama administration hopes will boost participation and stabilize markets roiled by premium increases and insurer withdrawals.

HealthCare.gov and state equivalents began taking applications Tuesday morning from people signing up for individual health coverage and learning about their eligibility for subsidies. This year is especially critical because consumers so far have been sicker and older than expected, which has led to higher-than-anticipated costs.

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If you are wondering why the Obamacare exchanges are in so much trouble, a whole slew of “experts” think they have the answer. From President Obama to health insurance industry CEOs to the editors of The New York Times to health policy gurus everywhere – the verdict is almost unanimous. Not enough young and healthy people are buying health insurance.

So, what’s the solution to that problem? Carrots and sticks, according to the conventional wisdom. We need to make health insurance more attractive to the young.

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Anthem Inc. said it may join other major U.S. health insurers in largely pulling out of Obamacare’s markets in 2018 if its financial results under the program don’t improve next year.

Anthem retreating from the Affordable Care Act would mean that almost all of the major American for-profit health insurers have substantially pulled back from the law. The other big insurers — UnitedHealth Group Inc., Aetna Inc. and Humana Inc. — have already scaled back, after posting massive losses. The retreats threaten to further destabilize coverage in the markets for individual coverage, known as exchanges, that provide insurance to millions of Americans.

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When Affordable Care Act insurance marketplaces launched in fall 2013, Arizona seemed like a success. Eight insurers competed to sign up consumers, offering a wide variety of plans and some of the lowest premiums in the country.

Today, with ACA enrollment starting Nov. 1, Arizonans will find in most counties only one insurer selling exchange plans for 2017. Premiums for some plans will be more than double this year, some of the biggest increases in the nation. Only last-minute maneuvering prevented one Arizona county from becoming the first in the nation to have no exchange insurers at all.

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One of the most popular pieces of ObamaCare could be hurting the administration’s push to attract more young people into the wobbly marketplace, according to several people who helped shape the law.

The administration is staging campus enrollment drives and pouring money into Facebook and Instagram ads this year in an attempt to boost ObamaCare enrollment among young adults. The sign-up period begins Tuesday.

Yet there’s a fundamental flaw in the effort — and it has to do with ObamaCare’s design.

Because of the healthcare law, the White House says nearly 3 million young people under the age of 26 have been able to stay on their parents’ insurance plans and don’t have to shop for coverage on HealthCare.gov.

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