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Former Florida Gov. Jeb Bush is set to become the third major Republican presidential candidate to introduce a plan to "repeal and replace" the Patient Protection and Affordable Care Act, a feat that has eluded Republicans since the law's passage more than five years ago.

Bush plans to unveil the plan Tuesday morning during a campaign stop in New Hampshire.

The plan, an outline of which was unveiled by his campaign Monday night, aims to foster "innovation," lower health costs by providing tax credits to shoppers and promoting health-savings accounts, and place more control in state government rather than Washington.

Bush is the third major Republican candidate to release an Obamacare-centric plan, along with US Sen. Marco Rubio (R-Florida) and Louisiana Gov. Bobby Jindal. Wisconsin Gov. Scott Walker unveiled his healthcare proposals earlier this year before he dropped out of the race.

Bush's entry highlights the extent of lingering Republican opposition to US President Barack Obama's signature legislative achievement, even as its provisions continue to kick in and the US Supreme Court earlier this year upheld a key provision of the law.

"Obamacare, a government takeover of more than one-sixth of the American economy, epitomizes why Americans are fed up with Washington," said Allie Brandenburger, a spokeswoman for Bush. "Jeb believes we must repeal Obamacare and offer a conservative vision and plan of healthcare for the future."

In his plan, Bush proposes to "provide a tax credit for the purchase of affordable, portable health plans that protect Americans from high-cost medical events," according to his campaign. His team said it would also "increase contribution limits and uses for Health Savings Accounts to help with out of-pocket costs."

As part of its effort, however, the Bush campaign said it would introduce a "transition" plan for what it estimated were 17 million individuals it said have become "entangled in Obamacare."

SEE ALSO: Jeb Bush is getting increasingly feisty with surging rival Marco Rubio

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Former Massachusetts Gov. Mitt Romney, the Republican Party's 2012 presidential nominee, appeared to take partial credit for Obamacare on Friday.

The Boston Globe's Taryn Luna quoted Romney praising the late Staples founder, Thomas Stemberg, for pushing him to expand healthcare reform in Massachusetts.

"Without Tom pushing it, I don't think we would have had Romneycare," Romney said of Stemberg, who died earlier in the day.

Romney added, "Without Romneycare, I don't think we would have Obamacare. So, without Tom a lot of people wouldn't have health insurance."

Political observers widely found that to be an eyebrow-raising comment. During the 2012 election, Romney criticized US President Barack Obama's signature healthcare bill, one of the most reviled pieces of legislation among conservative activists.

But as Romney's critics pointed out at the time, he pushed for a relatively similar healthcare overhaul in his state, including the controversial insurance mandate.

Friday afternoon, Romney clarified on Facebook that he still opposes the Affordable Care Act:

Getting people health insurance is a good thing, and that’s what Tom Stemberg fought for. I oppose Obamacare and believe it has failed. It drove up premiums, took insurance away from people who were promised otherwise, and usurped state programs. As I said in the campaign, I'd repeal it and replace it with state-crafted plans.

Check out the full Boston Globe story >>

SEE ALSO: Mitt Romney releases statement blasting Obama, ahead of his trip to Boston, on Obamacare

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US Supreme Court Justice Antonin Scalia was extra-fiery during a talk at Santa Clara University in California this week, saying in no uncertain terms that the court had been making a lot of bad decisions.

In his speech, Scalia said he believes the "liberal" Supreme Court is heralding the "destruction of our democratic system," according to an account from the SF Gate.

According to Scalia, the court is giving citizens rights that the Constitution doesn't specifically guarantee, like gay marriage and federally subsidized health insurance.

Scalia noted that this interpretation of the US Constitution as a "living document" arose in the 1920s, when Supreme Court justices at the time interpreted the "guarantee of due process of law to protect fundamental rights not explicitly mentioned in constitutional text,"according SF Gate.

To Scalia, this was the beginning of a slippery slope that the US will struggle to recover from.

At the bottom of this slippery slope, according to Scalia, is the now famous Obergefell v. Hodges case that legalized gay marriage across the country. In his dissent, his position is crystal clear: "To allow the policy question of same-sex marriage to be considered and resolved by a select, patrician, highly unrepresentative panel of nine is to violate a principle even more fundamental than no taxation without representation: no social transformation without representation."

In the landmark cases the Supreme Court decided this year, Scalia has found himself in the minority. In King v. Burwell, the decision that upheld the Affordable Care Act — aka Obamacare — Scalia derided his fellow justices' interpretation of the law as "jiggery-pokery" and called the eventual decision in favor of the ACA "pure applesauce."

With three current judges over 79 (the average age of retirement for Supreme Court justices is 78), the next president will have a lot of appointments to make. If the Democrats take the White House in 2016, Scalia will certainly have more applesauce to look forward to.

SEE ALSO: JUSTICE SCALIA: My decisions are sometimes 'stupid and even cruel'

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Nearly half of the 23 non-profit insurance plans created under Obamacare in 2011 at a cost of $2.4 billion have announced they will close by the end of the year.

Utah’s Arches Health Plan on Tuesday became the 10th health insurance co-op to announce that it was closing its doors.

The move comes soon after the Obama administration’s decision on Oct. 1 to provide just 12.6 percent of the $2.87 billion that insurers were seeking to offset losses caused by unexpectedly high coverage costs.

