New failures are piling up among the member-run health insurance co-ops carrying out one of the Affordable Care Act’s most idealistic goals, leaving just seven remaining when the health law’s fourth enrollment season starts in the fall.

There were 23 in 2014.

For the rest — which all posted annual losses in 2015, according to the National Alliance of State Health Co-Ops — survival is job No. 1. Some are diversifying to serve larger employers, no longer limiting themselves to their ACA mandate to offer health plans to individuals and small businesses. A Maryland co-op has sued the federal government to avoid paying millions of dollars to other insurers under the ACA’s complex formula to keep premiums stable by balancing risks among insurers and helping ailing ones. Other co-ops are trying to renegotiate contracts with hospitals and other providers.

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The Illinois Insurance Department moved Tuesday to shut down Land of Lincoln because of its unstable financial health, leaving about 49,000 policyholders in a lurch. They will lose coverage in the coming months, but neither regulators nor the company have said exactly when.

Policyholders will be able to buy insurance from a different carrier to cover them for the rest of 2016, according to the state Insurance Department. But switching plans is going to cost them.

The co-pays and deductibles enrollees have been paying since January will not transfer to new plans. A new plan will reset deductibles and out-of-pocket maximums paid by consumers.

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President Obama reflected upon the Affordable Care Act in an article published this week in the Journal of the American Medical Association. He acknowledged the law’s shortcomings and outlined what he believes to be the next steps in health care reform.

The President concluded, “Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs.”

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Lawyers well versed in federal health policy are skeptical that a handful of insurers will triumph in their lawsuits against the Obama administration over two separate but similar payment provisions of the Affordable Care Act (ACA).

Six insurers, including several of the ACA-created Consumer Operated and Oriented Plans, or CO-OPs, are suing the administration over money, while a number of others are 23 Comments lawsuits.

The insurers are suing over the ACA’s risk corridor and risk adjustment programs, which make up two of the “three Rs” built into the law to compensate insurers for losses stemming from market volatility in the first few years of ACA implementation.

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Centrist Democrats appear reluctant to join their party’s embrace of a public option for ObamaCare.

The idea of adding a government-run insurance option to compete with private insurers is making a comeback in the Democratic Party, with President Obama endorsing the idea Monday, two days after presumptive Democratic presidential nominee Hillary Clinton emphasized a public option as part of an effort to win over Bernie Sanders and his supporters after a contentious primary.

But among more centrist members of the Senate, where the “public option” was stopped in 2009, there is little enthusiasm for the idea.

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Health insurers in New Mexico and other states are gearing up for a legal fight with the Obama administration over millions of dollars the insurers both owe and are owed under separate provisions of the Affordable Care Act (ACA).

New Mexico Health Connections, the state’s Consumer Operated and Oriented Plan, or CO-OP, confirmed to The Hill that it is working with lawyers to frame lawsuits on both ObamaCare’s risk-adjustment and risk-corridor provisions, which make up two of the so-called three Rs of the ACA’s premium stabilization program.

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Bernie Sanders formalized the Democratic Party’s left turn on Tuesday, finally endorsing Hillary Clinton and praising her for embracing so many of his ideas. “We have begun a political revolution to transform America, and that revolution continues,” the Vermont socialist said—and the latest evidence for his boast is the revival of ObamaCare’s “public option.”

This liberal ambition—a new health-care entitlement akin to Medicare for all middle-class Americans under age 65—couldn’t pass a Democratic Congress in 2010. Mrs. Clinton revived the public option over the weekend, and now President Obama is also lending his support, in an op-ed that appears under his byline in this week’s Journal of the American Medical Association.

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Illinois moved Tuesday to take control of Land of Lincoln Health to begin an orderly shutdown of the insurance company, meaning about 49,000 people will lose their health coverage in the coming months.

The state said it will allow policyholders to buy coverage from a different insurer before their Land of Lincoln plans are terminated, but it’s unclear when the policies will lapse.

“It’s a bad day for the marketplace in Illinois and our consumers,” said Jason Montrie, president and interim CEO of Chicago-based Land of Lincoln. “This is the end.”

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Hillary Clinton on Saturday announced her plan to expand investments in community health care centers, the second of two proposals in a week apparently aimed at courting supporters of Sen. Bernie Sanders ahead of his possible endorsement.

The presumptive Democratic nominee’s proposal would double funding for primary care services at Federally Qualified Health Centers, which serve populations with limited access to health care. Community health care centers have been a key priority for Sanders, I-Vt., who successfully fought for the inclusion of $11 billion in funding for such centers in the Affordable Care Act of 2010.

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Health insurers in Michigan are seeking another round of double-digit rate increases next year for plans they sell to individuals, although smaller increases for their small group plans.

Insurance giant Blue Cross Blue Shield of Michigan has asked state regulators for permission to boost its premium rates by an average 18.7% for individual plans, along with a 14.8% increase for its Blue Care Network individual plans. Those plans — closely associated with the Affordable Care Act, commonly referred to as Obamacare — cover about 200,000 individuals in the state, down from 310,000 people as recently as a year ago.

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