The Affordable Care Act has proved the need for health reform, but it also has proved the need for significant changes to the law to reflect Americans’ demand for more choices of more affordable health coverage. Despite the president’s claims, most Americans are seeing much higher costs for health insurance. They want secure coverage and access to care that meets their needs and the needs of their families, but they want the law to live up to its name of “affordability.”

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Understanding exchange populations — their demographics, biometrics, health risks, and chronic conditions — is at the core of health insurance management. Government, health plan, employer, and provider leaders know that to create product strategies and plan designs without this information is not just futile, it’s bad business.

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Most Americans have not been paying close attention to King v. Burwell. A majority continue to say that the Affordable Care Act has not had an effect on them or their family, although the proportion that believes it has hurt and, separately, helped has risen. Views of the ACA remain more negative than positive.

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If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent.

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President Barack Obama declared Tuesday that his 5-year-old health care law is firmly established as the “reality” of health care in America, even as he awaits a Supreme Court ruling that could undermine it.

“This is now part of the fabric of how we care for one another,” he said.

Obama defended the health care overhaul during an address to the Catholic Health Association Conference in Washington, just days ahead of an anticipated decision by the Supreme Court that could eliminate health care for millions of people.

Obama poked fun at opponents who have issued “unending Chicken Little warnings” about what would happen if the law passed. None of those predictions have come true, Obama argued.

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The aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.

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President Obama reentered the political battle over healthcare Tuesday, delivering an extended defense of the Affordable Care Act as the Supreme Court prepares to issue its ruling on a case that could strip away health insurance from millions of Americans.

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Efforts by insurers to boost premiums are the latest evidence that President Barack Obama’s health care law “just doesn’t work” and must be replaced, the Republican chairman of the House Ways and Means Committee said Wednesday.

Rep. Paul Ryan of Wisconsin launched the GOP’s latest attack against the health care overhaul as Health and Human Services Secretary Sylvia Burwell defended it before his committee. Their conflicting views underscored that Obama’s 5-year-old law remains a partisan flashpoint, likely to reverberate through next year’s presidential and congressional elections.

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Every day there seems to be another article focused on how many individuals might lose their subsidies if the Supreme Court rules in favor of the plaintiffs in the King v. Burwell case.

Yet, an even bigger group of individuals harmed by Obamacare has an equally good claim for relief that hasn’t gotten as much attention—the people who, thanks to Obamacare, must pay more for health insurance but who never got subsidies.

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Even in Kentucky, which championed the 2010 health care law by expanding Medicaid and running its own insurance marketplace, about half of poor people say they have heard little about the Affordable Care Act, according to a Harvard University study published Monday in Health Affairs.

Awareness of Obamacare was even lower in Arkansas and Texas—two states that have not embraced the law as warmly. The study — which surveyed nearly 3,000 low-income residents in the three states last December– found 55 percent of those Texans and 57 percent of those Arkansans had heard little or nothing about the law’s extension of health coverage. Arkansas expanded Medicaid eligibility to cover more people under the law, but the state legislature prohibited spending public money to promote that or the federal subsidies available to help people buy private Obamacare plans.

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