That decision -- to decimate funding of a “risk corridor” program designed to reimburse insurers hammered by excessive losses due to a disproportionate share of very sick or elderly enrollees -- is triggering a mass exit of these co-ops from the market.

With a new Affordable Care Act enrollment period beginning on Sunday, many of the co-ops on shaky financial ground must decide before then whether to remain in business or shut their doors.

At least thus far, the Republican-controlled Congress has proven indifferent to their plight and officials in the Department of Health and Human Services have been unwilling to intervene.

As a result it is likely that other co-ops will announce they are going out of business by the end of this week. GOP lawmakers say the only solution to the problem is to scrap Obamacare and start over.

Even some senior Senate Democrats, including Sen. Chuck Schumer of New York – a state where more than 150,000 people will be losing their co-op insurance -- told The Fiscal Times last week that they were unaware of the crisis.

Last Friday, Consumers’ Choice Health Insurance Company in South Carolina announced that it, too, was going out of business – a decision that will send about 67,000 people and small businesses scrambling to find new health coverage.

The eight other co-ops that have announced they were closing their doors are in Colorado, Iowa, Kentucky, Louisiana, New York, Nevada, Tennessee and Oregon.

The crisis was foreshadowed earlier this year when the Centers for Medicare and Medicaid Services (CMS), which oversees Obamacare, issued warning letters to 11 of the co-ops, placing them under special scrutiny and requiring that they produce a plan of “corrective action.”

A report last July by the Inspector General of the Department of Health and Human Services said that 21 of the 23 co-ops reviewed had incurred net losses between Jan. 1 and Dec. 31 in 2014. Moreover, 19 of the 23 showed net financial losses because the claims they received exceeded premium revenue.

“Most of the 23 CO-OPs we reviewed had not met their initial program enrollment and profitability projections as of December 31, 2014,” the report stated. “The low enrollments and net losses might limit the ability of some CO-OPs to repay startup and solvency loans and remain viable and sustainable.”

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One of the Affordable Care Act's biggest success stories since its implementation came in an unexpected place.

That would be in Kentucky, the deep-red Southern state that has drifted further and further away from the policies of national Democrats and President Barack Obama.

The Bluegrass State's Democratic governor, Steve Beshear, embraced the law colloquially known as Obamacare — though he wouldn't dare call it that. The state set up an exchange, called Kynect, that thrived in 2013, as the federal government's website was mired in disaster.

And Kentucky expanded the federal Medicaid program, signing up more than 375,000 people over the first year of the expansion. One study found that the expansion could inject as much as $30 billion into the state's economy through 2021, in the form of tens of thousands of new jobs.

But most of Obamacare's success in the state is under significant threat after Republican Matt Bevin won Tuesday night's election for the governorship.

Bevin's surprisingly dominant win served as at least an implicit rebuke of the law in the state, and it cemented the trend of Southern states' continued shift to align more with the policies of the national Republican Party. Just on Tuesday, Beshear was touting Obamacare as a political winner in the state.

But Bevin, a polarizing figure even among Republicans after his primary challenge to Senate Majority Leader Mitch McConnell (R-Kentucky), ran an unabashedly conservative campaign. At the heart of it was a promise to rip up every last shred of Obamacare that had entered Kentucky's borders.

Attorney General Jack Conway, the Democratic gubernatorial candidate, said he would continue to implement the law in the same manner as Beshear. Overall, Kentucky's uninsured rate has fallen by more than 11 percentage points in the past two years, according to Gallup, the largest drop next to Arkansas.

It's unclear what happens next to the approximately half a million people who gained insurance coverage through either the private Kynect exchange or the Medicaid expansion. Bevin has been firm on his vow to get rid of the state exchange, which would leave the federal government running that operation.

He has been less clear on whether he will try to undo the state's Medicaid expansion. Earlier this year and over the summer he promised to get rid of the Medicaid expansion, saying Kentuckians would simply be ineligible to renew their coverage under his administration.

"When you reenroll, you may or may not have access to Medicaid going forward," Bevin said in an interview with Politico. "People are not on it for extended periods of time. It's not meant to be a lifestyle. It really isn't. The point of it is to provide for those who truly have need."

But Bevin seemingly hedged on that stance later in the campaign, suggesting he would follow the example of other Republican governors who had worked with the federal government on modified versions of expansion.

Larry Levitt, senior vice president of the Kaiser Family Foundation, said the fate of the state exchange was less important to the overall health of the law than whether Medicaid expansion continued, even in modified form.

"It would seem that Kynect's days may be numbered," Levitt said. "It's hard to imagine an ardent opponent of the Obamacare like Governor-Elect Bevin running one of the law's health-insurance exchanges. He could walk away from Kynect, signaling opposition to Obamacare, without taking insurance away from anyone because Kentuckians would still be able to get coverage and subsidies through healthcare.gov."

He added: "While ending Kynect wouldn't matter too much in practical terms, backing away from the Medicaid expansion would have much bigger consequences."

How Bevin approaches unwinding the law may serve as a test for Republicans trying to do the same thing nationally. Democrats still control part of the Kentucky Legislature, and then there's the test of how willing the public will be to having tangible benefits be taken away.

A Bluegrass poll conducted last week found that a majority of voters supported continuing the expansion. Overall, 54% said they would like to see the state's next governor continue the expansion. Only 24% said they wanted it repealed.

