Significant spikes in premiums, insurer dropouts and persistently low enrollment numbers are combining to make this fall’s sign-up period a crossroads for the Obama administration’s signature health law. Federal officials characterize the turbulence as temporary. At the same time, the administration is making a push in its final months to shore up the law by trying to sign up healthy people who are critical to the law’s sustainability but have so far rejected insurance. That push will take place against a backdrop of elections that will shape the law’s future.

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President Obama and his Democratic allies are seizing on the exodus of private insurers from ObamaCare markets to renew their push for a so-called “public option” — but Republicans say more “government intervention” is not the answer to the latest Affordable Care Act woes.

A public option — or insurance plan offered by the government — had been written into early versions of the bill but failed to make the final cut in the law signed by Obama in March 2010.

But with many states seeing private insurers exit ObamaCare markets amid concerns over cost and other factors, Democrats see a silver lining to what critics are calling another ObamaCare crisis — a reason to bring the option back.

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In its quest to remake the nation’s health care system, the Obama administration has urged doctors and hospitals to band together to improve care and cut costs, using a model devised by researchers at Dartmouth College.

But Dartmouth itself, facing mounting financial losses in the federal program, has dropped out, raising questions about the future of the new entities known as accountable care organizations, created under the Affordable Care Act.

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The Chicago Tribune editorial board lays out a succinct explanation of why the Affordable Care Act is failing: The law hasn’t tamed U.S. medical costs, the penalties for going uncovered are low compared to skyrocketing premiums, the law has straitjacketed insurers into providing soup-to-nuts policies, and too many carriers simply can’t cover expenses, let alone turn a profit, in such a rigidly controlled system. Is Obamacare plunging in a so-called insurance death spiral? Is the market so unstable that plans are doomed to get more and more expensive, driving more Americans and more insurers out of the market until Obamacare thuds to the pavement?  The next president and Congress need to reckon with Obamacare’s failures or wait for the thud.

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The best measurement of people who lack health insurance, the National Health Interview Survey published by the Centers for Disease Control and Prevention (CDC), has released early estimates of health insurance for all fifty states and the District of Columbia in the first quarter of 2016. There are three things to note.

First: 70.2 percent of residents, age 18 to through 64, had “private health insurance” (at the time of the interview) in the first quarter of this year, which is which is the same rate as persisted until 2006. Obamacare has not achieved a breakthrough in coverage. It has just restored us to where we were a decade ago. Further, the contribution of Obamacare’s exchanges to this is almost trivial, covering only four million people.

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Steve Banke employs 40 people at 3-Points, a small IT outsourcing company he founded almost 15 years ago. And he wants those workers and their families to have strong health insurance options.

Employees at the firm, based in Oak Brook, Ill., can choose between two types of Blue Cross and Blue Shield of Illinois plans: a PPO with a broader network of hospitals and doctors or a cheaper HMO network. Banke’s company covers a percentage of the premiums, and those costs have risen rapidly over the past several years, often more than 12% annually, he said.

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As the election enters the final two months, reporters have been speculating on an “October Surprise,” or perhaps a September one.

There are plenty of candidates, beginning with more Wikileaks about Hillary Clinton’s emails as Secretary of State. There is speculation about pay-to-play at the Clinton Foundation and what’s hiding in Donald Trump’s taxes.

What has received too little attention is the steady collapse of Obamacare and the impact that will have on insurance premiums, which will arrive just before Election Day. The Chicago Tribune called them “cardiac-arrest-inducing premium increases.”

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President Barack Obama and former top Obamacare official Dr. Ezekiel Emanuel are now floating the idea of a public option as an answer to the seemingly inevitable collapse of Obama’s landmark health care legislation.

Obamacare has seen better days: It’s had 16 health care co-ops go kaput, including in New York, some major health care providers are pulling out, and analysts have almost nothing rosy to say about the legislation in both the near and long term. As a result, Obama and his surrogates are scrambling to shore up the sinking ship.

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Average premium increases above 25%, roughly one-third of U.S. counties projected to lack any competition in the Affordable Care Act (ACA) exchanges next year, and enrollment less than half of initial expectations provide strong evidence that the law’s exchange program is failing. Moreover, the failure is occurring despite massive government subsidies, including nearly $15 billion of unlawful payments, for participating insurers. As bad news pours in and with a potentially very rough 2017 open enrollment period ahead, the Obama administration signaled on Friday that it may defy Congress and bail out insurers through the risk corridor program. Congress should take all steps at its disposal to prevent the administration from doing so.

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Leading progressive senators are demanding an explanation from the insurance giant Aetna about its abrupt decision to pull out of most ObamaCare exchanges this year, which they said appeared to be politically motivated.

Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) announced Thursday they are launching a probe into Aetna, which bailed on ObamaCare just weeks after the Justice Department moved to block its multi-billion merger with another top-five insurer.

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