Articles on the implementation of ObamaCare.

People joked for a while about how insurers were pulling out of Obamacare markets so fast we might end up with areas in which there were no insurers at all.  It’s no joke anymore: with Aetna’s massive withdrawal yesterday from the Affordable Care Act marketplace, Pinal County, Arizona, the third most populated county in that state, currently has no insurers selling policies on the Exchange.  The issue isn’t so much whether people will be subject to the individual mandate tax of up to 2.5% of their income when there are no policies available; an administration that has no difficulty calling a utility shutoff notice a hardship that excuses one from the individual mandate (whether or not the utility was actually shut off) should have no difficulty declaring the non-existence of any insurance to be grounds for an exemption.  The issue is that Pinal County, although a bit of an outlier for now, is a harbinger for fundamental problems with the ACA now manifesting themselves with greater clarity across the country. When an insurer covering over 7% of those in the Exchanges and previously hoping to expand instead drops out, we better look at what is going on.

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Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model.

Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result.

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So much for choice. In many parts of the country, Obamacare customers will be down to one insurer when they go to sign up for coverage next year on the public exchanges.

A central tenet of the federal health law was to offer a range of affordable health plans through competition among private insurers. But a wave of insurer failures and the recent decision by several of the largest companies, including Aetna, to exit markets are leaving large portions of the country with functional monopolies for next year.

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Tennessee’s insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.

The rate approvals, while a tough decision, were necessary to ensure that consumers around the state had options when open enrollment begins in November, said Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance. BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.

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All but the most hardened partisans understand that the Affordable Care Act’s insurance exchanges are in serious trouble. In 2010, the Congressional Budget Office predicted that 21 million people would have exchange-based coverage in 2016; the real number was about 12 million. As insurers head for the exits, the gap between initial hype and final reality will widen.

The tragedy is that this was entirely avoidable. The ACA’s exchanges were fundamentally flawed in their design, something that private-sector experts tried to point out at the time. In October 2009, PricewaterhouseCoopers published a report projecting that by 2016, the ACA would cumulatively increase individual-market health insurance premiums by 47 percent.

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An Arizona county is poised to become an Obamacare ghost town because no insurer wants to sell exchange plans there.

Aetna’s recent announcement that it would exit most of the states where it offers Obamacare plans leaves residents of Pinal County, Arizona, without any options to get subsidized health coverage next year, unless regulators scramble to find a carrier to fill the void between now and early October.

About 9,700 people in Pinal signed up for Obamacare plans this year, according to administration data.

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Aetna’s decision to pull back from ObamaCare is fueling new questions about the long-term viability of the Affordable Care Act (ACA).

When UnitedHealthcare announced in April that it was leaving most ObamaCare marketplaces in 2017, supporters of the law argued against drawing broad conclusions, calling it one company’s decision.

But since then two other large insurers, Humana and Aetna, have said they are slashing ObamaCare offerings due to heavy financial losses from the plans.

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Canceled health insurance plans, shrinking networks, surging premiums and failed co-ops resulting from President Obama’s 2010 health law are only hiccups compared to Obamacare’s Medicaid expansion.

Unlike other major parts of the law, Medicaid expansion is covering more people than intended. This is terrible news for taxpayers, and it will only get worse with the next economic downturn.

Most of Obamacare’s health insurance coverage gains result from expanding Medicaid–a welfare program previously reserved for the elderly, the disabled, pregnant women and impoverished families with children–to millions of working-age, able-bodied, childless adults. Medicaid expansion is paid for with billions in new federal deficit spending.

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Aetna the nation’s fourth-largest health insurer, just decided to stop offering plans on Obamacare’s exchanges in all but four states in 2017. The firm says that it was losing roughly $300 million per year on these policies. And it projected that its losses would only increase, since the share of covered individuals “in need of high-cost care” was growing, according to CEO Mark Bertolini.

Aetna isn’t the only insurer giving up on Obamacare. UnitedHealth, America’s biggest insurer, will sell plans in just three states next year, down from 34 this year. Humana will offer coverage in just 156 counties in 2017, 88 percent fewer than this year.

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Increasingly, there are two ObamaCares.

There’s the one in coastal and northern areas, where the marketplaces include multiple insurers and plans. And there’s the one in southern and rural areas, where there is often little competition, a situation that can lead to higher premiums.

“There’s really two kind of stories that are playing out,” said Cynthia Cox, who studies insurer competition at the Kaiser Family Foundation (KFF).
The trend is likely to be accelerated by the departure of Aetna and UnitedHealthcare from ObamaCare marketplaces in 2017. The loss of those insurers won’t affect all parts of the country equally, experts say.

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