Nearly 30 million American adults remain uninsured. Despite the Affordable Care Act’s vast—and growing—cost to taxpayers, it has failed to place the U.S. on the road to near-universal health insurance coverage. To deliver coverage that is more affordable and attractive to middle-class Americans, structural reforms to the ACA are urgently needed. Until then, America’s middle class will suffer the ACA’s high costs without enjoying its benefits.

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More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country.

The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent.

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With so many insurers pulling out of ObamaCare’s health insurance Exchanges–”the craziest thing in the world,” according to Bill Clinton–hundreds of thousands or millions of enrollees will see their plans disappear. The federal government will send up to 20 notices to ObamaCare enrollees whose plans disappear—and will choose replacement plans if they don’t choose one themselves.

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A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.

At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc. and some state or regional insurers quitting the law’s marketsfor individual coverage.

Sign-ups for Obamacare coverage begin next month. Fallout from the quitting insurers has emerged as the latest threat to the law, which is also a major focal point in the U.S. presidential election.

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The consensus is the ACA failed to reduce healthcare costs.

If we are to make healthcare affordable for everyone, the answer is not going to come from a President Hillary Clinton or a President Donald Trump. Instead, the solution can be found if we send healthcare back to the states where experimentation and innovative public policies can take place focusing on utilization and waste in healthcare.

It is there that we can look to states already on the move. Florida, Georgia, Tennessee and Alabama are considering a bold concept to reduce waste by reducing the need to practice of wasteful, defensive medicine.

Defensive medicine is any type of medical practice to avoid litigation such as tests, scans, medications and procedures.

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Obamacare will likely see a “significant slowdown” in enrollment next year, a Thursday analysis from S&P Global Ratings projects.

The report suggests effectuated marketplace enrollment will range between 10.2 million and 11.6 million in 2017. The analysts say their forecast “is clearly a bump in the road, but doesn’t signal ‘game over’ for the marketplace.”

“The marketplace would benefit from growth in enrollment, especially if it helps improve the morbidity of the risk pool. But 2017 will likely not be the year the marketplace sees significant expansion,” the report says.

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Obamacare was supposed to reduce health expenses for Americans, but that’s not how it’s working out.

Although many have benefited from government subsidies or the ability to buy insurance, health-care costs continue to rise and eat up a bigger percentage of household budgets.

In a recent though little-noticed study, economist Ann C. Foster at the Bureau of Labor Statistics found that health costs made up a record 8% of an average household’s budget in 2014, the last year for which data is available.

That’s a 40% jump compared to 10 years ago, and a 21% increase since 2010, the year the Patient Protection and Affordable Care Act was passed. Parts of the law were implemented shortly afterward but it wasn’t until 2014 that most of it took effect.

Minnesota’s Democratic governor said Wednesday that ObamaCare “is no longer affordable” for many people.

“Ultimately … the reality is the Affordable Care Act is no longer affordable to increasing numbers of people,” Gov. Mark Dayton said, according to a transcript provided by his office.

Democrats have long acknowledged that improvements need to be made to the health law, but Dayton’s remarks go farther and are more negative than usual from members of his party.

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More than 50 fiscally conservative groups are asking Congress to prevent the Obama administration from giving insurers “bailouts” for their Obamacare losses.

Congress should take two steps toward that end, according to a letter sent Wednesday by Freedom Partners and dozens of other groups.

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Ever since the Affordable Care Act’s insurance marketplaces opened for business in 2014, the Obama administration has worked hard to get Americans to sign up. Yet officials now are telling some older people that they might have too much insurance and should cancel their marketplace policies.

Each month, the Centers for Medicare and Medicaid Services is sending emails to about 15,000 people with subsidized marketplace coverage. The message arrives a few weeks before their 65th birthday, which is when most become eligible for Medicare.