Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people.

The nation’s big health insurers say they expect premiums — or the cost for insurance coverage — to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.

Mark Bertolini, CEO of Aetna Inc., one of the nation’s largest insurers, calls the price hikes “premium rate shock.”

“We’ve done all the math, we’ve shared it with all the regulators, we’ve shared it with all the people in Washington that need to see it, and I think it’s a big concern,” Bertolini said during the company’s annual meeting with investors in December.

Manor’s company employs 45 people. If he brings in just five more, his business would soon be subject to new minimum coverage standards under the 2010 law — and he does not know whether his current health plan would meet this threshold of coverage or how his premiums might be affected.

“These changes are less than a year away, and I still have no information about how much our premiums are going to cost,” said Manor, owner of Bittersweet Catering, Cafe and Bakery. “It definitely gives me pause when thinking about adding another location.”…

“There is tremendous confusion and fear among many of my competitors and other business owners in my network, particularly about what you have to cover and how you have to report,” said Hugh Joyce, owner of James River Air Conditioning in Richmond. “In speaking to them, I am convinced that the primary reason we aren’t seeing a robust economic recovery is the uncertainty and costs associated with this health-care law.”…

One in eight small-business owners who responded to a survey by the National Federation of Independent Business said their health insurance providers had notified them that their plans would be terminated. A study released last week by Adecco, a human resources consulting firm, showed that nearly a third of employers said they stopped hiring or cut their workforce because of the law.

Rachel Shein and Steve Pilarski, the married owners of the bakery, which employs 95 people, estimate this could cost their business up to $108,000, and they are weighing their options as the date approaches. “Our revenues are about $8 million, but the food business is a low-margin industry so cutting $108,000 out of our profits, which are just over $200,000, is a big deal,” said Ms. Shein, who is the chief executive. They are evaluating different ways to comply with the new law and finance the expense…

Option One is to provide the insurance. According to the law, Ms. Shein will have to offer health insurance or, most likely, pay a penalty, and she estimates the insurance will cost up to $108,000 a year for 90 employees (managers have insurance already)…

Option Two is to not offer health insurance and let employees find coverage elsewhere, perhaps on one of the new government exchanges. Under this option, the company will probably have to pay the mandated “employer shared responsibility payment” to the government.

The cost to the business would be $2,000 per employee a year, but the law exempts the first 30 employees, so the total would be $130,000 per year for a 95-person company…

Ms. Shein is considering a third option: outsourcing certain jobs to reduce the staff, because businesses with 50 or fewer employees will be exempt from the penalty. “We can outsource the cleaning and make the drivers independent contractors,” she said, “and we can cut the least profitable delivery routes, least profitable accounts or reduce the variety of items we create.”

Obamacare’s formal name is the Patient Protection and Affordable Care Act. But according to a new Kaiser Family Foundation poll, even Democrats are skeptical that the law will improve health care quality and reduce costs.

Kaiser’s health tracking poll found that 37 percent of Democrats said “the cost of health care for the nation as a whole” would be better as a result of the law, just 39 percent said health care quality would be better and 27 percent said consumer protections for private insurance would be better. However, 53 percent of Democrats said the law would improve access to health care for the uninsured.

The numbers are worse for the population as a whole.

The Affordable Care Act was sold as a way to solve both problems [universality and affordability]. What it really does, though, is extend, sloppily and expensively, a right to health insurance to all. It’s a law that deals with the universality problem, not the spending problem. The cost-cutting measures it does contain are mainly experiments that will take years to evaluate. Yes, the rate of growth in health care costs has remained stable for the last three years. But that is more likely the result of the recession, and of experiments in private networks, which began before Obama-care. Most of Obama-care has yet to take effect. The problem of rising health costs remains…

Expect the grumbling to become more pronounced as the administration struggles to implement Obama-care. The 2014 deadline for the individual mandate and state- and federal-based health insurance exchanges is looming, and there is no guarantee the government will meet it. We may be better off if it doesn’t. What might happen, for instance, if universal coverage is not achieved despite the mandate? What might happen if employers slough employees off to the exchanges? If costs rise as demand increases?…

Unless conservatives and Republicans offer their own solutions to the twin problems of universality and affordability—solutions that begin a long process of introducing real price discovery and consumer choice into health care—liberals and Democrats will use Obama-care’s flaws as the basis for additional government intervention. They will double down on the flawed insurance model. Their inability to realize unrealizable ideals through politics will provoke .  .  . well, more politics. Liberal griping will give way to liberal law-making. You’ve been warned.

In the three years since Obamacare — the legislative darling of the president’s first term — was signed into law, it has grown from an adorable 2,700-page binder full of rules and kickbacks into a towering 7-foot-3-inch, 300-pound behemoth totaling more than 20,000 pages of byzantine mandates and regulations. When House speaker Nancy Pelosi (D., Calif.) infamously said, “We have to pass the bill so you can find out what is in it,” she wasn’t kidding.

Now, thanks to some enterprising staffers in the office of Senate minority leader Mitch McConnell (R., Ky), the American people can finally see what their elected officials created. The so-called Red-Tape Tower became an instant hit on social-media sites after McConnell’s press office tweeted a photo on March 12 (hashtag #redtapetower) of all 20,000-plus pages of regulations that the administration has released since Obamacare became law. The tower was stacked neatly in a corner of the Capitol building and adorned with a red satin bow that a staff member found at a stationary shop in nearby Union Station. The photo has been shared by tens of thousands on Facebook and Twitter…

“If you think that’s bad,” he said, pointing at the tower, “wait until they try to fix it.”

On top of Obama’s 2008 victory, congressional Democrats were able to build on their gains from 2006, so that once all the votes were counted (and Sen. Arlen Specter defected) they had a filibuster-proof majority in the Senate. It was only the lopsided nature of the majorities that allowed a plan as ambitious as Obamacare to become law…

It’s quite possible that a Democrat still would have won the White House in 2008, even had the Iraq War never been fought. But that Democrat would not likely have been Obama, nor anyone nearly as liberal. And were it not for the war, no Democratic president would have come into office with as much political capital — or with such large majorities in Congress — as Obama did.

It’s hard to see how Obamacare would have become law if Bush had never invaded Iraq. This is a bitter pill to swallow for those conservatives who supported the war and bitterly fought Obamacare.

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