Many people contend that we should not worry about the premium rate shock because the ACA insulates most people from gross premiums. The oft-repeated idea is that the ACA basically requires only that people pay a percentage of their income in premiums. So, unless income goes up, a person’s net premium stays the same.

Reporters, pundits and bloggers should stop accepting or repeating this contention. Gross premium increases can matter a lot.

It is true that if you earn less than 400% of the applicable federal poverty level AND you purchased the second lowest silver plan the year before AND you continue to purchase the second lowest silver plan the following year, then your net premiums don’t go up even if the gross premium rises astronomically.

. . .

The U.S. Department of Health and Human Services on Thursday trotted out insurance executives who have found success selling health plans to individuals via the online insurance exchanges, a key part of the Affordable Care Act.

The conference, held in Washington and live-streamed to journalists and others, gave industry executives an opportunity to outline their strategies and challenges at a time when some major insurers are questioning the viability of plans sold on HealthCare.gov and the state-run exchanges.

In April, UnitedHealth Group Inc. announced it would stop offering exchange plans in many states next year, including Missouri and Illinois. The nation’s largest health insurer said it couldn’t make money on plans because of lower-than-expected enrollment and sicker people buying its plans.

. . .

Millions of people who pay the full cost of their health insurance will face the sting of rising premiums next year, with no financial help from government subsidies.

Renewal notices bearing the bad news will go out this fall, just as the presidential election is in the homestretch.

“I don’t know if I could swallow another 30 or 40 percent without severely cutting into other things I’m trying to do, like retirement savings or reducing debt,” said Bob Byrnes, of Blaine, Minnesota, a Twin Cities suburb. His monthly premium of $524 is already about 50 percent more than he was paying in 2015, and he has a higher deductible.

. . .

Last month, the Kaiser Family Foundation released the results of its 2016 survey of 671 people who purchased individual market plans compliant with the new mandates and rules established by the Affordable Care Act (ACA). As many insurers announce large premium hikes for next year and others announce they are withdrawing from the market, the survey reveals that enrollees are increasingly unhappy with their coverage. Given that these enrollees are one of the primary groups that the ACA is supposed to be helping, their declining satisfaction is particularly concerning and suggests a change of direction in federal policy is warranted.

. . .

The president and CEO of Blue Cross Blue Shield of North Carolina (BCBSNC) gives Obamacare a D+ for how it has performed in his state. In an interview with WRAL’s David Crabtree, BCBSNC CEO Brad Wilson conceded that he was a strict grader and that “on a good day” he might give the ACA a C+.

He acknowledged that the health law had provided coverage to 500,000 previously uninsured North Carolinians (“a very good thing”), but also warned that after two and a half years of operation, it was very clear that the financial underpinning of the Obamacare exchanges was not stable.

. . .

Obamacare supporters will say that increasing premiums don’t matter because anyone getting a subsidy has their premium share capped and they are therefore insulated from these prices and the follow-on big rate increases. The worst that can happen to them is that they will have to shop for a lower cost plan.

Those shoppers may well have to settle for plans with bigger deductibles and narrower networks to keep their premiums flat.

But the bigger thing this argument is missing is that half of the individual market does not get a subsidy in order to buy Obamacare health plans. The CBO has estimated that in 2017 both on and off the exchanges 12 million will get subsidies and 12 million won’t.

. . .

California is moving to become the first state to allow unauthorized immigrants to purchase insurance through the state exchange. The state Assembly voted Tuesday to open up Covered California to immigrants living in the U.S. illegally who want to purchase a health plan with their own funds.

SB 10, sponsored by Democratic state Sen. Ricardo Lara from southeast Los Angeles County, would authorize the state to apply for a federal waiver to make the change. The state Senate voted to pass the measure last June and an April staff report from Covered California also expressed support for the move.

. . .

UnitedHealthcare will stop offering Affordable Care Act plans in Illinois in 2017, the Tribune confirmed Tuesday.

The departure of the insurance company will reduce the number of coverage options for consumers in 27 counties.

UnitedHealthcare announced in April that it would pull out of nearly all of the ACA exchanges because of heavier-than-expected losses from covering a population that turned out to be sicker than it expected. The ACA plans, which the company offered in 34 states this year, are a small share of UnitedHealthcare’s total business.

. . .

Fresh problems for “Obamacare”: The largest health insurer in Texas wants to raise its rates on individual policies by an average of nearly 60 percent, a new sign that President Barack Obama’s overhaul hasn’t solved the problem of price spikes.

Texas isn’t alone. Citing financial losses under the health care law, many insurers around the country are requesting bigger premium increases for 2017. That’s to account for lower-than-hoped enrollment, sicker-than-expected customers and problems with the government’s financial backstop for insurance markets.

The national picture will take weeks to fill in. With data available for about half the states, premium increases appear to be sharper, but there are also huge differences between states and among insurers. Health insurance is priced locally.

. . .

A federal district judge ruled this month, in a lawsuit brought by House Republicans, that the Obama administration lacks the authority to pay cost-sharing subsidies to health insurers if Congress has not appropriated the funds. Some civil servants in the administration may agree.

The House Ways and Means Committee released a deposition Tuesday of David Fisher, former chief risk officer for the Internal Revenue Service. In it, Mr. Fisher recounts a series of events in late 2013 and early 2014 regarding the source and legality of Obamacare cost-sharing subsidies to insurers.

. . .