SEE ALSO: There's a new, emerging threat to Obamacare — and it's coming from Hillary Clinton and Bernie Sanders

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The Obama administration signaled Tuesday that it had nothing up its sleeve to salvage a crumbling network of non-profit insurance coops created under the Affordable Care Act, also known as Obamacare, to give more choice and less costly policies to consumers. The administration is hoping to keep the remaining dozen out of 23 operational for at least another year.  

During a House Ways and Means subcommittee hearing that was one part status report and one part post-mortem, Mandy Cohen, the chief operating officer of the Centers for Medicare and Medicaid Services, which operates Obamacare, said the administration was essentially cutting its losses while keeping close watch on the surviving health insurance co-ops.

“For co-ops that will not sell coverage on the marketplaces in 2016, CMS is working collaboratively with [state insurance offices] and the co-ops to wind down their operations in an orderly way, while minimizing disruptions to consumers,” Cohen told Republican and Democratic lawmakers.

As for the hundreds of thousands of Americans who face the loss of their health care coverage with the demise of many co-ops across the country, Cohen’s only consolation was that they are free to seek replacement policies through regular Obamacare insurance markets, which have begun accepting enrollments for 2016.

With 11 of the original 23 non-profit insurance plans created under the Affordable Care Act in 2011 now either defunct or nearly out of business, the co-op experiment is bordering on an unmitigated disaster. While Cohen and her Democratic allies on the committee blamed the Republican controlled Congress for systematically strangling the initiative by slashing the original $6 billion authorization to just $2.4 billion, Republicans blamed the failure on poor business models and management and the hubris of CMS officials who thought they could foster insurance competition from Washington.

Rep. Kevin Brady (R-TX), chair of the health subcommittee and a leading candidate to succeed newly elected House Speaker Paul D. Ryan as chair, greeted Cohen with a scathing critique of the star-crossed co-op program.

“Supporters of this program argued it would increase competition in the individual and small group health insurance markets,” he said. “That very premise should have been cause for alarm. Only in Washington would a group of bureaucrats think they knew how to micromanage competition instead of letting consumers and markets do what they do best.”

Brady charged that CMS “essentially allowed anyone to participate in the program, regardless of whether he or she had any prior experience running an insurance company.” As for financing, he added, the administration dipped heavily into government revenues to provide two types of loans –start up loans and loans to assure continued solvency, “both with incredibly favorable loans terms.”

“What’s most surprising about this situation is the Administration knew this was coming,” he added. “Their own credit estimates project massive losses for the program. And no matter the capital start-up funding or the backstops, a model that is wrong is not going to succeed.”

Rep. Jim McDermott of Washington State, the ranking Democrat on the subcommittee, offered a much different take, charging that after Republicans failed to block passage of Obamacare, they “have systematically and deliberately sabotaged the implementation of the Affordable Care Act.”

“The early challenges facing the co-ops are just the most recent consequence of this destructive Republican agenda,” he said. “In 2013, the Republican Congress slashed funding for loans and grants to co-ops by nearly two-thirds. These cuts have devastated co-ops across the country and prevented CMS from approving dozens of new applications.”

The latest non-profit plan to call it quits is a health insurance co-op that covers about one in three Arizonans, according to the Arizona Republic. The Arizona Department of Insurance announced last Friday that Meritus Health Partners/Meritus Mutual Health Partners had been placed into "supervision" and will only continue to serve clients until the end of the year. Earlier this year, ten other co-ops announced they had run into serious financial problems and were going out of business. Those include plans in Colorado, Iowa, Kentucky, Utah, Louisiana, New York – the largest in the nation with 150,000 enrollees -- Nevada, Tennessee, Oregon and South Carolina.

The most recent closings came soon after the Obama administration’s decision on Oct. 1 to provide just 12.6 percent of the $2.87 billion that insurers were seeking to offset losses caused by unexpectedly high coverage costs.

The crisis was strongly hinted at earlier this year when CMS issued warning letters to 11 of the co-ops that placed them under special scrutiny and required that they prepare a plan of corrective action. Some of those co-ops almost immediately announced they were closing their doors.  Cohen stressed during her testimony that “CMS takes its oversight of taxpayer funds seriously” and has closely monitored and evaluated all co-ops to assess their performance and compliance.

A report last July by the Inspector General of the Department of Health and Human Services stated that a shocking 21 of the 23 co-ops reviewed had incurred net losses between Jan. 1 and Dec. 31 in 2014. On top of that, 19 of the 23 showed net financial losses because the claims they received exceeded premium revenue.

“I’m not interested in blame,” Brady told Cohen yesterday. “I’m interested in understanding how many [other] of these programs are headed to failure, discussing where we go from here and figuring out how we’re going to bring some stability to those families that are affected.”

For now, however, many leaders of the Republican-controlled House and Senate have voiced indifference to the plight of the program, suggesting that the best thing that could happen is if the entire co-op system collapses, while the Obama administration lacks the resources or the will to intervene in a substantive way. It would be surprising if more co-ops go under in the coming weeks, during the new Obamacare enrollment season. But there’s no telling how many more might pull the plug on their operations if they run into more financial trouble during the coming year.

