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Obama Affordable Care Act ACA and its downfall are covered by two experienced authors over 2 book written over 2 decades. The authors are James Morone and David Blumenthal followed the healthcare issue over 25-30 years through the Clinton, Edward Kennedy and Obama efforts and wrote two books. The first was "The Heart of Power" on the healthcare situation from FDR to 2008. The last titled "Whiplash" in 2026, for which the authors are interviewed in Harvard Medicine magazine. C-SPAN has a book program on this book at a Washington DC bookstore. From the discussion on C-SPAN between Senator Michael Blumenthal, borther of one of the authors, James Morone and David Blumenthal physician, couple of conclusions are seen that may be new to readers. Q. What was the one single factor that doomed the Affordable Care Act? A. The deep antipathy towards the Obama administration influenced the response to the Obama handling of healthcare. The likelihood of Republicans accepting healthcare from a black person was simply not there say the book's authors in the discussion and Q&A on C-SPAN. Yet there were other reasons for the ACA failing. Obama had not gauged the mood of the nation well. UK Labour's Starmer won by a big majority in 2024 yet that does not reflect the mood of the British nation just 2 years later- by election year 2012 Obama's campaign was faltering and had to be rescued with Hispanic votes and a weak candidate in Utah's Mitt Romney. Obama lacked maturity and came in the way Bush came in when the list of candidates were mediocre in the US, similar to the period in the UK with David Cameron and Boris Johnson. To take on the health care issue required someone with the experience and caliber of LBJ, which Obama clearly lacked, coming from the minority community was not going to help in credibility. Obama's presidency was thus premature and to gain experience he would have done better in a key cabinet position such as at Department of State where an intellectual could have influenced world opinion in favor of emerging countries, a doable and necessary. Obama's lack of experience showed when he told Republicans two words in the first months in 2008- "We Won," perceiving arrogance it would set Republicans against him. The years 2008-2016 cost the US dearly in that the US needed a withdrawal from all of the Middle East which would require a strong president  with deep roots of support in all parts of the country including the south, to avoid recriminations. In the end by continuing the wars Obama weakened the US and let China move ahead. Q. Did Obama consider Medicare for All? A. Obama told Congressmen of his party according to Morone- if you can get 60 votes in the Senate for Medicare for All we can try.  Q. Would it take a major upheaval for Medicare for All to be accepted now that the health system is failing all Americans in 2026? A. It will take a world war or a economic depression- some major disaster for Medicare for All to be accepted in the US, say the authors. A pandemic happened in 1918 and again in 2019 the results were not positive, as the authors believe it unleashed the war on science after the vaccination for and against camps, leading to the culture wars in America seen today. Q  Obama's analytical mind thought he learned from the Clinton efforts in healthcare that failed. But he did not see things from the heart. There is good reason to think that the lessons learned of moving fast, letting Congress write the legislation, settling for what can be done not what needs to be done, were exactly the wrong lessons to be learned as opposed to writing off the Clinton experience entirely as Clinton's, and starting from scratch without preconceptions. In the end Obama if he was older, had more experience, and listened to the mood of the country would have realized that healthcare was for another day, and got right down to the most difficult challenge, to end the wars in the Middle East. Even small steps in the right direction would still have earned appreciation him today. Instead Bush and Obama, the most inexperienced of presidents will be remembered for wars they continued that weakened America.       ...

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The major provisions of the Republican House healthcare bill that passed by a vote of 217-213 are- 1. To help people buy insurance coverage the bill offers $2000 to $4000 a year, upto $14,000 a year in credits based mainly on age, reducing them for families making $150,000, individuals making $75,000. 2.  Under the Affordable Care Act insurers cannot charge older Americans more than 3 times for same coverage they offer to younger people, the new bill makes this 5 times. This would increase premiums for older Americans and reduce it for younger Americans. This is the most controversial part of the bill. Older Americans supported the Republican party in the presidential election. 3. The new bill ends Medicaid as an open ended entitlement and places this on a budget with cuts of $880 billion over 10 years. 4. To mollify conservative Republicans a provision allows state to opt out some provisions of the ACA that requires minimum benefits such as maternity care and emergency services. It retains coverage for pre-existing conditions to mollify moderate Republicans. The bill provides states with $138 billion over 10 years to subsidize premiums, provide coverage for pre-existing conditions, mental healthcare and drug addiction. 5. The bill removes the taxes imposed under the Affordable Care Act (ACA) on high income people of about $300 billion over 10 years by repealing a payroll tax increase and tax on investment income. This bill and the ACA offer 2 competing visions on healthcare, both bills passed only by a margin of 4-5 votes in the House. The ACA overlooked the impact on premiums causing discontent among middle income Americans. The new bill lets premiums rise for older Americans in order to keep premiums down for other Americans. This shows the many tradeoffs involved and choices being made, and the lack of a consensus on the issue of healthcare in the U.S., becoming a highly politicized issue instead of the way it is treated in western Europe.     ...

