More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country.

The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent.

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Donald Trump has said three things about health care. He wants to: (1) replace Obamacare with a much better reform; (2) cover everyone, leaving no one without access to care; and (3) do all this with money already in the system – using resources more efficiently, rather than relying on new taxes and more spending.

Unfortunately, the health reform described at the Trump campaign website falls far short of achieving these goals. It basically repeals Obamacare and allows individuals to deduct health-insurance premiums from their taxable income. But since roughly half the country doesn’t pay income taxes, a tax deduction is little help for most of those who are currently uninsured.

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With so many insurers pulling out of ObamaCare’s health insurance Exchanges–”the craziest thing in the world,” according to Bill Clinton–hundreds of thousands or millions of enrollees will see their plans disappear. The federal government will send up to 20 notices to ObamaCare enrollees whose plans disappear—and will choose replacement plans if they don’t choose one themselves.

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A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.

At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc. and some state or regional insurers quitting the law’s marketsfor individual coverage.

Sign-ups for Obamacare coverage begin next month. Fallout from the quitting insurers has emerged as the latest threat to the law, which is also a major focal point in the U.S. presidential election.

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The consensus is the ACA failed to reduce healthcare costs.

If we are to make healthcare affordable for everyone, the answer is not going to come from a President Hillary Clinton or a President Donald Trump. Instead, the solution can be found if we send healthcare back to the states where experimentation and innovative public policies can take place focusing on utilization and waste in healthcare.

It is there that we can look to states already on the move. Florida, Georgia, Tennessee and Alabama are considering a bold concept to reduce waste by reducing the need to practice of wasteful, defensive medicine.

Defensive medicine is any type of medical practice to avoid litigation such as tests, scans, medications and procedures.

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Obamacare will likely see a “significant slowdown” in enrollment next year, a Thursday analysis from S&P Global Ratings projects.

The report suggests effectuated marketplace enrollment will range between 10.2 million and 11.6 million in 2017. The analysts say their forecast “is clearly a bump in the road, but doesn’t signal ‘game over’ for the marketplace.”

“The marketplace would benefit from growth in enrollment, especially if it helps improve the morbidity of the risk pool. But 2017 will likely not be the year the marketplace sees significant expansion,” the report says.

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Minnesota’s Democratic governor said Wednesday that the Affordable Care Act is “no longer affordable” for many, a stinging critique from a state leader who strongly embraced the law and proudly proclaimed health reform was working in Minnesota just a few years ago.

Gov. Mark Dayton made the comments while addressing questions about Minnesota’s fragile health insurance market, where individual plans are facing double-digit increases after all insurers threatened to exit the market entirely in 2017. He’s the only Democratic governor to publicly suggest the law isn’t working as intended.

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Obamacare was supposed to reduce health expenses for Americans, but that’s not how it’s working out.

Although many have benefited from government subsidies or the ability to buy insurance, health-care costs continue to rise and eat up a bigger percentage of household budgets.

In a recent though little-noticed study, economist Ann C. Foster at the Bureau of Labor Statistics found that health costs made up a record 8% of an average household’s budget in 2014, the last year for which data is available.

That’s a 40% jump compared to 10 years ago, and a 21% increase since 2010, the year the Patient Protection and Affordable Care Act was passed. Parts of the law were implemented shortly afterward but it wasn’t until 2014 that most of it took effect.

Health and Human Services Secretary Sylvia Mathews Burwell recently told reporters that in the marketplace, “85 percent of folks receive subsidies.”

This leaves out something important: that there are millions of people buying their own coverage outside of the marketplace. And none of them receive subsidies. So they don’t have any financial cushion to protect against the larger premium increases most observers expect to see in 2017.

“They are the red-haired stepchildren of American health reform,” says Kevin Coleman, head of research and data at HealthPocket. “They don’t have strong sympathy within the government and have typically been ignored.”

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Minnesota’s Democratic governor said Wednesday that ObamaCare “is no longer affordable” for many people.

“Ultimately … the reality is the Affordable Care Act is no longer affordable to increasing numbers of people,” Gov. Mark Dayton said, according to a transcript provided by his office.

Democrats have long acknowledged that improvements need to be made to the health law, but Dayton’s remarks go farther and are more negative than usual from members of his party.

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