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The Republican victories in Kentucky’s gubernatorial race and Virginia’s state legislative elections on Tuesday provided a jarring wakeup call to Democrats that they could be facing a tough slog in the 2016 campaign.

In Kentucky, Republican Matt Bevin, a wealthy Louisville businessman and Tea Party favorite who promoted himself as a Donald Trump-like outsider, defeated Democratic Attorney General Jack Conway for the governorship, with 52 percent of the overall vote. In Virginia, Republicans retained control of their narrow majority in the state Senate despite an all-out effort by Democratic Gov. Terry McAuliffe to flip control and salvage his progressive agenda.

Party officials and political analysts are pouring over the results of these key off-year elections for clues to Southern voting trends in the run-up to the 2016 presidential, congressional and gubernatorial elections. The 48-year-old Bevin’s stunning victory could mark the start of a new era in Kentucky, where Democratic governors have ruled for all but four of the past 44 years. And Virginia Republicans demonstrated remarkable staying power in state and local races across the board.

One important preliminary finding is that the Kentucky and Virginia election results may be a harbinger for Republican efforts to dismantle Obamacare and block a further extension of Medicaid health care benefits to many of the nation’s poorest individuals and families.

Under Democratic Gov. Steve Beshear, Kentucky has been one of the major success stories of the Affordable Care Act. The state both created and operated its own health insurance exchange and took advantage of the law to expand Medicaid coverage to more than 400,000 low-income residents. But Obamacare was a highly contentious issue in this year’s gubernatorial campaign and Bevin at one point vowed to abolish the state-run market, Kynect, and shift responsibility back to the federal government while rescinding Beshear’s Medicaid expansion order.

In the face of strong criticism from Democrats and even some prominent Republicans, Bevin tempered his remarks in the closing weeks of the campaign and suggested that he would simply stop new enrollments for Medicaid while allowing those currently in the program to retain their coverage. But once he takes control of the state, Bevin could have another change of heart and turn his sights on reducing the Obamacare program.

One likely move is for the governor-elect to seek a federal waiver – not unlike those obtained by other states including Pennsylvania and Indiana -- to experiment with more restrictive versions of the Medicaid expansion program. One option involves raising the income limits to qualify for the benefits.

However, Robert Stivers, president of the Republican-controlled state Senate, has said that the Kentucky General Assembly will decide what happens to the Medicaid expansion, according to The Courier-Journal.

The outcome in Virginia is equally troubling for Democrats, both now and for 2016. All 140 seats in the legislature were up for grabs in the off-year election. While Republicans greatly outnumbered Democrats in the state House, the GOP held a slim 21-19 advantage in the state Senate. McAuliffe, a longtime confidant of presidential frontrunner Hillary Clinton, campaigned hard to pick up at least one seat so that he could tap his Democratic lieutenant governor to be a reliable tie-breaker.

Had the chamber flipped, the new Democratic majority no doubt would have revived McAuliffe’s stalled effort to expand Medicaid in the commonwealth, one of his top legislative priorities, which state house Republicans have staunchly resisted. Instead, Republican held onto all of their seats. And due to Virginia laws limiting any governor to a single, four-year term, it seems McAuliffe’s goal of forging a lasting legacy by bringing in more federal money for healthcare has gone up in smoke.

Currently, 30 states and the District of Columbia have approved Medicaid expansion, while the remaining 20 states have blocked it or have it under consideration. Nine of those 20 states are in the South, while the remainder are largely in the Midwest and Southwest. A few of those states, including South Carolina, Florida and Virginia, are likely to be crucial battleground states in the 2016 presidential election.

The Virginia GOP’s ability to withstand a well-financed campaign by Democrats could also spell trouble for a national Democratic Party that hopes to once again win the purple state in 2016.

Tuesday’s results could complicate plans by Clinton and others to tout their support of Obamacare and Medicaid expansion as Republicans turn their opposition into an advantage. 

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First, the administration revealed that enrollments for Obamacare next year will barely hit 10 million, far below previous projections.

Then last week, the consulting firm of McKinsey & Company estimated that premiums for policies under the Affordable Care Act, also known as Obamacare, were going up substantially in 2016. For instance, the median rate increase for the lowest priced, highly popular “Silver” plan will rise by 11 percent – compared to just a seven percent increase in 2015.

Now there are troubling reports  that consumers will be facing soaring out-of-pocket costs for deductibles next year – increases that in many cases will neutralize the benefits of their health care plans or discourage some from purchasing coverage.

“That these deductibles are so high is clearly one of the reasons people aren’t buying a plan—they simply don’t see themselves getting anything for the money,” Robert Laszewski, president of Health Policy & Strategy Associates, a business and policy consultant, said in a newsletter on Monday.

Department of Health and Human Services officials insist that there are still plenty of plans available with low premiums for those willing to aggressively shop on the federal and state operated insurance exchanges. Americans have until the end of the year to enroll for the third season of Obamacare. But even in cases where consumers find good deals on premiums, they are likely to be stung on the back end by requirements to pay sizeable out of pocket costs before their Obamacare coverage actually kicks in.

The average annual out-of-pocket costs per worker increased nearly 230 percent between 2006 and 2015, according to an annual survey of employer health benefits coverage by the Kaiser Family Foundation.

An eye-opening report by The New York Times published over the weekend found that many of the newly insured are “feeling nearly as vulnerable as they were before they had coverage.”

