The ACA needs such adjustments, but it’s also being undermined by Republican opposition. The GOP-led General Assembly refused to set up a state-run exchange, thus stripping the insurance commissioner of his leverage on premiums or his ability to adjust to suit the state market. And the legislature refused to expand Medicaid, leading some low-income people whose medical costs could have been borne by the government to instead be enrolled in a Blue Cross or other private ACA plan.

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