Articles on the implementation of ObamaCare.

As many as 20 million Americans soon will be getting a letter from the Internal Revenue Service “suggesting” they sign up for ObamaCare insurance.

Getting a letter from the IRS can be a threatening and nerve-racking experience; it seldom is seen as a suggestion and more of a threat.  But at President Obama’s direction, the IRS is “reaching out” to people who paid the tax penalty for not buying mandatory health insurance or who claimed an exemption in hopes of “attracting” more people to sign up for ObamaCare insurance.  The government is particularly interested in compliance from healthy young people.

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As ObamaCare’s troubles mount, I’ve heard my patients and my peers in healthcare ask: How could the law’s authors not have seen this coming?

For my part, I think a different question needs to be asked: What if they did? What if ObamaCare was purposely designed to fail?

Every day, it seems like there are a dozen new headlines about the crisis facing ObamaCare. Premiums are rising faster than ever. Meanwhile, health insurance companies are abandoning the law’s exchanges left and right, unable to compete in the top-down, regulation-driven environment created by the law. Less than three years into its implementation, the law has never looked so precarious.

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Roughly 8 million people faced ObamaCare individual mandate penalties this year totaling more than $3 billion, an analysis of the latest IRS data reveals.

Despite the controversy and high-stakes legal battle that has surrounded the individual mandate, the scope of the penalties paid this year has gone unreported by major news outlets as attention has focused on ObamaCare’s latest and most glaring problems: weak enrollment, surging premiums, and insurer losses that have provoked the exit of UnitedHealth, Aetna and Humana from most state exchanges.

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Deep into the final year of his presidency, Barack Obama is working behind the scenes to secure Obamacare’s legacy, struggling to bolster a program whose ultimate success or failure will likely be determined by his successor.

With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage. The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options.

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Progressive senators and activists are launching a campaign Thursday calling for every American to have the choice of a public health insurance option.

They aim to build on Democratic presidential candidate Hillary Clinton’s support for a public option with what they hope will be the biggest health care push by Democrats since the passage of the Affordable Care Act in 2010.

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The premium-stabilization programs of the Affordable Care Act (ACA) will expire this year, and even insurers like Blue Cross Blue Shield — once considered the companies of last resort — are considering leaving the exchanges.

While many Blues plans continue to assert their commitment to the ACA market, successive rate hikes and insurer withdrawals from the exchanges temper their assurances.

“These Blue Cross plans will stay longer, but they can’t stay forever,” said Robert -Laszewski, president of Health Policy and Strategy Associates and former insurance executive. Laszewski, a consultant for the plans, added that Blue Cross Blue Shield of Texas lost 40 percent of its reserves in the first two years of ObamaCare. “They can’t continue losing surplus forever.”

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The CMS says some Medicare beneficiaries are receiving tax credits to purchase insurance through the Affordable Care Act marketplace. The agency is warning them to cancel their exchange coverage immediately and pay back the credit they’ve received.

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Senate Democrats and liberal groups are unveiling a new push to add a public option on ObamaCare on Thursday.

The effort is led by senators including Chuck Schumer (D-N.Y.), on track to be the next Democratic leader, and Bernie Sanders (I-Vt.), who galvanized liberals in his presidential campaign with a push to go even further and set up a “Medicare for all” system. Sen. Jeff Merkley (D-Ore.) is spearheading the effort.

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Sen. Lamar Alexander is introducing a bill Wednesday that would extend Affordable Care Act subsidies to plans off of the exchanges for some eligible consumers.

The Tennessee Republican is proposing that states could opt to expand the Obamacare subsidies to plans sold off of the exchanges.

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What happens to Obamacare after its namesake leaves the White House? The Affordable Care Act (ACA) has faced fierce opposition from congressional Republicans and many GOP-led state governments, survived unexpected legal challenges, and overcome a disastrous rollout of Through it all, ACA supporters could count on President Barack Obama to defend the law. But come January 20, 2017, that will change. If Donald Trump becomes president and Republicans maintain congressional majorities, the GOP could seek to repeal major ACA provisions, though Trump’s health care agenda is uncertain.