Indeed, in many states more than half the plans being sold on Obamacare insurance exchanges have a deductible of $3,000 or more, according to a survey by the newspaper.

For many, that means they must pick up the cost of many routine doctor visits and treatment, while counting on their insurance primarily for catastrophic or other major medical expenses.

Among the findings of The Times survey:

• In Miami, the median deductible for health insurance is $5,000, with half the plans above the median and half below it.
• In Jackson, Miss., the median deductible is $5,500.
• In Chicago, it is $3,400.
• In Phoenix, $4,000
• And in Des Moines, Iowa, it is $3,000.

According to HealthPocket.com, Bronze plan deductibles are rising on the Obamacare federal exchanges by an average of 11 percent to $5,731 and Silver Plan deductibles are rising by 6 percent to an average of $3,117.

A survey by the Commonwealth Fund published last November found that three in five low-income adults and about 50 percent of adults with moderate incomes believe that deductibles are “difficult or impossible to afford.”

Health care policy experts say insurers designed their plans with substantial rising deductibles and other cost-sharing measures as a way to encourage low and moderate income Americans who qualify for federal subsidies to try to hold down their medical costs. Moreover, advocates of this approach argue that even with the higher deductibles, enrollees nonetheless benefit from preventative services like mammograms and colonoscopies and other visits with doctors that are provided without out-of-pocket payments.

But that provides little solace for many consumers who have been stunned by the overall cost of their policies. Many are simply not buying new policies – preferring to pay a penalty of $695 and gambling that they won’t encounter steep medical costs.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” David R. Reines, 60, of Jefferson Township, N.J, who suffers from chronic knee pain, told The Times

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President Barack Obama swore he wouldn't smoke after the Affordable Care Act passed.

It's been almost six years, and in an interview with GQ, he told Bill Simmons that he's stayed true to his word. 

Number of cigarettes you’ve smoked in the White House since you got here?
Zero in the last five years. I made a promise that once health care passed, I would never have a cigarette again. And I have not.

Obama had struggled with the habit in the past, and The Hill reported that one of the reasons he said he finally quit was because he was scared of his wife. 

"Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No," Obama said at a press conference in 2009, according to The Hill.

Obama's desire to quit follows the national trend. More American adults today are former smokers than current ones, according to the US Centers for Disease Control and Prevention. And 69% of current smokers say they want to quit. 

The number of adults in the US who smoke has fallen since the health care bill passed, too — from around 20% in 2010 to about 17% today:

And that drop is part of a larger trend over time. More than 42% of adults smoked in 1965. 

There have been rumors that Obama has fallen off the wagon, even recently. When this picture surfaced on Instagram in June, people speculated that it looked like the President was holding a pack of cigarettes in his hand: 

But the White House denied that's what he was holding. 

Obama's commitment to smoking cessation is good news for him, and the country. We all know the many health dangers of smoking: Just one cigarette can take 11 minutes off your life.

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UnitedHealth Group might ditch the Affordable Care Act, aka Obamacare.

In a release Thursday morning, UnitedHealth said the company is "evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017."

Said another way, the country's biggest health insurer is wondering if it still makes sense to offer insurance to people through an Obamacare-mandated exchange.

UnitedHealth tempered expectations for its 2015 and 2016 earnings, citing losses on "individual exchange-compliant products related to the 2015 and 2016 policy years."

UnitedHealth said earnings for the full-year 2015 would now be around $6.00 per share, or $0.26 per share below what the company previously expected.

Next year, the company expects to earn $7.10-$7.30 per year for the full year. UnitedHealth is set to hold an investor conference December 1. In afternoon trade on Thursday, shares of UnitedHealth were down about 5%.

The Affordable Care Act requires all people to have health insurance. To facilitate this, the government set up exchanges where people can go to compare and ultimately buy insurance for themselves and their families.

And UnitedHealth is now coming out and saying it might not make sense for them to participate in these exchanges anymore.

According to The Wall Street Journal, UnitedHealth CEO Stephen Hemsley said on a call this morning: "We can't subsidize a market that doesn't appear at this point to be sustaining itself."

In its statement, UnitedHealth added that the company "remains a strong supporter of sustainable efforts to ensure access to affordable, quality care for all Americans, and has advocated publicly for this for more than 20 years, including as one of the first businesses to focus on serving people through managed Medicaid and Medicare."

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(Reuters) - Health insurer Aetna Inc said on Friday its individual commercial business has continued to perform in line with its expectations, echoing smaller rival Centene Corp after UnitedHealth Group Inc said it may exit the business.

Aetna said its individual business had continued to perform in line with its projections through October 2015 and the company reaffirmed its full-year 2015 operating earnings forecast of $7.45 to $7.55 per share.

In October, Aetna had said it was not making money from the business, which sells government-subsidized plans on exchanges created under the Affordable Care Act, but had said profitability could improve next year.

However, UnitedHealth said on Thursday it would evaluate if it will offer these plans in 2017 as it was unable to sustain losses from the plans, raising new questions about the long-term sustainability of the key Obamacare program.

The news had dragged down shares of health insurers and hospital operators on Thursday. These stocks were untraded premarket on Friday.

Centene on Thursday also reiterated 2015 profit forecast.

