After six years of rock-solid defense, top healthcare advocates in the Democratic Party are now willing to acknowledge that the Affordable Care Act has fallen flat on affordability.

At the Democratic National Convention this week, some of Hillary Clinton’s closest allies on healthcare are setting her up for a major battle to lower the cost of care, an issue they said needs to top her agenda as president.

“Healthcare costs, I really see as the next generation of healthcare reform,” Neera Tanden, the president of the Center for American Progress, said at a luncheon in downtown Philadelphia on Wednesday.

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Anthem Inc. said it is now projecting losses on its Affordable Care Act plans this year, a turnaround for a major insurer that had maintained a relatively optimistic tone about that business.

Anthem said it now believed it would see a “mid-single-digit” operating margin loss on its ACA plans in 2016, due to higher-than-expected medical costs. It expects better results next year, because it is seeking substantial premium increases.

Anthem’s financial performance on ACA plans had previously been a relative bright spot among major insurers, many of which continue to struggle.

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Health insurer Anthem Inc on Wednesday vowed to fight U.S. government efforts to block its planned acquisition of Cigna Corp and said it expects to lose money this year on its business selling individual health coverage under President Barack Obama’s healthcare law.

Anthem has argued that its planned $45-billion purchase of Cigna will give it greater leverage to negotiate better prices from healthcare providers and pass on those savings to consumers, including those signing up for “Obamacare” plans on public insurance exchanges.

“To be clear, our board and executive leadership team at Anthem is fully committed to challenging the (U.S. Department of Justice’s) decision in court,” Chief Executive Joseph Swedish told analysts on a conference call.

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At issue in House v. Burwell is whether the administration has been illegally paying cost-sharing reduction subsidies to insurers. This issue was also the subject of a Republican House investigation, which resulted in a recent report concluding that the administration knowingly made the payments without a congressional appropriation, which is illegal.

In May, district court judge Rosemary Collyer sided with the House, deeming the payments illegal. The administration is appealing. If it is unsuccessful, it will be a serious blow to already struggling Obamacare exchanges.

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Bernie Sanders said Monday night that the Democratic party’s platform — and this election — is about universal healthcare and giving the citizenry a public option.

Other Democrats including Massachusetts Sen. Elizabeth Warren, New York Sen. Kirsten Gillibrand and First Lady Michelle Obama also touted the importance of healthcare in the election.

“I am happy to tell you that at the Democratic Platform Committee there was a significant coming together between the two campaigns and we produced, by far, the most progressive platform in the history of the Democratic Party,” Sanders said.

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Thousands of Illinoisans heeded federal law and bought health insurance last year via the state’s Obamacare exchange. They signed up with Land of Lincoln Health, a state-approved insurer. They paid their premiums and deductibles. Many counted on that coverage to manage chronic illnesses or other long-term treatment.

Now, a kick in the teeth: Land of Lincoln has collapsed. Its customers must scramble for new coverage in an upcoming “special enrollment” period. They will have 60 days to find another plan on the Illinois exchange to cover the last three months of the year.

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The big rate increases announced last week for health insurance policies sold by California’s version of the federal health reform are the latest evidence that the Affordable Care Act, despite its name, cannot do much to tame the rise of health care costs.

The government-run health insurance market is facing all the same cost pressures that the private market has confronted for years, plus more that have resulted from the dynamics of the federal law itself.

Covered California, the state insurance agency created to implement the federal law, announced last week that rates for insurance sold through the program will increase an average of 13.2 percent in 2017. The state’s two biggest insurers, Blue Shield and Anthem Inc., will increase rates by 19.9 percent and 17.2 percent, respectively.

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Bernie Sanders celebrated the health care concessions he won from Hillary Clinton Monday night as he gave a rousing endorsement to his former presidential rival.

In a Democratic convention speech that revisited the agenda of his surprisingly competitive campaign for the nomination, Sanders reminded the audience that while he may have lost the race, he did succeed in convincing Clinton to support three important proposals: a “public option” for Obamacare, letting people join Medicare early, and a big funding increase for community health centers.

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Progressive supporters of health reform wanted a public plan option to compete with private insurers offering insurance in the state and federal health exchanges. To draw support from progressives, proponents of the Patient Protection and Affordable Care Act (ACA) created a type of nonprofit health insurance cooperative that would compete with established health insurers. Consumer Operated and Oriented Plans, or health insurance COOPs, as they are commonly known, were a political compromise for those who supported allowing non-seniors to buy their way into Medicare or a similar public program.

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Pence has always been a vocal opponent of the Affordable Care Act, even after the federal law passed in 2010 and was upheld by the Supreme Court.

But when faced with the choice of whether to expand Medicaid to cover Indiana residents who earn incomes that are 138 percent or below the federal poverty level — a key part of the ACA — Pence made a compromise. He debuted a conservative-friendly version of the expansion, one that requires Medicaid recipients to pay a monthly contribution, based on income, into a health savings account.

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