There is no precise headcount of how many people have gained coverage because of the Affordable Care Act. And it is downright impossible to reliably estimate the number of people who might lose coverage if Congress repeals and replaces it. The “20 million” figure appears to have originated in a March 2016 report by the U.S. Department of Health and Human Services. That report declared that “the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016.”

Estimates by the Heritage Foundation find that 14 million people (including children) gained public or private coverage in 2014 and 2015. Unlike government surveys, Heritage examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

They found that 84% of the newly insured gained coverage through Medicaid and a related government program for low-income children.

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Obamacare has already failed, and it failed because the government violated several basic economic and free-market principles, resulting in devastating outcomes for those seeking coverage, people already covered, and taxpayers.

Under Obamacare, our most vulnerable citizens in Pennsylvania are paying more for health insurance with fewer choices. According to the Kaiser Family Foundation, individual premiums increased by more than 50% in Philadelphia this year. Deductibles for a family plan now exceed $6,000, and the choices continue to shrink.

Pennsylvania’s health care delivery system should encourage participation in the health-insurance market rather than mandating it as Obamacare did, offer the option of using open network, lower-cost, catastrophic plans supported by health savings accounts, and place much greater emphasis on prevention and addressing the causes of poor health.

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It keeps getting harder to sell Affordable Care Act policies, says Steven Mendelsohn, a Montgomery County licensed insurance salesman.

It’s bad enough that United Healthcare pulled out of the Pennsylvania exchange that sells the subsidized health insurance parties last year, when rates went up 10%. Or that Aetna — which less than 10 years ago dominated the local market for individual policies — stopped writing the policies here earlier this year, when rates went up another 10%.

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Washington experts have been frequently wrong about the Affordable Care Act.

They projected far more enrollees in ACA exchanges than materialized. They also projected that the individual insurance market would stabilize in 2016 with robust competition. Instead, the country is grappling with enormous premium hikes and fewer choices.

A new government report reveals perhaps the largest mistake yet: Medicaid enrollees who gained coverage through the ACA cost almost 50 percent more, on average, than the government projected just one year ago.

ACA supporters often point to Medicaid expansion as the law’s greatest success since it reduced the overall uninsurance rate. We now know that result comes with a gigantic price tag.

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Twenty-three co-op plans, funded with $2.4 billion in government loans, opened enrollment in 2013. By the end of 2015, 12 plans had failed, leaving $1.3 billion in delinquent loans, more than 700,000 people in 13 states scrambling for coverage, and hospitals and doctors with hundreds of millions of dollars in losses uncovered by the assets of the failed co-ops.

This result is hardly surprising. The people running the co-ops had no experience running an insurance company – co-ops were forbidden to have anyone affiliated with insurers on their boards. Their premiums were too low and their benefits too high. The failed co-ops went on to lose $376 million in 2014 and more than a billion in 2015. Only one co-op turned a profit in 2014, and all lost money in 2015.

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House Speaker Paul Ryan’s health care blueprint, released late last month as part of his “A Better Way” reform agenda, would deliver affordable, accessible health coverage at less cost and with less disruption to the health care market than Obamacare. Ryan’s plan would slash premiums by, among other things, getting rid of Obamacare’s costly essential-health-benefit mandates. People would be free to purchase low-cost plans that don’t cover procedures they don’t want or need. The plan would also make health coverage more affordable for middle class families by replacing Obamacare’s complicated scheme of subsidies with more straightforward, age-based, refundable tax credits.

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In a presidential campaign that has been much more about personality than policy, here’s some news: A lot of Americans really do care about health care.

Terrorism and the personal attributes of Donald Trump and Hillary Clinton top a list of 10 issues that registered voters consider “extremely important” in a recent poll, but not far behind are gun policy, the economy and, at No. 5, health care. The Kaiser Tracking Poll found 37 percent of voters checked off this issue.

And the Trump vs. Clinton race offers voters a stark choice, starting with their views on the Affordable Care Act, also known as Obamacare. Clinton wants to improve it and make it more affordable. Trump has vowed to kill it, starting on the day he takes office.

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A new analysis of deductibles across the country, relying on data from the Robert Wood Johnson Foundation and the federal agency overseeing the ACA, calculated weighted average deductibles by enrollment across gold, silver, and bronze plans.

All three categories increased by an average of $254, or 17 percent, in Pennsylvania this year. Silver plans – with 259,000 enrollees, the most popular in the state – now have deductibles averaging $2,632, while bronze plan deductibles average $6,118. New Jersey was hardly any better. All three plan categories increased by an average of $209, or 10 percent.

In other words, the 298,000 Pennsylvanians with bronze and silver plans will have to pay between $2,632 and $6,118 before their health-insurance coverage kicks in, while 163,000 New Jerseyans will have to pay hundreds of dollars more than last year.