(Reporting by Amrutha Penumudi in Bengaluru; Editing by Savio D'Souza)

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The nine most dreadful words in the English language are We’re from the government, and we’re here to help. The Affordable Care Act has proven this time and again since the very beginning. Every promise made to promote this program has turned out to be a lie. PolitiFact declared Barack Obama’s pledge “If you like your plan, you can keep your plan” to be the Lie of the Year for 2013.

The president’s parallel promise, “If you like your doctor, you can keep your doctor,” turned out to be equally untrue for millions of Obamacare exchange consumers who found access to providers so limited that they had no option to return to their previous clinics. Ditto for Obama’s assurance that the average family of four would pay $2,500 less per year in premiums.

Now, as The New York Times reported this weekend, even the words “affordable” and “care” have turned out to be untrue as well. The sharp rise in premiums has garnered the most headlines in the first three open-enrollment seasons of Obamacare, but equally if not more pernicious has been the increase in deductibles. As Eric Pianin explained for The Fiscal Times on Monday, deductibles have increased an average of 11 percent on Bronze level plans for 2016, intended to be the most affordable of all options, and now average over $5,700. For Silver level, deductibles rose 6 percent and now average over $3,100.

When the media focused on skyrocketing premiums (rightly so, considering the large serial increases for health insurance on the individual exchanges since the introduction of the Affordable Care Act) its advocates defended the system by pointing out that many on the exchanges qualified for subsidies to absorb the costs. For instance, Obama himself promised, “Most Americans will find an option that costs less than $75 a month,” and HHS Secretary Sylvia Burwell claimed that 80 percent of Americans would pay no more than $100 in premiums after the subsidies.

Those claims may be true, but those subsidies don’t just fall out of the trees; they come from higher taxes on providers and manufacturers, and eventually out of the pockets of consumers, as do all business taxes. However, that defense doesn’t work on deductibles, which insurance companies were forced to raise when the state and federal governments tried to squeeze premium increases for the exploding demand down to a dull roar.

Subsidies do not mitigate the fact that consumers have to pay both the premium and then thousands of dollars for care out of their own pocket before insurance takes effect, except in rare and catastrophic circumstances.

Consumers used to have an option for that kind of health insurance – catastrophic coverage, used to indemnify against unforeseen major health events. Those policies featured low premiums and left routine care for consumers to negotiate directly with providers on a cash basis. Combined with health-savings accounts (HSAs), those plans offered a rational approach to balancing health and economic requirements, especially for younger consumers who rarely need more than one or two clinic visits a year, which would cost far less than either comprehensive-coverage premiums or deductibles even in the pre-ACA era.

Instead of “affordable care” promised by President Obama and Democrats, consumers have instead discovered they have effectively been forced to pay for catastrophic health insurance at comprehensive-plan prices. They have become victims of a bait-and-switch scheme that the government would vigorously prosecute – if it wasn’t masterminding the scheme itself. The consumers interviewed by Robert Pear in The New York Times figured out that they’ve been had.

“Basically I was paying for insurance I could not afford to use,” said one Texas man who decided to drop his coverage. Another 60-year-old New Jersey man told Pear, “We have insurance, but can’t afford to use it,” thanks to a $3,000 deductible on top of his premiums. One woman told Pear that she’d be better off saving the money from her premiums as a form of self-insurance against catastrophe – since Obamacare no longer allows for low-premium catastrophic coverage in most cases.

Small wonder, then, that Gallup found disapproval for Obamacare rising again as open enrollment began. The most telling metric in Gallup’s poll comes when approval gets broken out by insurance type, when aggregated between its 2014 and 2015 surveys. The law is most popular among those enrolled on Medicaid or Medicare, with a 44/50 approval rating. That drops to 41/56 for those with private insurance. The uninsured – for whom the ACA was ostensibly enacted – Obamacare’s approval rating plummets to 30/59.

Expect that demographic to grow over the next few years, whether it results in fines or not. People will not pay $1,200 a year just to pay another $5,000 before they see the first benefit from their insurance. And as premiums and deductibles continue to increase, expect more Americans to realize they’ve been had by those who claimed to be here to help.

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Yet the problems facing the exchanges are important all the same. During the Obamacare debate, Democrats were divided over whether they ought to pursue a comprehensive overhaul of federal health insurance policy or if they should instead pass a “skinny bill,” an incremental, stripped-down version of Obamacare that would just include popular provisions like expanding Medicaid and imposing new consumer-friendly regulations on insurers.

George W. Bush presided over a big Medicaid expansion, so why couldn’t Obama? Proponents of a “skinny bill,” like Rahm Emanuel, then President Obama’s chief of staff, warned that there wasn’t enough public support for anything more ambitious.

Obamacare’s mix of carrots and sticks isn’t working terribly well.

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Troubling signs about the Affordable Care Act and the state of health care in the U.S. have bubbled up in the last few weeks.

The administration’s Obamacare enrollment projections for the coming year are down, the projected cost of premiums and out of pocket costs are up, nearly half of the insurance co-ops associated with the program are going out of business, and UnitedHealth Group, the nation’s largest health insurer, said it may withdraw from the government marketplaces in 2017.

Now comes a new survey by Gallup showing growing discontent with Obamacare and the U.S. health-care industry more generally after years of relative satisfaction with the quality and cost of the health-care system.

