It directly affects the personal life of every American, and it controls or regulates a complex sector of the American economy that is slightly larger than the entire economy of France.

If you guessed Obamacare, you’ve been paying attention for the past four years.

Four years ago, many health policy analysts, including those at The Heritage Foundation, predicted some of the effects this law would have on Americans. These are all coming true. Here are nine of our predictions that have come to pass—and it’s not over yet.

1. The individual mandate is an enforcement nightmare.

As a candidate, President Obama worried that an individual mandate to buy insurance would be unenforceable. He changed his mind once he became president. This year—the first year that the mandate penalties are to be imposed—he has already started backtracking on the enforcement of the provision he signed into law.

2. The law will create new disincentives to work.

Between Obamacare’s higher taxes and its subsidies that drop off if you raise your income, there’s not a lot of incentive here to work harder and better your situation.

3. The law, particularly the employer mandate, will impose new costs on businesses that undercut jobs and wages.

The employer mandate has been delayed until 2015, but the uncertainty Obamacare has created—and its 18 new tax hikes—have put a huge dent in job creation.

4. The law undermines competition and further consolidates health insurance markets.

Heritage Foundation analysis of federal and state exchanges shows that the law has, in general, reduced competition and consolidated health insurance markets. Between 2013 and 2014, the number of insurers offering coverage on the individual markets in all 50 states has declined nationwide by 29 percent.

5. The law guarantees major premium increases.

As Heritage predicted, the average annual premiums for single and family coverage in 2014 are rising in the state and federal health insurance exchanges all around the country. In 11 states, premiums for 27-year-olds have more than doubled since 2013; in 13 states, premiums for 50-year-olds have increased more than 50 percent.

>>> Get more details on all of these Obamacare effects

6. The law discourages insurance enrollment among the young.

The law’s insurance rules and new benefit mandates will make it cheaper for many younger Americans simply to remain uninsured and pay the penalty fine. It’s not surprising that young people have been staying away.

7. The law’s Medicare savings would not financially strengthen Medicare.

The law’s proponents originally promised that “savings” from Medicare changes would be spent simultaneously in two places: helping Medicare and expanding Obamacare. But money can be spent only once, so that didn’t work.

8. The law’s Medicare changes will result in reduced benefits and threaten seniors’ access to care.

The law’s impact is fairly straightforward: Fewer Medicare providers, reimbursed at rates progressively reduced over time, will create access problems for patients. Medicare cuts have been underway for several years now.

9. The law compels taxpayers to fund abortion and weakens protections of the right of conscience.

Obamacare mandates health plans that include coverage of abortion. It also spawned the Health and Human Services regulatory mandate that forces American employers to provide coverage for abortion-inducing drugs. It is safe to say that four years ago, millions of Americans did not expect that the national health care law would become a vehicle for an aggressive government infringement of personal liberty or coerce Americans to fund medical procedures and drugs in direct violation of their ethical and religious convictions.

Is it any wonder public opinion is against this debacle? It’s unfair, unworkable, and unaffordable. We need real health reform that puts patients back at the center and increases choice for Americans.

Read the Morning Bell and more en español every day at Heritage Libertad.

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