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State based exchanges in New Mexico, Oregon and other states have experienced difficulties setting up and running the exchanges. Many states have turned to the federal government to operate the exchanges.

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This article by Horowitz in the NYT shows some of the criticism leveled against the Clintons and how they were out of touch with the white working class voters who have drifted to Mr. Trump.  It may be overdone in that not all white working class voters have drifted to Trump, and a Gallup survey has shown Trump supporters to be some white working class but also many from other groups in society, and many older less educated voters.  Trade Unions have played a large role in this election, and workers in manufacturing have voted Democratic in midwestern states such as Wisconsin, Michigan and Illinois. Horowitz also ignores some points in this campaign such as when Bill Clinton was adept at openly stating that he agreed with people who said Obamacare had increased premiums, and that some of the Obamacare program needed to be fixed. This took some of the criticism of Republicans on Obamacare and turned this around. He also showed a better understanding at times of the plight of working class people just from his habit of listening and thinking about how this affects ordinary people, a skill he has even to this day. A 2014 NBC/WSJ poll showed Bill Clinton with a 56 percent favorability rating, which is higher than president Obama, and exceeded only by Michelle Obama at 64 percent. ...

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Public opinion in the district of Steve King, a Republican in the House of Representatives favoring defunding of Obamacare healthcare law.

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Bob Kocher, special assistant to President Obama for healthcare policy in 2009-2010 describes how hospital mergers with the passage of the Obama Healthcare Law are not doing much to control health care costs in the U.S. This is contrary to what was expected during the policymaking in 2009. In 2015 there were 112 hospital mergers in the U.S.  He says smaller physician led health care organizations do better at taking steps to improve productivity, adopt technological improvements and control costs.

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This report on the tax bill in Congress cites the views of senators who could decide the fate of the bill. Senator Collins sees removing the individual mandate  from Obamacare in the tax bill as a problem as it would increase premiums and negate benefit to the middle class. Senators Flake and Corker told ABC News they see the deficit impact as a negative factor that could lead to them voting against it.

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The problems facing U.S. Speaker of the House of Representatives, John Boehner, as a government shutdown occurs in October 2013. Republicans and Demorats fail to agree on raising the debt ceiling and financing of the government. Boehner faces a movement in the Republican party led by Senator Ted Cruz of Texas for defunding the Obamacare law.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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The Obama Center in Jackson Park, Chicago, is a 20 acre complex opening on June 19, 2026, built by Todd Williams Billie Tsien Architects. The Obamas chose land that was once use for the World Columbian Exposition World Fair. Using public space was controversial, made up for by a new branch of the Chicago Public Library, a basketball court and playgrounds. The most controversial part is the Obamalisk (obelisk type) tower which is as dour as one can get. One of Obama's speeches with letters on the tower top the architect says is not legible, but thats just fine he says, as if it is empty rhetoric. Or as Kennicott says just rhetoric, ornament, did all those words 17 years back really matter or were they merely oratorical good vibes. So much has happened since then that Kennicott rightly looks at the new Obama Tower with skepticism of what Obama ever accomplished. In healthcare the Obamacare plan is now not working or being replaced. Obama continued the wars Bush started, were they really that different.  At every turn from the entry there are questions like this. At the entry itself with the Declaration of Independence there is a display of unequal treatment, questioning the very experiment of Jefferson, Washington, by placing their formative ideas for a new society that had already been born in Britain with the abolition of slavery in 1772 with Somerset vs Stewart. Ben Franklin forming the Abolition of Slavery Society in Pennsylvania as early as 1775 and becoming its president in 1787. None of the founders get any credit for envisioning a different society, than they had to live in, and which even Abe Lincoln struggled with from 1850's till the Emancipation as way to win the Civil War. The entry to the Smithsonian has done the same. Yet it is this same document the Declaration which says "All men are created equal and they are endowed by their creator with some inalienable rights, life liberty and the pursuit of happiness,"  that has inspired  and given new hope to hundreds of millions of Chinese and Indians, Africans, and other Asians by 1900 and 1950, the vast majority of people on the planet. Philip Kennicott of the Washington Post asks the questions over and over in this report-  was America sleeping when it should have been alert? Lighthizer and Jamieson says this on this page that 5 million jobs were lost, economic growth was down by 1% to 2% instead of 3% of the period 1960-2000, and $20 trillion in America's wealth transferred overseas by the combination of Bush-Obama in the 2000-2020 period, manufacturing decimated, wages stagnant, America's working class communities destroyed, all the while this high minded rhetoric went on. As Kennicott says the period of rhetoric and oratory is gone, in the past, the presidency merely decades of decadence of America's elites as Marco Rubio says in a new book. ...