Fifty-three percent of Americans rate the quality of the U.S. health-care system as “excellent” or “good,” according to Gallup, which is what the polling organization has found since 2013. Yet that approval rating is down from the more positive and upbeat assessments as high as 62 percent between 2008 and 2012, during the heady early years of the new Obama administration and passage of the Affordable Care Act. 

Since November 2013, shortly after the Obamacare insurance exchanges first opened amid major technical snafus and missteps, no more than 54 percent of Americans have given solid grades to the quality of health care in this country. The combination of unrelenting negative media coverage of the startup of the exchanges and the Republicans’ unrelenting calls to end the program undoubtedly played a major role in the public’s souring views.

What’s more, the public’s satisfaction with their health-care system has dipped even more on the critical issues of coverage and cost.

Just 33 percent of those interviewed by Gallup rated the extent of coverage in this country as excellent or good, slightly down from 38 percent in 2009. But on the bottom line question of premiums and related costs, a mere 21 percent of respondents said they were satisfied. As an analysis accompanying the Gallup poll noted, 28 percent of Americans had been satisfied with costs in 2001, but that satisfaction subsequently dropped and didn’t rise again until 2009, shortly after Obama began his first term and began lobbying Congress for enactment of the Affordable Care Act.

“This increase ... may reflect optimism about the possibilities of Obama’s health-care reform,” Gallup said in its analysis. “However, satisfaction has since slipped.”

The bottom line? According to Gallup, “Although Americans were more positive about the cost, quality and coverage of U.S. healthcare in the early years Obama’s first term, that optimism has faded to some degree. Americans’ ratings of healthcare coverage are not high, but remain higher than they were in George W. Bush’s second term.”

Here are the detailed findings of Gallup, including the latest survey of 1,021 adults conducted Nov. 4-8:

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According to one new study, it seems to have given them a bit more leeway to bum around and find themselves—which is just about what you'd expect to happen when getting a job isn't a prerequisite for getting insurance. In a working paper released earlier this month, economists Gregory Colman and Dhaval Dave conclude that thanks to Obamacare's coverage rules, young adults are now less likely to work but a bit more personally content, as they spend more time with friends, in school, and searching for (presumably) fulfilling employment. They might be a little lazier. But that's not necessarily such a bad thing.

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Bad news is piling up for President Obama's signature Affordable Care Act, aka Obamacare, but that doesn't mean it's done for, according to Citi analysts.

In recent weeks, the law has had a rough go of it. One of its greatest successes, the healthcare exchanges in Kentucky, has come under threat.

Enrollment numbers for the exchanges are undershooting expectations, and it could lose the business of UnitedHealthcare, one of the nation's largest insurers.

Despite the setbacks, Citi's Ralph Giacobbe said it's too soon to say the whole system is unraveling.

UnitedHealthcare's "negative earnings revision on the heels of Exchange pressures, its commentary/retrenchment around this end-market, and the recent drop-off in enrollment have led to questions and concerns around l-t viability of the public Exchanges — and implications to both managed care and hospital/provider groups," Giacobbe wrote in a note to clients on Tuesday.

"Calls for the demise of ACA/Exchanges may be premature, which should bode well for managed care and hospitals longer-term," he said.

Obamacare has set up a number of exchanges, at the state and federal levels, allowing Americans to compare and purchase health insurance. UnitedHealthcare said last week that it was losing money by providing plans on the exchanges, which has prompted it to consider removing itself.

According to Giacobbe, UnitedHealthcare is jumping the gun by considering this move.

"Given our analysis, we believe it is premature to write off this end market and believe potential for longer-term growth still exists," said Giacobbe.

One of the main problems is that people are not signing up for the exchanges at the expected rate. This is especially true for young, healthier people who would help subsidize the rest of the plans and keep premiums down.

According to Giacobbe, as the penalty for not having insurance goes up next year, so too will the number of people enrolling.

"Importantly, the penalty for not having hc insurance escalates from the higher of $95 or 1% of income above tax filing threshold in 2014, to the higher of $325 or 2% of income above tax threshold in 2015, to the higher of $695 or 2.5% of income above tax threshold in 2016," wrote Giacobbe.

"As the penalty escalates we would expect rational economic decisions, particularly for heavily subsidized individuals that could obtain healthcare insurance coverage for below the cost of the penalty."

Based on his analysis, for about 7 million uninsured people, the cost of paying the penalty will be greater than getting a plan through the exchanges. This should drive more people into the program, thus alleviating some of the tension.

According to Giacobbe, as long as people look at the plans rationally, the all-important enrollment numbers should increase.

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NEW YORK (Reuters) - UnitedHealth Group Inc's chief executive officer on Tuesday defended the company's possibly exiting the Obamacare health insurance exchanges in 2017, citing losses on health plans it said were designed to succeed.

CEO Stephen Hemsley said that the health insurer had kept costs down by selling plans with small doctor networks, and that it had priced them competitively. The company signed up members with better health than the overall exchange population, but it still lost money, he said.

"We could not sustain the eroding level of losses on our exchange products," Hemsley said during its annual meeting with investors. UnitedHealth last month warned of mounting losses and said it might pull out of the exchanges.

That news surprised investors, pulling down shares of UnitedHealth and competitors on the exchanges, including Aetna Inc and Anthem Inc.

