This past week, the so-called Affordable Care Act (Obamacare) reached its sixth birthday. Despite repeated promises, many Americans were forced to leave their doctors, premiums and deductibles have increased, state exchanges and co-ops had to close their doors, while some doctors have simply left their medical practice rather than be faced with costly mandates. Twila believes there's an Obamacare I and an Obamacare II. Obamacare I is about the premiums, deductibles, exchanges, preexisting conditions, penalties and subsidies that everyone knows about. Obamacare II is about the dramatic transformation of the health care delivery system, which will change the regulations about how doctors and hospitals are paid, to move them to limit care in order to not be penalized, but instead to be rewarded by the government.