Progress in reducing the number of people without health insurance in the U.S. appears to be losing momentum this year even as rising premiums and dwindling choice are reviving the political blame game over President Barack Obama’s health care law.

The future of the Affordable Care Act hinges on the outcome of the presidential election, and it’s shaping up as a moment of truth for Republicans.

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U.S. Senate Majority Leader Mitch McConnell predicted Monday that the federal health care overhaul championed by President Barack Obama is likely to undergo changes next year, regardless of who wins the White House and which party has the upper hand in Congress.

The Kentucky Republican, who has long advocated repealing the Affordable Care Act, told a business audience in his hometown that the law “can’t possibly go on like it is.” He predicted the overhaul “will be revisited by the next president, whoever that is.”

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With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.

If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.

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The tanning salon industry is feeling burned by “Obamacare.”

Business owners around the country say the little-noticed 10 percent tax on tanning in President Barack Obama’s health care overhaul has crippled the industry, forcing the closing of nearly 10,000 of the more than 18,000 tanning salons in the U.S.

Experts say the industry is overstating the effects of the “tan tax” and that it has been hurt by other factors, too, including public health warnings about the dangers of tanning and the passage of laws in dozens of states restricting the use of tanning salons by minors.

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Election Day 2016 will raise the curtain on the final act in the nation’s long-running political drama over President Barack Obama’s health care overhaul.

If Republican Donald Trump wins, the unraveling begins.

“We have an obligation to the people who voted for us to proceed with ‘repeal and replace,'” said Sen. John Barrasso, a Wyoming Republican.

If Democrat Hillary Clinton goes to the White House, it gets very difficult for Republicans to keep a straight face about repealing “Obamacare.”

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A government report finds that the cost of expanding Medicaid to millions more low-income people is increasing faster than expected, raising questions about a vital part of President Barack Obama’s health care law.

The law provided for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year.

Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things.

In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated.

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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.

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Aetna became the latest health insurer to cast doubt upon its future in the Affordable Care Act’s insurance exchanges after it called off a planned expansion Tuesday and suggested it could abandon that market completely.

A departure by Aetna, the nations’ third-largest insurer, could further reduce the number of choices for customers and eventually push insurance prices higher. Competition by insurers is a key feature of the exchanges, designed to keep a lid on prices, but several insurers are abandoning them because they are losing enormous amounts of money.

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A struggling Illinois health insurance co-op is suing the federal government, claiming it is being shortchanged $72.8 million in promised payments under the Affordable Care Act.

Chicago-based Land of Lincoln Health filed the lawsuit Thursday in the U.S. Court of Federal Claims in Washington, D.C. At least four other insurers have filed similar claims over the so-called risk corridor payments, a temporary provision of the health care law meant to help unprofitable insurers and stabilize consumer prices during the first three years of the law’s new insurance exchanges.

Land of Lincoln’s balance sheet has been deteriorating rapidly. The 3-year-old startup lost $90 million in 2015 and $7 million in the first quarter of 2016.

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With time running out for the Obama administration to prove the success of the Affordable Care Act, officials are aggressively targeting a group that could help turn things around: young people.

Federal health officials announced Tuesday they will comb tax records to find 18-34 year-olds who paid the penalty stipulated under President Barack Obama’s health act for not buying health insurance and reach out to them directly with emails to urge them to avoid even higher penalties scheduled for this year. They also plan to heavily advertise the enrollment campaign, including a promotion with trendy ride-sharing service Lyft to offer discounted rides to enrollment events.

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