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America whether under Eisenhower or under Truman, Johnson or Reagan embodied some measure of fairness and good sense. How this was lost when it comes to pharmaceutical pricing under Bush in 2003 and Obama in 2008 is shown here in a WSJ podcast. Bush and Republican allowed Medicare to pay for pharmaceuticals yet taking away its right to negotiate prices. Obama and Democrats in 2008 this podcast shows allowed the Bush introduced violation of good financial common sense to continue in exchange for support for Obamacare from the manufacturers. Over 15 years by 2019 pharmaceutical costs soared and remaining goodwill withered, this podcast shows. During this same period the financial industry went through a similar cycle and with it the ideas of a free market economy. The free market economy like everything else in life depended on good common sense, and a sense of how it benefits all, as both Adam Smith and the country's principal founders constantly reminded people.      ...

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U.S. president Obama offers his own assessment of the divisive rhetoric of Trump and its origins in the way the Republican Party has opposed him throughout his two terms, including opposition to Obamacare, and ways to tackle poverty, joblessness, without offering alternatives. He says conservative news outlets encouraged this trend till Mr. Trump said he could do this better by raising the level of rhetoric. Democratic candidates Hillary Clinton, Bernie Sanders and voices in the Republican Party are critical of the way Trump conducts his rallies, and the abusive rhetoric for Latinos, Muslims and minorities.

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The Journal says Santorum needs to fit his economic point about helping manufacturing into a broader economic policy, and broaden his support base beyond the social conservative base. It says about Romney that he needs to find an authentic message that appeals to conservatives beyond catchphrases about repealing Obamacare. The problem it says is both candidates do not appeal to the whole Republican party. One candidate Romney lacks the fervor and firm convictions and the other Santorum has fervor and firm convictions about social issues, but can't do the same for economic issues and the other concerns of Republican voters.

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Former Louisiana fovernor Bobby Jindal comes under severe criticism from the Washington Post for policies it says hurt the poor by turning down federal Medicaid funds under Obamacare, for using rainy day funds, and cutting spending on education and other needed programs in the state. It says Jindal pursued Grover Norquist's no tax pledge leading to spending cuts in the state and budget gaps, merely to appeal to voters in the GOP presidential primaries. Jindal's appeal to Republican voters actually fell sharply because of unpopular policies and he did not qualify for participation in the presidential televised Republican debates. Republican voters turned to outside candidates such as Trump, Carson and others.

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WSJ Analysis of $1 trillion Medicaid Cuts in the One Big Beautiful Act-who it impacts most. It means less money for insurers, hospitals, and 9 million able bodied Medicaid recipients being moved to being covered by new employers. Under extension of Obamacare able bodied Americans were added to Medicaid in some of the states. Some states such as Texas and Florida and other southern states decided not to do this. The One Big Beautiful Act removes this extension of Obama care and the funding to states and adds the able bodied requirement to cut funding by about $1 trillion. Insurance companies who covered the insured and got payments from the federal government will lose these payments. Hospitals will also lose these payments from the federal government that sent money to the states for funding Medicaid. Overall Medicaid funding is proportionally cut more in Republican states. In Arizona, Kentucky and Virginia Medicaid cuts will be 18%, compared to 9% in New York and 13% in California. 93% of the cuts are in states that have expanded Medicaid to include able bodied adults. The Big Beautiful Act also cuts down on provider taxes which hospitals used to get more funding. Rural hospitals are given access to a $50 billion fund in the Act  so they can be kept open. ...