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Obama Affordable Care Act dropped by 10% of subscribers in 2025 and 17% likely to drop out in 2026. The AFA becomes unaffordable to millions after the expiration of federal subsidies.

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High 2025 ACA premiums showing the failure of Obama patchwork on the failing US healthcare system.

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Note that ACA shares had lost 95% of their value and were down to 50 cents by the time Standard and Poors cut its credit rating of ACA to CCC in December. Now it appears that prior to the downgrade S&P had only looked at subprime securities created in 2006 and not subprime investments from 2005 and 2007 which ACA had insured. Why did it take so long for S&P's models to refect the true situation and why did the 2005 and 2007 information take till December to evaluate for a downgrade?

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NYT reports show the Republican health care bill AHCA 33 votes short of passing the House and likely to fail. Conservative Republicans were looking to whittle down the safety net in the Affordable Care Act, and moderate Republicans could not stomach the whittled down bill removing guarantees of essential benefits for instance. The basic problem- no real consensus among Americans about providing health care to all Americans, and no real solutions possible as long as there is acceptance of disproportionately high levels of medical care costs for treating each disease in the U.S. compared to Europe and other countries.

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With Democrats emboldened by winning governor races in NJ and Virginia government shutdown on issue of ACA subsidies continues on November 8 2025. Speaker Johnson refusal to commit to holding a vote in the Senate on ACA subsidies means negotiated compromise cannot be made on a future vote for ACA subsidies so that the government funding takes place.

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With the rushed approach adopted by the Trump administration not enough consideration was given to winning support in the House from 25 conservatives in the Freedom Caucus. Without their support the bill cannot be passed in the House of Representatives. The fight also includes one over what are essential health benefits including whether  maternity care would be included. As a result some moderate Republicans are also expressing opposition on the grounds that less people will be covered and fewer benefits will be provided under the Republican House plan called AHCA. President Trump has not involved himself in the details, and the bill comes very early in the first 100 days, leading to the perception that health care has become a partisan conflict without really grappling with the problems of high cost of health care and creating a solution that all can support. Democrats are seen as having made the same error early in Obama administration's first term. President Trump sees this as a much needed win with a drop in his approval ratings, making this even less of an effort to come out with a good plan.  ...

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The Affordable Care Act subsidies are basically a band aid approach to a fundamentally broken health care system in the US, says Washington Post Editorial Board on Nov. 1, 2025. The 22 million ACA subsidies will cost $350 billion over 10 years. Democrats have the government shutdown over this issue of extending Obama ACA subsidies where enrolment increased in the covid and Biden years with generous subsidies. The Washington Post looks at how we got here since 1945, decisions made about employer insurance plans that created a patchwork of plans from private sector and other plans outside it with perverse incentives and inefficient subsidies. It calls the system stupid, and politicians looking to the next 2 year midterm elections wary of addressing the whole problem in the proper way for a system that will benefit all the people of the US.

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The modernization of the Indian Air Force proceeds with the phase out in 2 years of all MiG 21's to be replaced with Rafale jets from France and new Advanced Medium Combat Aircraft AMCA which will be made in India with advanced technologies for the Air Force and the Indian Navy.

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The Affordable Care Act or Obamacare gave families of 4 with incomes of less than 125,000 or single income less than $60,000 a chance to buy insurance with federal subsidies. When these subsidies were increased under the IRA Act of president Biden the enrolment has doubled in the last 5 years to $24 million. These subsidies expire in 2025. Under the One Big Beautiful Act the policy of subsidies for ACA is not being renewed when it expires in 2025. This shows the band aid approach of Obama to healthcare and the lack of a comprehensive approach. The policy on migrants during the Obama and Biden administration also stretched public funding resources. Insurance companies now plant to make up for the los of subsidies from the government by raising prices for this subpopulation in a broken healthcare system in the US by 15-20%. This report in WSJ shows a young woman on ACA insurance in Illinois with a payment of $590 a month to Blue Cross of Illinois facing a new payment of $678, almost the size of a mortgage. ...

