Bob Kocher and Ezekiel Emanuel, who worked in the Obama White House on health care reform, argue that it’s “misleading” to raise concerns about the fact that individual market health insurance premiums have nearly doubled under Obamacare. “Premiums today,” they say, “are 20% lower than the Congressional Budget Office predicted when the ACA was passed.” Their argument is nonsensically out of touch, and it illustrates why the designers of the ACA got so many things wrong. The unaffordability of exchange-based insurance is the ACA’s most serious problem. As research from Avalere Health has shown, enrollment in ACA-based insurance is alarmingly low among those whose incomes exceed 200% of the federal poverty level.

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President Barack Obama delivered a robust defense of Obamacare on Thursday, but also acknowledged his signature domestic achievement needs fixes as premiums rise and insurers are fleeing the law.

Obama hailed the achievements of the federal health care law six years after passage, providing coverage to an additional 20 million Americans and reducing the uninsured rate to the lowest level ever recorded. And he sought to remind Americans that they likely benefit from the law’s consumer protections, even though just a small fraction of the country actually buys coverage from Obamacare’s insurance marketplaces.

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Major insurers participating in Obamacare have won approval for substantial premium hikes next year in a dozen or more states. The increases range as high as 30 percent to 50 percent, according to new data.

Shaken by the decisions of Aetna, UnitedHealthcare, Blue Cross Blue Shield and other giants to pull out of many states after incurring hundreds of millions in losses, state insurance regulators appear more than willing to go along with these rate increases to prop up insurers remaining in the program.

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Under pressure to stabilize wobbly insurance markets nationwide, the Obama administration is making a new push to sign up Americans for health coverage through the Affordable Care Act, aiming to increase enrollment by about 1 million in 2017. With insurers canceling health plans or raising premiums by double digits in many parts of the country, that represents only modest enrollment growth over 2016.

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After months of health insurer exits from the Affordable Care Act marketplace in Arizona, state regulators have approved plans from two companies that will be the only marketplace insurance providers next year.

Blue Cross Blue Shield of Arizona will sell marketplace plans in every county except Maricopa County in 2017. The Phoenix-based insurer’s average rates will increase 51 percent, Arizona Department of Insurance filings show.

Maricopa County residents only option will be Centene Corp., which said it will sell its “Ambetter” plans. State regulators approved a 74.5 percent increase for Centene/Ambetter plans.

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The 40% “Cadillac” Tax on expensive employer-sponsored health insurance is on a deathwatch because both parties in Congress dislike it. It would be best if Congress were to replace the Cadillac Tax with a simple and clear limitation on the tax preference for employer-paid premiums, as is called for the House GOP’s “Better Way” health plan. For decades, economists have complained that the open-ended tax break for employer-paid health insurance premiums is a major distortion in the marketplace. This approach is fair and promotes more transparency in the health care marketplace.

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Less than half of the approximately 27 million uninsured people in the U.S. are eligible for federal financial assistance, an analysis released Tuesday by the Kaiser Family Foundation shows.

Roughly 11.7 million, or 43 percent of that population, are not taking advantage of some sort of federal assistance to get health insurance that they are eligible for, according to the analysis. That assistant may be in the form of a subsidy to purchase a policy on the Affordable Care Act exchange or a Medicaid plan a consumer is eligible for but not signed up for.

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The forecast illustrates the administration’s confidence in enrolling more people and keeping those who are covered from dropping out in a challenging year. But the Obamacare exchanges are still not attracting enough young, healthy and higher-income individuals who could help spread the health-care costs of the sickest over a bigger group.

“What we are still missing is the young and invincible,” said Deep Banerjee, an analyst at S&P Global Ratings. “The exchange market has to grow a lot more to become stable.”

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In the last moments of the final presidential debate Wednesday, the candidates used a question about entitlements to restate their positions on Obamacare. Donald Trump again vowed to “repeal and replace” the law and said that he was glad premiums had gone up, presumably to make his point that President Obama’s signature health care reform law was “destroying our country.” Hillary Clinton said repealing Obamacare would make maintaining the solvency of Medicare more difficult.

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President Obama and Hillary Clinton love to talk about the “20 million people” who’ve allegedly been added to the health insurance rolls under Obamacare. But in truth, a lower percentage of Americans have private health insurance now than in 2007, even though Obamacare is the law. This is according to the federal government’s own figures. According to the Centers for Disease Control and Prevention, 67% of those living in the United States had private health insurance in 2007. Now, as of 2015, only 66% have private health insurance.

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