At the start of 2015, Marilyn Tavenner held one of the most important jobs in health care: Implementing Obamacare, as the head of CMS. Six months later, she’d swapped it for a completely different major role: Lobbying to change Obamacare, as the head of America’s Health Insurance Plans.

It’s an unusual career shift, and it’s given Tavenner — a long-time government official turned top lobbyist — a rare perspective on the changes unfolding in the industry.

. . .

Over the past year, a new wrinkle has emerged. Federally subsidized co-ops included in the ACA after the defeat of the government-payer “public option” began failing rapidly when Congress limited their potential subsidy to taxes collected through the ACA. Most of them have now closed after having lost access to nearly unlimited amounts of red ink in the HHS budget. Joining them are a growing number of private insurers, unhappy about the losses they continue to absorb in Obamacare exchanges.

In short, the individual markets keep marching closer and closer to collapse. Whether or not the imposition of a single-payer system on all Americans in a crisis was the secret plan all along for ACA advocates, the existential crisis for this market is nearly upon us. This is the time to spring socialized medicine in the US, right?

. . .

Clinton tried hard to get health reform passed when she was first lady in the 1990s. Now that President Obama has done that, she would continue to implement his law if she wins in November. But she has shown a deep interest in more healthcare reform, proposing a number of policies aimed at making coverage more affordable.

Last fall, she released a plan to reduce prescription drug costs that included capping out-of-pocket drug expenses for consumers and requiring pharmaceutical companies to pay larger rebates to Medicare for low-income patients.

In a healthcare proposal on her campaign website, she also calls for requiring insurers to cover more doctors visits even before a patient pays the deductible and providing families with a tax credit to help pay for out-of-pocket health expenses.

. . .

In an effort to prevent more insurers from abandoning the Obamacare exchange in Tennessee, the state’s insurance regulator is allowing health insurers refile 2017 rate requests by Aug. 12 after Cigna and Humana said their previously requested premium hikes were too low.

Cigna and Humana filed to increase last year’s premiums an average of 23 and 29 percent, respectively, on June 10. But in the interim, both insurance companies have told state regulators that the requests would not cover the expected claims, said Kevin Walters, spokesman for the Tennessee Department of Commerce and Insurance.

. . .

“Last week, I outlined eight possible futures for Obamacare. By curious coincidence, few of them looked like the paradise of lower premiums and better care that the law’s supporters had promised. In the best case scenarios, they looked more like what critics had warned about — “Medicaid for all,” or fiscal disaster, or a slow-motion implosion of much of the market for private insurance as premiums soared and healthy middle-class people dropped out.

What I did not explore was why we seem to have come to this pass — which is to say, why insurers seem suddenly so leery of the exchanges and why premiums are going up so much for Obamacare policies. No one really seems to know exactly why insurers are having so much trouble in the exchanges. . . .”

. . .

Republican-led states are pushing back on a federal proposal to limit the use of short-term health plans. The Obama administration aims to move more healthy people into the Affordable Care Act marketplace by limiting cheaper but less-robust coverage options.

Under a proposal co-drafted by the IRS, HHS and Department of Labor, short-term policies may be offered for only less than three months and coverage cannot be renewed at the end of the three-month period. As things are now, consumers can stay in such plans for 12 months.

. . .

Moving beyond “Obamacare,” political activists are looking to state ballot questions to refocus the nation’s long-running debate over government’s role in health care.

This fall, California voters will decide whether to lower some prescription drug prices, while Coloradans will vote on a state version of a “single-payer” government-run health system, similar to what Vermont Sen. Bernie Sanders proposed in his unsuccessful bid for the Democratic presidential nomination.

Sanders supports both the California and Colorado initiatives, said spokesman Michael Briggs.

. . .

The next president could be dealing with an ObamaCare insurer meltdown in his or her very first month.

The incoming administration will take office just as the latest ObamaCare enrollment tally comes in, delivering a potentially crucial verdict about the still-shaky healthcare marketplaces.

The fourth ObamaCare signup period begins about one week before Election Day, and it will end about one week before inauguration on Jan. 20. After mounting complaints from big insurers about losing money this year, the results could serve as a kind of judgment day for ObamaCare, experts say.

. . .

The push is on in Colorado for a universal health care system. But can the state afford it?

Amendment 69, which will be on the Nov. 8 ballot this fall, would “replace most private health insurance in the state — including Colorado’s Obamacare exchange — with universal coverage overseen by an elected 21-member board,” according to a report in The Denver Post.

Sure sounds like sunshine and roses, and there are a lot of people fighting for it. But a new analysis shows the system would be in the red to the tune of as much as $8 billion — by the 10th year of the program.

. . .

Another day, another healthcare co-op failure. In July alone, three co-ops, HealthyCt in Connecticut, Community Care of Oregon, and Land of Lincoln in Illinois announced they are closing up shop. They join 13 other failed co-ops out of the original 23 that were a centerpiece of the Affordable Care Act’s vision for the future of healthcare organization — an unrealistic vision based on wishful thinking and sabotaged by the ACA itself.

The ACA created Consumer Operated and Oriented Plans (co-ops) — private, state licensed, non-profit health insurance companies — to provide low-cost, consumer friendly coverage to individuals and small businesses. The theory was that since the co-ops didn’t have to show a profit, they could charge lower premiums, provide more services and be more responsive to their members. They would use collective purchasing power to lower administrative and information technology costs and keep members healthy through preventive care and evidence-based medicine.

. . .