While health care has not been central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.

Hillary Clinton and Donald Trump have laid out different approaches to addressing these and other health care issues. Central among these is their position on the future of the ACA. Hillary Clinton would maintain the ACA, and many of her policy proposals would build on provisions already in place. Donald Trump, in contrast, would fully repeal the ACA, and although his policy proposals and positions do not offer a full replacement plan, they do reflect an approach based on free market principles.

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About 27,000 Hoosiers will lose their Obamacare plans next year after Indiana University Health Plans announced it is withdrawing from the Indiana marketplace, citing big losses from the new enrollees. It had covered 15% of marketplace enrollees last year. Indiana Sen. Dan Coats, a Republican, said the announcement from IU Health Plans is evidence the healthcare law is “collapsing before our eyes.”  “Because of the broken Obamacare system, Hoosiers continue to face rising premiums and limited choices rather than reliable, affordable healthcare,” Coats said.

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Obamacare’s fourth open enrollment period will begin November 1. For the Internal Revenue Service, it will be open season on uninsured taxpayers. In an effort to maximize enrollment, the IRS is mining the personal tax information of people who have chosen not to buy Obamacare policies or claimed an exemption. CMS proclaims Obamacare policies are “a product consumers want and need” and plans an outreach campaign. The agency can’t understand why millions of people—many of them young and healthy—still don’t realize what they want and need it.

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Several RAND Corporation health economists have offered very rough estimates of the coverage and cost effects of the hazy health policy proposals by the two major presidential candidates, Hillary Clinton and Donald Trump. In choosing to fill Trump’s policy vacuum with their own void of limited health policy modeling, the RAND researchers conclude that Trump’s proposals would increase the number of uninsured individuals within a range of 16 to 25 million individuals (relative to current-law ACA arrangements), with disproportionate losses suffered by those with low incomes or in poor health. However, Trump doesn’t spend much more taxpayer money to achieve these results, and his plans in health policy would increase the federal deficit by somewhere between $0.5 billion to $41 billion.

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BlueCross BlueShield of Tennessee sent shock waves Monday across Tennessee with the company’s decision to exit the Obamacare exchange in Nashville, Memphis and Knoxville, a move that highlights persistent volatility in the young health insurance marketplace.

Three years into the Affordable Care Act exchange, the state’s largest insurer is grappling with hefty losses and ongoing uncertainty on the marketplace. BCBST is open to coming fully back into the market once uncertainties about policies and the membership wane.

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In yet another sign of instability in Obamacare’s health-insurance Exchanges, BlueCross BlueShield of Nebraska has announced it will leave that state’s Exchange entirely, while BlueCross BlueShield of Tennessee will exit the Exchange in all three of that state’s major metropolitan areas. The moves will leave 112,000 Tennesseans and tens of thousands of Nebraskans scrambling to find new coverage for 2017 from a dwindling number of carriers.

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Insurers have announced that they are sharply raising prices or pulling out of the Obamacare markets entirely. Many consumers will have fewer choices of insurance plans, and many insurance plans will include fewer doctors and hospitals. Many of the most important problems can be understood if you think of an Obamacare marketplace as a particular kind of restaurant: an all-you-can-eat buffet. It can be a solid business, but it’s hard to get the pricing right. For example, you can be in deep trouble if your buffet suddenly becomes the favorite hangout of the high school football team.  Unless you make major adjustments, you will quickly lose money. That may be what has happened to some of the companies selling health insurance.

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ObamaCare is plainly unaffordable for many young Americans. We’re at the start of our careers—and the bottom of the income ladder—so paying so much for something we likely won’t use makes little sense. The IRS penalty of $695 or 2.5% of our income is often cheap by comparison. We may be young, but we can do the math.

Young Americans aren’t looking for “outreach” and “engagement” from President Obama. We’re looking for affordable health-insurance plans—and ObamaCare doesn’t offer them.

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Legislative auditors said Wednesday they can’t confirm that the Medicaid application backlog numbers state officials have reported are correct.

Applications have been backlogged for about a year following the rocky rollout of a new computer system, an administrative decision that funneled all applications through a single state agency and a larger-than-expected influx of applications during the Affordable Care Act open enrollment period.

The auditors said the Kansas Department of Health and Environment gets the backlog number from Accenture, the contractor that built the new software platform known as the Kansas Eligibility Enforcement System, or KEES.
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A liberal attempt to revive the public option is opening old wounds between the Democratic Party’s liberal and moderate wings. Thirty-three mostly-liberal Democrats, including all the Senate leadership, have signed onto a nonbinding Senate resolution to add the public option to Obamacare. But missing from the list are vice-presidential nominee, Sen. Tim Kaine and a half-dozen other moderates who face reelection in 2018. Kaine’s absence is especially striking since Hillary Clinton embraces the public option.

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