This week, we learned that ObamaCare enrollments are nearly 40% below the original projections—further proof that the American people want nothing to do with this flawed system.

Under the Obama administration, we are becoming a nation of rules—not laws—dictated by a president and a White House who are more concerned with pursuing a partisan political agenda than they are with serving the American people.

Nowhere is the disregard for the laws of our nation—and the failure of our bloated, inept, partisan government—more obvious than in the way the Democrats foisted ObamaCare on us. And the way in which it has utterly failed to help Americans get the quality, affordable health care we were promised.

Presidential candidate Carly Fiorina outlines her blueprint to repeal ObamaCare and promote the free market in health care.

The law being implemented today is in many ways quite different than the law passed by a very temporary super-majority of Democrats back in 2010. It is highly likely that the ACA-as-implemented could not possibly have secured enough votes for passage in March 2010.

Likewise, we already know that neither the ACA-as-enacted nor ACA-as-implemented could possibly secure majority support in today’s Congress. Not only do all Republican presidential candidates want the law repealed and replaced, but so does the current front-runner in the New Hampshire Democratic primary.

Too many in the general public do not realize that five provisions of Obamacare have already been repealed.

One reason why the anger over ObamaCare has subsided somewhat could be that more than 70 significant changes have been made to the law since it was enacted in 2010—delaying, weakening, and eliminating some of its more onerous and burdensome provisions. The law that is being implemented is not the one Congress passed.

By our updated count at the Galen Institute, at least 43 of the changes to the Affordable Care Act have been made unilaterally by the Obama administration, 24 have passed Congress and been signed into law by President Obama, and three were made by the Supreme Court, which had to rewrite the law to uphold it.

The Congressional Budget Office (CBO) issued a new budget forecast last week. It should be a wake-up call to policymakers, and to the candidates running for president. It is also a clear indictment of fiscal policy during the Obama presidency.

The forecast shows annual federal budget deficits rising throughout the coming decade, pushing total federal debt to levels well above the historical norm. CBO projects the federal budget deficit will be $544 billion in 2016, or 2.9 percent of GDP. By 2026, the annual deficit will be nearly $1.4 trillion, or 4.9 percent of GDP. Over the period 2016 to 2025, CBO expects the federal government will need to borrow an additional $9.4 trillion, pushing total federal debt up to $23.8 trillion, or 86 percent of GDP.

The deficits projected in CBO’s forecast, and the level of debt they would cause, are almost unprecedented in the nation’s history.

In the wake of Louisiana governor John Bel Edwards’ announcement last week that his state would expand Medicaid under ObamaCare, the White House rolled out a new scheme to persuade the 19 states that are still holding out to fall into line and expand their programs: throw more money at them.

But these state officials should resist the temptation, for at least three reasons:

  1. First and most obvious is that expansion states have all experienced the same thing: More people signed up than expected, and it blew a hole in the states’ budgets.
  2. The second reason is that there’s no such thing as “free” federal dollars. The money comes with conditions, which effectively shifts policymaking from the receiving state’s legislature and governor to a distant federal bureaucracy (in this case, the Centers for Medicare & Medicaid Services), which dictates how states must spend federal Medicaid funds.
  3. The third reason is less abstract: Medicaid will harm those it’s meant to help. Often lost in the expansion debate is that Medicaid is the worst form of health coverage in the country.

Last week’s seven-candidate debate hosted by the Fox Business Network once again found much to discuss in terms of national security issues, immigration law enforcement, even a little economic policy, and, of course, the latest round of character attacks and counter-attacks. Still missing in action: at least the first subcutaneous probe of where the respective candidates stand on health policy issues.

Based on recent performance, it’s questionable whether health policy has attracted sufficient interest among the media and Republican primary voters to command more than a few seconds on the debate stage. But it’s not for lack of potential lines of inquiry.

Here are some questions to the candidates from Tom Miller of the American Enterprise Institute that still await new rounds of oversimplified, evasive, or (one might hope) thoughtful answers.

Moving to single-payer in the U.S. would require massive new taxes that would stifle growth, and consolidating all power over the health system in the federal government would lead, in time, to second-rate health care for many millions of people. Democrats praise Medicare’s simplicity, but giving the Medicare bureaucracy the power to set prices for all medical services in the U.S. would lead to the misallocation of billions of dollars.

The federal government has no good way to know what the proper price should be for the thousands of different services provided to patients, and thus would overpay for many while underpaying for many others. The result of applying this kind of mindless regulation system-wide would be impaired access to many needed services and the slow exodus of the nation’s best and brightest out of medicine and into other pursuits.

While Democrats are quite eager to point out that ObamaCare has reduced the number of uninsured by 17.6 million, they have conveniently failed to point out that in 2014, American taxpayers effectively paid about $6,000 for each person who became newly covered due to ObamaCare.

Is it really worth reducing worker wages by $1,200 apiece just to cover 2.3 million young adults? And leaving aside all the chaos created by millions of cancelled policies, premium increases paid by tens of millions who received no taxpayer subsidies whatsoever to soften the blow and similar market dislocations, are ObamaCare defenders really prepared to claim that it is worth paying $6,000 apiece to reduce the ranks of the uninsured?

Reconciliation shows repeal is possible. Now is the time to show that replacing ObamaCare is possible too. To do that, Congress should spend the next year building a framework for a patient-centered, market-based alternative that empowers individuals to control the dollars and decisions regarding their health care. Congress must use sound financing, stabilize and liberate the health care market, and make financing simpler, transparent and direct to individuals.

iMost of the people who tell you that consumerism can’t work in health care tend to work in health care themselves. But if they were doing such a great job, maybe our health care system wouldn’t be riddled with high costs, fatal medical errors, and hundreds of billions of dollars in waste and fraud.

Companies in other industries – from Wal-Mart to Trip Advisor, Amazon, and Google – have figured out ways to simplify incredibly complex systems to lower the amount of time and the cost for consumers to identify affordable, quality products. Those companies have just one thing in common: they answer to consumers.

Rather than focusing on how health care worked in the past, policymakers should encourage competition by clearing away outdated regulations that prevent savvy, tech-based entrepreneurs from empowering patients with the information they need to find the providers who deliver the best outcomes – often at a more affordable cost.