President Obama’s Patient Protection and Affordable Care Act is increasingly unpopular with the public — Republicans and Democrats alike — but, for better or worse, the law is already changing the face of the health care industry, well before insurance exchanges are set to be implemented in January 2014. Provisions like tougher oversight of health insurers, expanded coverage for young adults, and greater protection for workers with pre-existing conditions have already begun to take effect in many states, in anticipation of reform, whether or not that reform takes the shape of PPACA. In addition, competition is disappearing across the country: hospitals are buying up other hospitals, doctors are leaving small practices, and smaller insurance companies are disappearing because they can’t stay competitive.

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