Late last month, Hillary Clinton began releasing the details for her vision for health reform.

That vision is little more than Obamacare on steroids. “I will defend the Affordable Care Act, but as president I want to go further,” the Democratic presidential hopeful said at a recent community forum in Iowa. “I want to strengthen the Affordable Care Act.”

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The two largest state health insurance co-operatives created as part of a grand ObamaCare experiment have announced they are closing at the end of this year, joining others that have failed and even more that are insolvent and likely to fail.

The Kentucky Health Cooperative announced on Friday it is going out of business and will not enroll new members next year, leaving 51,000 members to find other coverage. It had the second-largest co-op enrollment in the country, garnering 75% of people who enrolled in coverage through the state’s health exchange.

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The largest private provider of health insurance policies on Kynect, Kentucky’s health insurance exchange, is going out of business.

The Louisville-based Kentucky Health Cooperative Inc. announced Friday that it will end current memberships on Dec. 31 and will not add new members because of financial problems. It will not offer health insurance plans on Kynect when open enrollment for 2016 coverage starts on Nov. 1.

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Apparently not. For every person who has obtained insurance in the (Obamacare) exchanges, there are two other eligible people who have not enrolled. We now have a good idea why that is.

When people who were previously insured in the individual market obtain insurance in the exchanges, on the average they are worse off. And here is a surprise. When the previously uninsured obtain insurance in the exchanges, they are also worse off.

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The Patient Protection and Affordable Care Act is the law of the land and will likely continue to be for some time, despite opponents’ best efforts to get it thrown out in court.

But what the law will look like a few years down the line is anybody’s guess. In fact, the landmark legislation has already been changed significantly since it was originally enacted more than five years ago.

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Mercy will be the 58th rural hospital to close in the United States since 2010, according to one research program, and many more could soon join the list because of declining reimbursements, growing regulatory burdens and shrinking rural populations that result in an older, sicker pool of patients. The closings have accelerated over the last few years and have hit more midsize hospitals like Mercy, which was licensed for 75 beds, than smaller “critical access” hospitals, which are reimbursed at a higher rate by Medicare.

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A new breed of health insurers created under the Affordable Care Act — representing one of the government’s most innovative attempts in decades to foster better coverage — is on shaky financial ground in many of the 23 states where the plans began.

The nonprofit health plans were envisioned as a consumer-friendly counterweight to for-profit insurers, a way to provide more competition, greater consumer choice and better coverage in markets typically dominated by big commercial carriers. The government allocated billions of dollars in loans for them.

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Health insurers that lost millions of dollars last year under the Affordable Care Act may wait years for the government to deliver the aid it promised them.

Companies, including Downtown-based insurer Highmark, want about $2.87 billion to help cover their first-year losses from online insurance marketplaces — a centerpiece of the landmark health care law. But a federal relief program meant to limit their risk is more than $2 billion short, leaving the companies to collect only 12.6 percent of those requests late this year, the Centers for Medicare & Medicaid Services said this month.

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In 2009 and 2010 President Barack Obama and Health and Human Services Secretary Kathleen Sebelius designed and championed the largest expansion of the welfare state since the New Deal with little more than political force and broken promises. While the American people are forced to accept Obamacare until it can be repealed, the Supreme Court empowered states to accept or reject Obamacare’s Medicaid expansion. So far 20 states have said no.

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President Obama signed a small but significant bill this week that rolls back a requirement in his signature health law, the Affordable Care Act. Last week, Congress voted on bipartisan lines to repeal a small group insurance markets rule that was slated to go into effect in 2016. Many business groups said that without the change, premiums would have gone up for millions of workers.

Enactment of the bill was a small victory for Obamacare critics, but it could also pave the way for new, piecemeal approach to repealing Obamacare.

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