Hemsley said it was not yet known if the exchange problems were limited toUnitedHealth, or if they reflected a structural issue with the exchanges. The exchanges were created under the Affordable Care Act, also known as Obamacare, and provide insurance to more than 9 million individuals.

Under the law, insurers cannot refuse coverage to anyone, and many insurers including Aetna and Anthem have said some members are using medical services heavily, contributing to losses.

"There likely won't be a single broadly accepted marketplace conclusion for some time," Hemsley said. The company formed its view based on its own business, he said, but indications were that other insurers in the marketplace were seeing similar dynamics.

In the first half of 2016, UnitedHealth will decide whether to take part in any given region after doing a "product by product, market by market" review, Hemsley said.

(Editing by Franklin Paul and Jeffrey Benkoe)

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Insurance giant UnitedHealth Group on Tuesday seemingly took another step closer to bailing out of Obamacare in 2017 when its top corporate executive engaged in more public handwringing over financial losses and conceded strategic mistakes in rushing into the system.

While a pullout by UnitedHealth would deliver a serious blow to the future of President Obama’s signature health insurance law, a larger concern is whether its departure would trigger a stampede to the door by other bigger players in Obamacare, including Aetna and Anthem.

“What United and other big insurers will do hinges in a big way on how much enrollment in the [American Care Act] marketplaces grows over the next couple years,” said Kaiser Family Foundation Senior Vice President Larry Levitt. “Increasing enrollment will keep insurers interested in the market, and will also bring in more healthy consumers, which will moderate premium increases.”

“However, if enrollment stagnates, I could see some other big, national insurers follow United’s pessimistic lead,” he added in an interview.

UnitedHealth shook up the market Nov. 19 by revealing that it was considering pulling out of Obamacare after suffering hundreds of millions of dollars in losses related to Affordable Care Act business.

In a mea culpa to investors meeting in New York today, UnitedHealth CEO Stephen Hemsley said that the company should have stayed out of the Affordable Care Act market a little longer than just the first year to better size up its profitability.

“It was for us a bad decision,” Hemsley said, according to Bloomberg Business. “I take accountability for sitting out the exchange market in year one so we could in theory observe, learn and see how the market experience would develop. This was a prudent going-in position. In retrospect, we should have stayed out longer.”

The company gingerly entered the market last January after sitting out the first full year of Obamacare operations in 2014 to better gauge the potential profitability. The company revealed Nov. 19 that it was leaning towards pulling out after the coming year after a surprisingly poor performance this year providing individual policies in federal and state-run insurance markets.

Hemsley said that his company had kept costs down by selling plans with small doctor networks and pricing the plans competitively, according to Reuters. UnitedHealth generally enrolled consumers with better health than the overall exchange population but it still lost money, he said.

"We could not sustain the eroding level of losses on our exchange products," Hemsley said.

UnitedHealth’s latest warning of a better than 50-50 chance that it will pull out is the latest serious blow to the Obamacare system. The administration’s Obamacare enrollment projections for the coming year are substantially down to 10 million, the projected cost of premiums and out-of-pocket costs are up, and nearly half of the insurance co-ops associated with the program are going out of business at the end of the year.

Moreover, there will be a sharp reduction of more than 40 percent in the number of health plans on HealthCare.gov known as PPOs – or preferred provider organizations – which offer enrollees greater flexibility in where they can get medical services covered by their insurer.

During his session with investors, Hemsley said it was too soon to say whether the exchange problems were limited to his company, of if they reflected a “structural issue” that may plague the other major insurers, including Aetna and Anthem.

Under the terms of the Affordable Care Act, insurance companies cannot deny coverage to anyone, including those with pre-existing health care problems. Hemsley said that many insurers have complained that some customers are making frequent use of their policies, which had contributed to losses.

"There likely won't be a single broadly accepted marketplace conclusion for some time," Hemsley said, while adding that other insurers were encountering similar problems to those of UnitedHealth.

Although it is the largest health insurance provider in the country, UnitedHealth holds a relatively small part of the overall Obamacare market. According to The Los Angeles Times, United Health has sold health insurance plans to just 5.5 percent of the approximately 10 million Americans who use Obamacare to acquire coverage, and is offering plans in 34 states this year.

In the coming weeks, the administration and industry analysts will keep a close watch on other major insurers within the Obamacare network, including Aetna, Anthem (BlueCross Blue Shield), Cigna and Humana, all of which saw their stocks tumble following United Health’s announcement that it was considering withdrawing from the field.

“It’s still important to remember that while United is a very big insurer, they have never been a major player in the individual insurance market,” Levitt said. “The individual market has always been dominated by Blue Cross Blue Shield plans.”

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WASHINGTON (AP) — Republicans have muscled legislation through the Senate aimed at crippling two of their favorite targets: President Barack Obama's health care law and Planned Parenthood.

Thursday's 52-47 vote came with GOP lawmakers all but applauding a promised veto by Obama.

They want to use that veto as a message to signal voters in next year's elections that sending a Republican to the White House could doom the health care overhaul and the money Planned Parenthood gets from federal taxpayers.

After the House's expected rubber stamp in coming days, the bill will be the first to reach Obama's desk demolishing his health care law and blocking Planned Parenthood's federal money.

Democrats say the bill would deny health coverage to millions of Americans who have gained coverage from the law.

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