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Another Obamacare health insurance enrollment period dawns Wednesday with millions of Americans facing harsh reality: They’ll pay more for less next year. Just like they did last year. And the year before. They’ll find the Obamacare marketplace even more confusing. Some silver plans, for instance, will cost more than gold plans. But bronze plans could be free for some working-class customers; that’s because tax credits increase along with the costs of plans. Be alert, shoppers. (10/31)

If you’re confused about the state of health insurance, join the club. On Nov. 1, the fifth annual open enrollment begins on the insurance marketplaces created by the Affordable Care Act. And, given what’s been going on in Washington, there is, understandably, a lot of confusion. Here are a few points to remember for the 90,000 Kentuckians who buy their health insurance on the ACA exchanges (healthcare.gov) and their friends and families: (10/31)

Iowa is scheduled for the largest premium increases in the land next year, a whopping 69 percent according to health care consultancy Avalere. The average premium on the benchmark “silver” plans will rise to $1,000 a month. What is going on in the state of Iowa? A rash of tragic combine accidents? Are Iowans getting lung diseases from all that corn pollen blowing about on the wind?Not quite. What’s happening in Iowa is sick people. Lots and lots of sick people cramming into an individual market that doesn’t have enough healthy patients to offset their costs. (Megan McArdle, 10/31)

Here’s a strange paradox: Health-care costs have increased by an unsustainable rate of about 8.5% each year over the past decade, according to PwC’s Health Research Institute. Already, the average employer-based family health insurance plans costs more than $18,000 annually. But Medicare spending has been relatively stable. Over the past three years, the program’s payouts to hospitals have increased by only 1% to 3% a year, roughly even with inflation. The prices paid for some core services, such as ambulance transportation, have actually gone down. (Keith Lemer, 10/31)

Regardless of your political persuasion, every Iowan can agree that health care in America is at a crossroads. The Affordable Care Act (ACA) continues to be the law of the land, and each passing day moves us closer to implementation of one of the more controversial aspects of the program – the Independent Payment Advisory Board (IPAB). (Joe Hrdlicka, 10/31)