A Plain Dealer analysis of plans offered through healthcare.gov, the exchange website, shows that deductibles, co-pays, and co-insurance expenses are putting up significant barriers to accessing medical care, particularly for middle-income earners. The average deductible for a silver-level plan – among the most affordable options for someone with medical needs – is $3,561 in Cuyahoga County for a 40-year-old male earning $30,000, according to the analysis. The maximum annual out-of-pocket expense for that individual averages $6,277.

About 4,500 Medical University of South Carolina patients currently covered by Consumers’ Choice Health Plan need to pick a new policy by Tuesday to remain insured on Jan. 1. Medical University Hospital CEO Pat Cawley told the MUSC Board of Trustees on Thursday that the announcement created “an administrative nightmare.”

Only 35% of 67,000 Consumers’ Choice customers across the state have selected a new plan so far.

The lone health insurance cooperative to make money last year on the ObamaCare insurance exchanges is now losing millions and suspending individual enrollment for 2016. Maine’s Community Health Options lost more than $17 million in the first nine months of this year, after making $10.9 million in the same period last year. A spokesman said higher-than-expected medical costs have hurt the co-op. An Associated Press review of financial statements from 10 of the 11 surviving co-ops shows that they lost, on average, more than $21 million in the first nine months of this year.

Instead of more federal regulation and subsidies, what U.S. health care needs is adoption of market principles, starting with broad empowerment of the patient-consumer. The proposals advanced in this volume would replace many counterproductive and outdated federal policies with practical, market-based reforms that aim to provide all Americans with access to high-quality health care at affordable prices.

“Woefully sloppy and willfully ignorant” is how Chairman Tim Murphy (R-PA) described the oversight of the state-run health insurance exchanges at an Energy & Commerce oversight hearing Tuesday.

Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), testified before the subcommittee on the use of federal funds provided to establish state-based marketplaces under the Affordable Care Act.

CMS doled out more than $5.5 billion in grant money to construct exchanges in 17 states, but lawmakers now question whether this money has been used properly. Chairman Murphy noted that every single state exchange faces significant budget shortfalls. For example, $733 million was given to establish state exchanges in Hawaii, Nevada, New Mexico, and Oregon. All four exchanges failed to become self-sustaining and were forced to transition consumers to the federal marketplace. It is increasingly unclear whether or not the money will be recouped.

Congresswoman Marsha Blackburn (R-TN) questioned Slavitt about a recent report from the Government Accountability Office which revealed that some state exchanges’ information technology systems were still functioning improperly. The report found that CMS “did not always clearly document, define, or communicate its oversight roles and responsibilities to states as called for by best practices for project management.” State administrators say communication with CMS has been poor, which “adversely affected states’ deadlines, increased uncertainty, and required additional work.”

CMS is charged with reviewing states’ funding requests and conducting audits to ensure all money is being spent legally. After January 1, 2015, states were not allowed to spend grant money on operation expenses such as rent, utilities, telecommunications, or software maintenance. Chairman Murphy cited a report from the Office of Inspector General revealing that Washington state may have used its grant money for operational costs, contrary to law.

Slavitt contended all current state marketplaces are sustainable despite these compelling challenges. When asked by Congressman David McKinley (R-WV) whether anyone has lost their job for giving erroneous advice to the state exchanges, Slavitt was unable to provide a single name.

Tuesday’s hearing was the second Energy & Commerce oversight hearing to address the tumultuous problems within the state marketplaces in an effort to ensure that taxpayer dollars are being spent wisely and in accordance with the law.

The ObamaCare program for small business in Illinois—known as SHOP—has been troubled from the start. Only two insurers sold health plans on the online marketplace to Chicago small businesses: startup Land of Lincoln Health and Blue Cross & Blue Shield of Illinois. Now there’s just one. Facing massive financial losses, Chicago-based Land of Lincoln has stopped signing up new small-business customers.

ObamaCare is performing worse than expected when it became law: plans are less attractive, enrollment is lower, premium increases are higher, and risk pools are sicker. Medicaid expansion is a key problem with the law. The main problem with Medicaid, which existed before the ACA took effect, is that enrollees receive little value from the program. The joint federal-state health care program needs large scale reform so that it provides better value for both enrollees and taxpayers.

Cassandra Gekas, operations director for Vermont Health Connect, said staff members are working on a problem in which hundreds of people who paid their monthly premiums on time were canceled for nonpayment. Apparently, the cancellations were related to a five- to seven-day period it takes for the system to process end of the month payments. Vermont Health Connect was plagued with technical glitches and security problems after its launch Oct. 1, 2013.

When Oregon Attorney General Ellen Rosenblum filed suit against Oracle last year, she claimed the contractor “repeatedly lied and defrauded the state” during the course of its work on the failed Cover Oregon health exchange. The defunct health exchange website cost $300 million in federal grants, which could mean that even if Oregon prevails in court and wins a judgment for the billions it is seeking, the state might not be able to keep any of it.

States increased their spending in fiscal year 2015 by the biggest margin in more than 20 years, but most of the increase was thanks to huge leaps in Medicaid spending under the first full year of the Affordable Care Act. Spending increased last fiscal year, which ended on June 30 for most states, by 7.8 percent, according to new estimates from the National Association of State Budget Officers (NASBO).