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As concerns increase about higher health insurance premiums on the government exchanges, President Obama on Wednesday urged navigators and others helping with the new open enrollment to persevere to get more people signed up for plans. "You are changing people’s lives with your work," Obama said on a conference call with Health and Human Services Secretary Sylvia Mathews Burwell. (O'Donnell and Jackson, 11/4)

But the nonprofits have been caught in a financial squeeze. A federal formula to spread out risk among insurers resulted in many co-ops paying steep fees. At the same time, lawmakers eager to chip away at the Affordable Care Act put restrictions on a federal government program to cover insurance company shortfalls. Of the 23 operating co-ops, 11 have recently folded or said they would close. One other never got off the ground. (Armour, 11/4)

After nearly two years in operation and millions of dollars spent in development, the small business health insurance exchange created by the Affordable Care Act is struggling to catch on. Nationally, about 85,000 people, from 11,000 small businesses, have coverage through the online marketplace known as the Small Business Health Options Program, or SHOP, according to the latest federal data released in May. Those totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015. (Galewitz, 11/5)