One of the biggest surprises of the Sunday debate was the moment that Obamacare came up as an audience-member question.

Hillary Clinton basically said she’ll mend it, and Donald Trump vowed to end it.

Gone are the days of, “if like your plan, you’ll keep your plan.”

So many health insurers have bailed out of Affordable Care Act markets that the Obama Administration plans to assign affected consumers with remaining insurance companies.

…“Urgent: Your health coverage is at risk,” declares a sample “discontinuation notice,” drafted by the government for use by insurers. It tells consumers that “if you don’t enroll in a plan on your own, you may be automatically enrolled in the plan picked for you.”

That may make for a jarring start to the health law’s fourth annual open enrollment period, which starts Nov. 1, a week before Election Day, and runs through Jan. 31. While the administration says 20 million people have gained insurance through President Obama’s signature health law, it has suffered setbacks: Nonprofit health insurance co-ops created by the law have shut down; major health insurers have withdrawn from its marketplaces; and the ones that remain have raised premiums sharply.

For some reason, the Obama administration is worried about backlash.

…Some consumer advocates say this latest effort will help people retain coverage in a challenging year when premiums also are rising. Other advocates, however, worry it will cause confusion. Insurers fear a backlash from customers disappointed with reduced options. The administration says consumers have the last word on accepting any “alternate” plan they’re offered.

…The administration said it isn’t able to provide an estimate of the number of people who’ll get notices about their new plans. It could range from several hundred thousand to 1 million or more, say independent experts.

So, what is the alternative for a customer who rejects the “recommended plan”? Perhaps finding more unaffordable insurance or paying the Obamacare penalty. In fact, nearly 8.1 million taxpayers paid $1,694,088,000 in penalties for not having health insurance in 2014, the first year the penalty was in effect, according to the the Internal Revenue Service.

Returning to the Sunday debate, the key difference between the Democratic and Republican candidates is how they would handle the health insurance companies:

Clinton said that if Trump is elected and succeeds in repealing Obamacare, Americans would lose a slew of gains they’ve made under the ACA, including a bar against charging women more for health insurance, prohibiting insurers from discriminating against customers for pre-existing health conditions, and allowing people under age 26 to stay on their parents’ health plans. She said getting rid of Obamacare would unshackle insurance companies.

Asked what he would do to replace Obamacare, Trump repeatedly cited his proposal to allow insurers to sell health plans across state lines, which he said would add competition to the marketplace.

At this point, the competition that is the heart of a free market system is dead.

Perhaps if Trump is elected, people could pick a plan they liked and see their preferred doctors, too.

If Clinton is elected, and based on the current Obamacare trajectory, it is likely that we will all be assigned government-issued healthcare. You can refer to the VA hospitals for that is likely to work out for us.

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