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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The Cuomo administration late Friday announced emergency regulations that would upend the federal government’s risk adjustment program, a move meant to protect some of the state’s smaller players and keep them from bolting the still nascent small-group market created by the Affordable Care Act.

The move comes the same day as the deadline for health insurance companies to contract with New York State of Health, the state-run exchange that sells insurance to individuals and small groups, and follows threats from several insurers that said they would not sell small group plans in 2017 if changes to the program were not made.

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When lawmakers and advocates were pushing to pass the Affordable Care Act, commonly referred to as Obamacare, the list of promises to the American people was long.

The law was supposed to dramatically reduce the number of uninsured, the average family was supposed to save an average of $2,500 in health-insurance premiums per year, and we were going to be able to keep our doctors and insurance plans. But the ACA has failed on these promises.

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Iowa Insurance Commissioner Nick Gerhart can hardly believe he’s giving some consumers this advice: If you can’t find an affordable, full-fledged health insurance policy, he tells them, maybe you should consider going without one.

The Affordable Care Act started requiring most Americans to have health insurance in 2014. But the law offers an exemption for people who can’t find policies that would cost them less than about 8 percent of their household incomes.

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Massachusetts will be responsible for at least $162 million in new costs over the next decade to fund the federal expansion of health insurance coverage, according to a new report.

The paper from the Pioneer Institute, a free-market-oriented Boston think tank, said that additional spending will squeeze the state budget and divert money from other priorities such as education and transportation.

The costs come in the form of a fee that is part of the Affordable Care Act, which extended insurance coverage to millions of people. The law makes more Americans eligible for Medicaid and provides subsidies to many people on private insurance plans, depending on their level of income. Pioneer said it is the first organization to calculate the long-term costs of the fee.

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As insurers push large premium increases for 2017 Obamacare plans, some of the steepest hikes have been requested by insurers in crucial swing states that could determine control of the Senate.

In nine of 11 states with competitive Senate races, at least one insurer seeks to hike rates for Obamacare customers by at least 30 percent next year: Highmark Blue Cross Blue Shield in Pennsylvania wants to jack up average premiums by more than 40 percent. In Wisconsin, three insurers have asked for rate hikes of more than 30 percent. In New Hampshire, two of the five carriers want to sell plans with rate increase above 30 percent.

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The Affordable Care Act enrollment period doesn’t begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums.

But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services.

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State insurance officials say they are feeling pressure to approve large ObamaCare premium increases to prevent more insurers losing money from dropping out of the market altogether.

Tennessee’s insurance commissioner, Julie Mix McPeak, this week announced the approval of premium hikes of 62 percent, 46 percent and 44 percent, respectively, for the three insurers on the state’s marketplace.

She said her department’s actuaries had found the rate increases to be justified.

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Tennessee’s insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.

The rate approvals, while a tough decision, were necessary to ensure that consumers around the state had options when open enrollment begins in November, said Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance. BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.

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Aetna’s retreat from most ObamaCare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona.

The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year.

State regulators still have until Aug. 23 to try to lure other companies into the marketplace, but it could be a tough sell after one of the nation’s largest insurers decided to pull back because of costs.

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