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The US government shutdown ends with Republicans + 8 Democrats in Senate voting to end shutdown on November 10, 2025. This keeps the filibuster voting rule which requires 60 votes to pass. Support of some Democrats was essential to make this happen. After bipartisan negotiations 7 Democratic Senators and Angus King Independent from Maine split with their party leaders Schumer and Jeffries of New York who called for a 1 year extension of Obama ACA healthcare subsidies which the Republicans opposed.  Democrats ensured the funding for SNAP benefits continues to Sept 2026 and the 4000 federal layoffs would be reversed and prevent future layoffs in the federal workforce. Democratic Senators voting with Republicans were Cortez Masto and Jacky Rosen of Nevada, Jeanne Shaheen and Maggie Hassan of New Hampshire. Tim Kaine of Virginia and Dick Durbin of Illinois joined the Senators from New Hampshire and Nevada. John Fetterman who has voted independently of the Democrat party to meet views of Pennsylvania constituents supported the move. This splits New Hampshire, Maine, Nevada, Illinois and Pennsylvania from the Schumer-Jeffries leadership from New York. Tim Kaine voted with Republicans by getting them to agree to reverse federal workforce layoffs, get back pay and stop layoffs. King, Hassan and Shaheen formed the core of Democrats who believed there was no chance Obama ACA subsidies would be extended for another year as long as shutdown continued whereas there was some chance after it ended. Both Senators from Nevada Rosen and Masto were following the needs of their constituents, and so was Fetterman of Pennsylvania. ...

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The Republican House Health Care pLan in 2017 relies on tax credits of between $2000 and $4000 based on age. Under the Affordable Health Care Act the elderly poor in high cost insurance areas received additional help. These people would lose over $2000 per person and may forgo full coverage or coverage entirely under the Republican House Health Care Plan. A report by Standard & Poor's estimates about 2 to 4 million people who are in 50's and 60's not yet qualifying for Medicare might lose their coverage they now have under ACA. The Republican plan also gives incentives through tax credits higher for older people, $4000 for a 60 year ol and $2000 for a 25 year old. Under the ACA the insurers are not allowed to charge more than three times what is charged for younger people, under the Republican plan this goes up to five times. 

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The U.S. House of Representatives votes to repeal and replace the Affordable care Act 217-213. Moderates were won over by an addition of $8 billion  to add coverage for a popular feature of the ACA that covered people for pre-existing conditions.  The bill that passed gives credits of $2000 to $4000 a year, depending mostly on age, upto $14,000 for a family. Credits are reduced for individuals making over $75,000 a year or families making over $150,000. There is no mandated insurance coverage. This trims the federal budget deficit, yet also is expected to keep 24 million more Americans without health coverage after 10 years. The bill now goes to the Senate where moderate Republicans are worried that this may increase premiums for older people, one of the drawbacks of the earlier version of the House Republican bill.

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Tim Kaine's reason for joining Senate vote- to reduce hardship across the US, knowing the key actors and the chances of Republicans approving ACA subsidies were zero. Tim Kaine in his own words says why he joined in meeting with 2 New Hampshire Senators Shaheen and Hassan, and Angus King of Maine, to end the shutdown. He says he got Republicans to agree on support funding for food assistance and for veterans families and for workers in the federal government. Other reports show that over 300,000 workers in the federal government are from Tim Kaine's voter base in Virginia- he is a former governor of Virginia- all affected by job cuts and needing back pay, and he was doing what he though was right for them and for the Nation. 

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This article in the NYT provides a look at the features of the Republican House Health Care Plan- Both the Affordable Health Care Act and the House Plan provide incentives for buying insurance- the ACA bases these incentives on income levels whereas the House Plan does not provide additional help for low incomes or elderly. Incomes at $20,000 would see a loss greater than  $2000 under the House Plan and as many of the elderly poor living in high cost areas may not have the resources to make up for this loss of subisidies they may forgo buying insurance or have insurance coverage that protects only in a limited way. President Trump has given assurances that all will be covered. For people with incomes of $50,000 or $75000 the loss of $2000 subisidies would also have some impact. At larger incomes or the well to do the subsidies are not handed out under either plan. Under the ACA the emphasis was on income levels and high cost insurance areas the subsidies were greater, under the House Plan the subisidies would be higher for the elderly compared to the young but very low income levels are not given additional help.     ...

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The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

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Hakeem Jeffries of Brooklyn NY accomplishes little from a 43 day shutdown of the US government. Tim Kaine expresses his view on the pages of the NYT that he knows the key actors and the prospect of Republicans negotiating agreement on restoring ACA Obama subsidies were zero, just zero he says. BBC's Zurcher's analysis says the Jeffries based NYC leadership accomplished little, that a sober assessment by the region of New Hampshire and Maine, leaders from Robert Frost country with their keen sense of the right direction for the people and country- separate from warring ideologies and vested interests-has put the US on the right path to the future. As Robert Frost of the New Hampshire countryside says-

"Two paths diverged in the woods and I- I took the one less travelled by.  And that has made all the difference."

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Margot Sanger-Katz of the NYT provides an excellent summary of winners and losers under the new Republican House healthcare bill that passed the House in a 217-213 vote on May 4, 2017. On the whole middle income people and higher income people stand to benefit, with sharp cuts in Medicaid, and higher premiums as well as smaller subsidies based on age affecting older people. Pre-existing conditions and minimum benefits are included as in ACA, with the provision that states can in some ways limit that coverage. Employers are no longer required to provide mandatory health coverage, helping large and small business owners.