Articles on the implementation of ObamaCare.

For the sake of competition in Maryland’s Obamacare marketplace — particularly for those who buy insurance as individuals, not through their employers — Evergreen Health needs to survive. CareFirst BlueCross BlueShield had 80 percent of Maryland’s individual insurance market in 2014, according to the Kaiser Family Foundation, up from 74 percent three years before. Evergreen, with nearly 40,000 members and growing fast, is expanding in the state at a time when other carriers are pulling back. Though still relatively small, it provides another option for consumers and puts pressure on the dominant carrier to innovate and contain costs.

. . .

A rarely discussed aspect of Obamacare, one that appeared to give states an “exit strategy” to avoid provisions of the health care law, is likely to become more widely known next year.

But while states led by Democrat governors are beginning to see “innovation waivers” as a way to change their health care systems—and move toward proposals such as a public option—states with Republican governors are proceeding with caution.

The waivers come with strings attached by the Obama administration that some policy experts say constrain free market health care reforms as an alternative to government mandates.

. . .

Six and a half years after the ACA was signed into law, health reform no longer feels like a steady forward march toward progress. It feels more like World War I: dotted with landmines, lined with trenches, and ending inconclusively. In 2010, the Congressional Budget Office predicted that 21 million people would be enrolled in the ACA’s insurance exchanges by 2016; as of now, only 12 million are. That gap between hype and reality is likely to further expand over time.

What happened? It’s a long story, of course. But the simple answer is that the ACA’s exchanges were designed poorly and implemented poorly, by overconfident advocates who dismissed any and all criticism, no matter how well-reasoned.

. . .

The Obama administration is worried that insurers bailing out of the health law’s markets may prompt their customers to drop out, too. So it plans to match affected consumers with remaining insurance companies.

The hope is to keep people covered, but there’s concern that the government’s match-making will create confusion and even some disappointed customers.

. . .

Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

. . .

South Carolina became the fifth state to have only one company offering health insurance through its Affordable Care Act exchange.

The South Carolina Department of Insurance announced on Tuesday that Blue Cross Blue Shield of South Carolina will be the sole provider for South Carolinians looking to get covered through the ACA, better known as Obamacare, according to The Post and Courier.

. . .

The 18- to 34-year-olds who helped elect Barack Obama could consign his signature domestic policy achievement to failure.

That’s because not enough millennials have signed up for Obamacare to make it work well. Despite repeated outreach — including entreaties from all manner of celebrities, including NBA stars and Obama himself — young people make up less than 30 percent of Obamacare customers. he White House had set a goal of 40 percent in that age bracket to sustain a healthy marketplace because millennials tend to be healthier and, therefore, balance the costs of sicker, older customers.

. . .

If policy makers want to instigate more competition in the ACA, they can start by broadening “credibility adjustments” to make it easier for new plans to get started. The exemptions should cover all new carriers that enter the exchanges. They should be deeper and apply for an extended period over which a new carrier faces high startup costs.

A far better alternative would be to scrap the caps on health plan operating margins altogether, and make it easier for new plans to channel revenue into startup costs and investors to turn profits off these investments. The law already provides some flexibility toward these ends. It states that the HHS Secretary can adjust the individual market cap if “the Secretary determines that the application of the 80% may destabilize the individual market in such State.” So long as consumers have transparency (and reliable metrics) on the value of the benefits that different plans offer, the exchanges would benefit from giving new health plans far more flexibility on how they allocate their capital.

. . .

When open enrollment in Obamacare starts next month, enrollees in four states will be able to choose plans from only one insurer.

Alaska, Alabama, Wyoming and Oklahoma have confirmed to the Washington Examiner that they will have only one insurer offering Obamacare plans for 2017. The revelation comes in the wake of defections from some major insurers that have left Obamacare exchanges due to financial losses.

. . .

The Affordable Care Act’s defenders have spent the past six years dismissing the law’s critics for predicting that it would enter a “death spiral.” But it turns out we were prophets – just look at what’s happening all across Arizona.

The past couple of months have seen the Affordable Care Act’s – Obamacare’s – online exchanges crumble in our state. Three years in, health-insurance companies have discovered that the law’s top-down, one-size-fits-all approach is a bureaucratic and financial disaster. So naturally, they’re abandoning the law in droves.

. . .