My local Sunday paper had an above-the-fold headline the other day: “Obamacare rate could see big spike in NH next year.” This refers only to my state, where an unidentified government official leaked to the press a document projecting an average Obamacare-exchange premium rate increase of 44%.

The headline could easily have said “another spike.” Obamacare-linked price hikes are old news. Still, I’m glad this wound up on the front page. That indicates that at least one assignment editor doesn’t take big increases for granted.

The story said that the document was stamped Confidential and Draft Only and Not for Distribution. I wish I knew who leaked it so I could deliver my personal thanks. I don’t like being surprised during enrollment season. The principal factor in the projected increase, according to the news report (I haven’t read the actual document), is Medicaid expansion. Without that, the projected increase is closer to 17%.

I don’t want my neighbors covered by Medicaid expansion to get sicker or forgo mental health care or substance abuse treatment. What irks me is that anyone in government or media could be surprised or distressed that expansion actually leads to cost increases and distortions in how health care is provided.

I hope no one’s surprised when the resulting premium increases for my non-Medicaid neighbors leads to changes in their behavior, such as dropping insurance altogether.

Last year’s price spike finally pushed me over the edge and out of the market. In the government’s view, I am uninsured, having opted for a healthshare program that Obamacare benignly tolerates. My husband has retained a conventional policy, and we’re keeping records to see how our costs compare over time.

Ideal? No. My costs are pretty much under my control, right up to the time I’m badly injured or develop a serious medical condition. I would then be at the mercy of my fellow sharers and of the bean-counters in my healthcare providers’ offices. Further, I am waiting uneasily for the Obamacare fans to amend the law so that healthshare programs are no longer penalty-free. Frankly, I think that kind of amendment is likely to come much sooner than any Republican health-insurance reform.

Medicaid is permanently expanded. I believe that. So will there be any health insurance “fixes” this year that would head off a 44% average increase in premiums on my state’s exchange next year? I don’t see how, no matter who’s in the White House. I’m pessimistic about the financial aspect of government health insurance because I’ve seen over the past five years that elected officials can’t even get the little things right.

By “little,” I don’t mean unimportant. I’m thinking of Obamacare’s contraceptive mandate. That’s the government policy that treats being a woman as a pre-existing condition by calling women’s contraceptives “preventive” care. Business owners who offer health insurance to employees, and who have moral objections to coerced involvement in their employees’ birth control decisions, have had to go to court to escape the mandate.

President Trump’s recent religious-liberty order was tightly limited and it did not undo the mandate. The Little Sisters of the Poor will benefit from his order, because he’s taken a personal interest in their case. Dozens of other mandate challengers are still making their way through the courts, with only these words from the President’s order to comfort them along the way: [cabinet departments] “shall consider issuing amended regulations, consistent with applicable law, to address conscience-based objections to the preventive-care mandate.”

In five years, regardless of the party in power, Congress has failed to repeal the mandate. A Republican president has managed only to tell his people to “consider issuing amended regulations.” The Supreme Court has had the chance to throw out the mandate as a religious liberty violation, and it has not done so.

I can’t trust them to fix even one small but critical aspect of health care policy. I sure can’t trust them to fix the whole thing. Bring on the spikes.

Ellen Kolb blogs about New Hampshire life-issue policy at Leaven for the Loaf and looks farther afield in ellenkolb.com