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We are just a year from November 8, 2016, and the election that will largely determine the fate of Obamacare, and the news isn’t good for President Obama’s centerpiece legislation. Premiums continue to rise, doctor and hospital networks continue to shrink, Americans continue to balk at buying government-mandated insurance, the legislation continues to be historically unpopular, and Republicans are getting close to uniting behind a conservative alternative that can lead to full repeal.

The administration now projects that the average premium for the second-lowest-cost, “silver�� Obamacare plan in each area—that’s the plan used to calculate taxpayer-funded subsidies to insurance companies—will rise 7.5 percent from 2015 to 2016. That’s more than the real (inflation-adjusted) median American household income has risen in the past quarter of a century—in fact, it’s more than 10 times as much. According to the Census Bureau, the real median household income was $53,306 in 1989 and $53,657 in 2014, an increase of just 0.7 percent. Try keeping up with Obamacare’s inflationary premiums on such paltry increases in income.

Just because you pay your premiums, moreover, doesn’t mean you’ll get to keep your doctor. The Wall Street Journal reports,

Many insurers are tweaking their health-care-provider networks. Health Care Service Corp., which owns Blue Cross and Blue Shield plans in five states, lost money on its 2014 exchange business. For next year, it will stop offering preferred-provider-organization plans on the exchange in Texas, while in the Illinois marketplace it will no longer sell the PPO that featured the biggest selection of hospitals and doctors.

The insurer is developing plans like one it will sell in the Chicago area next year, with a network that, for most care, includes just one large health system.

So health care options are shrinking to a “single provider.�� If conservatives don’t repeal and replace Obamacare, “single payer�� will be next. That’s because the administration can’t get people to buy Obamacare-compliant insurance, despite a dual-track effort at bribery and coercion. The carrot of subsidies and the stick of decreeing—for the first time in U.S. history—that private citizens must purchase a product or service of the federal government’s choosing, under penalty of law, haven’t been enough to get people to buy expensive insurance with narrow doctor networks.

Americans�� refusal on this count has been remarkable. Right after the Supreme Court’s high-profile Obamacare case was decided in the summer of 2012, the Congressional Budget Office projected that 23 million Americans would have Obamacare exchange coverage by 2016. The administration now says its goal is less than half that. A few weeks ago, a press release declared, “U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced today that she expects 10 million individuals to be enrolled in coverage through the Health Insurance Marketplaces and paying their premiums—so-called effectuated coverage—at the close of 2016.�� HHS’s release added, “ ‘We believe 10 million is a strong and realistic goal,�� Burwell said.��

Even if the administration hits its far less ambitious goal, a clear majority of the newly insured will continue to be people simply dumped into Medicaid at taxpayer expense. So far, the CBO says, about 60 percent of Obamacare’s newly insured are on Medicaid.

Obamacare continues to be the most unpopular cornerstone legislation in memory. Since Obama began his second term, Real Clear Politics has listed 197 polls on Obamacare; 194 of them have found it to be unpopular. Just this past week, Republican Matt Bevin, a Tea Party favorite who campaigned against Obamacare, was elected governor of Kentucky, an office the Democrats have held for all but 4 of the past 44 years. Bevin, who polls claimed was a few points behind as of Election Day, won by 9 points against an opponent who touted the alleged benefits of Obamacare’s Medicaid expansion in the state. The New York Times reports, “Mr. Obama’s health care law was an especially contentious issue in the race.��

To achieve repeal, all that’s been missing is a new House (check), a new Senate (check), a new president (pending), and a conservative alternative that would repeal Obamacare and fix what the federal government had broken even before Obamacare was passed (gaining momentum).

Obamacare is on the ropes. It’s time to knock it out. And it’s time for GOP presidential candidates, who have been strangely silent on this matter, to start talking about how they would land the decisive blow.