Under Obamacare, doctors have been strained by costly new regulations, intricate payment “reforms” that tie their Medicare reimbursement to complex federal reporting requirements, and mandates that they install and make “meaningful” use of electronic health records.

Add a new burden to the mix: The proportion of patients they see are rapidly shifting away from commercial health plans and toward Medicaid, which sometimes pays doctors pennies on the dollar that they were previously reimbursed under private insurance.

The data comes from ACAview, a product of athenahealth that aims to measure the impact of Obamacare on medical practices. The project, jointly funded with the Robert Wood Johnson Foundation, is the first large-scale examination of data derived directly from outpatient medical practices belonging to more than 60,000 providers. It gives a unique insight into how the Affordable Care Act is impacting patients at the point of care.

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About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked with a smile.

“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”

I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.

The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”

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Even as federal regulators take steps to constrain administrative spending by private health insurers, government overhead on health coverage has soared.

In a Health Affairs blogpost published Wednesday, David Himmelstein and Steffie Woolhandler use actuarial estimates from the Centers for Medicare and Medicaid Services to project that between 2014 and 2022, national spending on private insurance overhead and government administration will rise by $273.6 billion related to the health-care overhaul.

The authors both favor single-payer health insurance; Mr. Himmelstein co-founded Physicians for a National Health Program, an advocacy organization directed to that end. They close their piece by saying that “In health care, public insurance gives much more bang for each buck.”

Yet overhead in the public sector is growing much faster than in the private sector.

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New research about implementation of the Affordable Care Act finds that Obama administration regulations are allowing taxpayer subsidized health insurance for some people earning less than the statutory income floor and also for unlawful immigrants.

A new study by Andy S. Grewal, an associate professor at the University of Iowa College of Law, explains that the ACA provides tax credits to U.S. citizens with incomes between 100 and 400% of the Federal Poverty Level (FPL). However, IRS regulations were written to extend credits to citizens below 100% FPL in some cases.

Also, Section 36B of the ACA grants credits to some non-citizens with low-incomes only if they are themselves lawfully present in the U.S. and cannot obtain Medicaid coverage.

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The High Cost Plan Excise Tax, or “Cadillac Tax,” is one of the key provisions of Obamacare, both from the perspective of raising revenue and health policy. Beginning in 2018, there will be a tax of 40 percent on the amount of employer-provided insurance that exceeds a threshold. The threshold is set at $10,200 for individuals and $27,500 for family coverage in 2018, but is adjusted upward each year based on the Consumer Product Index (CPI). The Cadillac tax has been politically contentious from the outset and is garnering increasing attention, in part because some employers are already exceeding the threshold and are contemplating life with the tax.

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45% approve, 52% disapprove of the Health Care Law. The survey of 1,000 Likely Voters was conducted on May 21 and 24, 2015 by Rasmussen Reports. The margin of sampling error is +/- 3 percentage points with a 95% level of confidence. Field work for all Rasmussen Reports surveys is conducted by Pulse Opinion Research, LLC. See methodology.

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Public Approval of Health Care Law stands at 42.3% approve, 51.5% disapprove.

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The U.S. West Coast port labor contract ratified by dockworkers will require shipping companies and terminal operators to cover the tax on high-cost health plans beginning in 2018 under the Affordable Care Act, widely called the “Cadillac tax.”

Health care benefits were an important part of the negotiations that culminated in an agreement in February and last week’s vote by the cargo handlers in favor a five-year contract that included wage increases, pension upgrades and substantial health care coverage.

Under the contract, the Pacific Maritime Association, a group of port terminal operators and shipping companies, will provide full health care benefits for members of the International Longshore & Warehouse Union, their dependents and retirees including full coverage with no premiums, no in-network deductibles or co-pays, $1 prescriptions and 100% coverage of hospital care.

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Employer groups and insurers are pushing to keep businesses with 51 to 100 workers exempt from a provision of the federal health law that they say could significantly increase their costs.

For these midsize employers, the Affordable Care Act’s requirements for what health plans must cover—and how they are priced—are set to take effect on Jan. 1, 2016.

Already the law requires insurers to sell individual and “small group” plans to everyone at the same price, regardless of their health. Those rules, which kicked in Jan 1, 2014 for businesses with 50 or fewer workers, also set standards for what health-benefits packages must cover.

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A group of Republican Senators is getting ready for a game of chicken with the administration if the Supreme Court strikes down Obamacare health care subsidies.

Sen. Ron Johnson (R-WI) and a handful of senators are rallying around a contingency plan if the court rules against the administration in King v. Burwell and eliminates health subsidies for millions of people currently enrolled in the federal exchange, HealthCare.gov, Politico first reported.

Related: Some States are in Debt Over Obamacare Exchanges

The GOP plan would create a patch for the subsidies until 2017, sparing millions from losing health coverage. In exchange, the proposal eliminates two major provisions of Obamacare—the employer mandate and the individual mandate, which, policy experts warn, would cause a crippling ripple effect through the insurance market.

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