Republican presidential candidate Donald Trump vowed on Tuesday to summon Congress into a special session to end and replace the Affordable Care Act, as he portrayed the repeal of the contentious health-care law as a prime reason for voters to elect him.

In midday remarks in the battleground state of Pennsylvania, Trump went slightly beyond his previous promise to try to end the ACA, widely known as Obamacare, on the first day of a Trump administration. But his call for a special session puzzled many, as the current Congress is scheduled to reconvene after the election, and the new one will gavel in January, before Inauguration Day.

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Republican presidential candidate Donald Trump on Tuesday argued that spikes in health insurance premiums for Affordable Care Act plans provided an urgent rationale for his election on day that also brought fresh signs of a flagging campaign.

Trump’s finance chairman said that the GOP nominee has no further high-dollar fundraising events planned for the remainder of the campaign, dealing another serious blow to the GOP’s effort to finance its get-out-the-vote operation before Election Day.

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More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country.

The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent.

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Delawareans are again facing steep price increases for health insurance next year under the Affordable Care Act.

Insurance Commissioner Karen Weldin Stewart has approved an average rate increase of 32.5 percent in the individual market for Highmark Blue Cross Blue Shield of Delaware, which has the vast majority of the individual market share in Delaware. That follows an average premium increase of 22.4 percent for individual Highmark plans this year.

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Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

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The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act through a move that could circumvent Congress. Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces. The payments likely would draw from an obscure Treasury Department fund intended to cover federal legal claims, controverting congressional will and intent.

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In the event of a victory by Donald Trump in November, political analysis will take on a forensic cast. How did establishment politics — first in the GOP primaries, then in a national electorate — come to die?

Privately, Democrats would regret their selection of one of the most joyless, least visionary presidential candidates in recent memory. Publicly, they would blame trends that incubated within the Republican coalition, particularly a nativism incited by conservative media and carried by a candidate — alternately cynical and frightening — who is unbound by truth, consistency or decency.

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Seven years after the passage of the federal Affordable Care Act, health care costs are still going up at a robust rate for many in the region, according to a new survey of Washington area companies. Health insurance costs at a broad sample of local companies are projected to increase by 7.3 percent in 2016, the Human Resource Association of the National Capital Area reported.

The association, which represents area human resource executives, said the survey found more local employers are offering higher-deductible plans and putting new restrictions on expensive prescription drugs. The percent of the organization’s membership offering so-called “consumer-directed” health care plans jumped from only 15 percent in 2008 to 50 percent in 2016.

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Enrollment in the insurance exchanges for President Obama’s signature health-care law is at less than half the initial forecast, pushing several major insurance companies to stop offering health plans in certain markets because of significant financial losses.

As a result, the administration’s promise of a menu of health-plan choices has been replaced by a grim, though preliminary, forecast: Next year, more than 1 in 4 counties are at risk of having a single insurer on its exchange, said Cynthia Cox, who studies health reform for the Kaiser Family Foundation.

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All but the most hardened partisans understand that the Affordable Care Act’s insurance exchanges are in serious trouble. In 2010, the Congressional Budget Office predicted that 21 million people would have exchange-based coverage in 2016; the real number was about 12 million. As insurers head for the exits, the gap between initial hype and final reality will widen.

The tragedy is that this was entirely avoidable. The ACA’s exchanges were fundamentally flawed in their design, something that private-sector experts tried to point out at the time. In October 2009, PricewaterhouseCoopers published a report projecting that by 2016, the ACA would cumulatively increase individual-market health insurance premiums by 47 percent.

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