After months of health insurer exits from the Affordable Care Act marketplace in Arizona, state regulators have approved plans from two companies that will be the only marketplace insurance providers next year.

Blue Cross Blue Shield of Arizona will sell marketplace plans in every county except Maricopa County in 2017. The Phoenix-based insurer’s average rates will increase 51 percent, Arizona Department of Insurance filings show.

Maricopa County residents only option will be Centene Corp., which said it will sell its “Ambetter” plans. State regulators approved a 74.5 percent increase for Centene/Ambetter plans.

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The 40% “Cadillac” Tax on expensive employer-sponsored health insurance is on a deathwatch because both parties in Congress dislike it. It would be best if Congress were to replace the Cadillac Tax with a simple and clear limitation on the tax preference for employer-paid premiums, as is called for the House GOP’s “Better Way” health plan. For decades, economists have complained that the open-ended tax break for employer-paid health insurance premiums is a major distortion in the marketplace. This approach is fair and promotes more transparency in the health care marketplace.

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In the last moments of the final presidential debate Wednesday, the candidates used a question about entitlements to restate their positions on Obamacare. Donald Trump again vowed to “repeal and replace” the law and said that he was glad premiums had gone up, presumably to make his point that President Obama’s signature health care reform law was “destroying our country.” Hillary Clinton said repealing Obamacare would make maintaining the solvency of Medicare more difficult.

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State insurance regulators across the country have approved health care premium increases higher than those requested by insurers, despite a national effort to keep rates for policies sold on Affordable Care Act exchanges from skyrocketing, a USA TODAY analysis shows.

In eight states, regulators approved premiums that were a percentage point or more higher than carriers wanted, said Charles Gaba, a health data expert at ACASignups.net who analyzed the rates for USA TODAY. As of Tuesday, those states are Arizona, Pennsylvania, Colorado, Florida, Georgia, Kansas, Minnesota and Utah.

Pennsylvania regulators approved individual plan rate increases Monday of 33%, which is eight points higher than requested. Two insurers — Keystone Health Plan and Geisinger Quality Option — will also no longer offer plans on the ACA exchange for the state.

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When the Affordable Care Act was signed into law in 2010, it promised to extend health insurance to tens of millions of people. And although the law has helped push the U.S. uninsured rate down to a record low, the ACA’s new insurance markets are proving to be volatile, with insurers recording big losses and pulling out. Meanwhile, there are still millions of people without health insurance.

One key to stabilizing the law is drawing in more of those who are uninsured, particularly the younger, healthier ones. In fact, young people are the most likely to go uninsured, according to a detailed analysis by the Kaiser Family Foundation. The analysis shows that those who lack insurance cut across age and income and vary from state to state. Taking a look at who these people are can give clues to how the health law is falling short, and what can be done to fix it.

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Finalized rates for big health insurance plans around the country show the magnitude of the challenge facing the Obama administration as it seeks to stabilize the insurance market under the Affordable Care Act in its remaining weeks in office.

Market leaders that are continuing to sell coverage through HealthCare.gov or a state equivalent have been granted average premium increases of 30% or more in Alabama, Delaware, Hawaii, Kansas, Mississippi and Texas, according to information published by state regulators and on a federal site designed to highlight rate increases of 10% or more.

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WikiLeaks published a memo dated November 23, 2015 about serious problems with the Affordable Care Act from Chris Jennings, the former Deputy Assistant to President Obama for Health Policy, to presidential candidate Hillary Clinton and John Podesta, the chairman of her campaign. Team Clinton’s private assessment of the problems bedeviling the ACA—that enrollment has fallen short of expectations, that the participant pool is much sicker than expected, and that the ACA’s risk corridor program lacks sufficient funds and authority to bail out participating insurers—markedly resembles that of skeptical outside analysts.

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Longtime ObamaCare lobbyists are soundly rejecting one of Hillary Clinton’s most prominent healthcare pitches: the public option.

Leaders of the nation’s largest hospital, pharmaceutical and insurer trade groups said on Tuesday they wouldn’t support a Clinton administration’s push for a public option without first ensuring the Obamacare marketplaces work.

“We think we need to make these [marketplaces] viable before we give any consideration of going to a public option,” Rick Pollack, president of the American Hospital Association, told a crowd at the U.S. Chamber of Commerce.

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Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients.

The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans — including Blue Shield of California — that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

The Obama administration is considering changes to how these dollars are allocated in the state and federal exchanges, but critics say the proposed modifications don’t go far enough.

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The debate over what’s wrong with Obamacare matters beyond this political cycle; what happens to the health care system in the next administration will be driven by what Americans think needs fixing. And while the headlines and stump speeches have focused on the struggles of the exchanges, the Affordable Care Act is quietly reshaping the entire system. It’s reining in the spiraling growth of health care costs, cutting by half the ranks of the uninsured, and providing a host of new protections and perks to the insured.

The political debate has been primarily detached from that transformation.

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