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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Aetna’s retreat from most ObamaCare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona.

The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year.

State regulators still have until Aug. 23 to try to lure other companies into the marketplace, but it could be a tough sell after one of the nation’s largest insurers decided to pull back because of costs.

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Late Monday evening, health insurer Aetna confirmed a major pullback from Obamacare’s exchanges for 2017. The carrier, which this spring said it was looking to increase its Obamacare involvement, instead decided to participate in only four state marketplaces next year, down from 15 in 2016. Aetna will offer plans in a total of 242 counties next year — less than one-third its current 778. Coupled with earlier decisions by major insurers Humana and UnitedHealthGroup to reduce their exchange involvement, Aetna’s move has major political and policy implications

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There are a lot of people in the U.S. who dream of single-payer health care. And what a dream it is! Government as the only entity paying for care, able to drive down costs while ensuring universal coverage. There are not a lot such dreamers who think that the transition to such a system is imminent here.

Politically, it may be easier to get a single-payer system on the ballot in a blue state than it is to get it onto the floor of the U.S. Congress. But practically, it’s even harder to implement one that doesn’t bankrupt the government and enrage the citizenry. Such an experiment would certainly have effects on health-care policy for the rest of the nation — presumably a swing away from single payer.

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After last year’s 4% rate increase, California’s Obamacare insurance exchange rates appear to be catching up to the rest of the country.

The two biggest carriers are raising rates by much more than the average 13.2% increase. Blue Shield said its average increase was 19.9% and Anthem said it would increase rates an average of 17.2%

According to the LA Times, Covered California officials blamed the big increase on the “rising costs of medical care, including specialty drugs, and the end of the mechanism that held down rates for the first three years of Obamacare.”

Well, once again when it comes to Covered California’s explanations, not exactly.

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Blue Shield of California is shutting down for the four days after Labor Day to reduce its payroll-related liabilities, citing losses in California’s Covered California Obamacare exchange and other commercial and individual lines of business.

The move will affect most of its 6,000 employees in California, except about 1,000 who work for Care1st, which it acquired last fall for $1.2 billion, and some staffers in customer service and related areas who will remain on the job. The exact number of workers involved hasn’t yet been tabulated, according to the San Francisco-based insurer.

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A government report finds that the cost of expanding Medicaid to millions more low-income people is increasing faster than expected, raising questions about a vital part of President Barack Obama’s health care law.

The law provided for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year.

Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things.

In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated.

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The health insurance exchanges that are the beating heart of Obamacare are on the edge of collapse, with premiums rising sharply for ever narrower provider networks, non-profit health co-ops shuttering their doors, and even the biggest insurance companies heading for the exits amid mounting losses.  Even the liberal Capitol Hill newspaper is warning of a possible “Obamacare meltdown” this fall.

Three states – Alaska, Alabama, and Wyoming – are already down to just a single insurance company, as are large parts of several other states, totaling at least 664 counties.

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In an effort to prevent more insurers from abandoning the Obamacare exchange in Tennessee, the state’s insurance regulator is allowing health insurers refile 2017 rate requests by Aug. 12 after Cigna and Humana said their previously requested premium hikes were too low.

Cigna and Humana filed to increase last year’s premiums an average of 23 and 29 percent, respectively, on June 10. But in the interim, both insurance companies have told state regulators that the requests would not cover the expected claims, said Kevin Walters, spokesman for the Tennessee Department of Commerce and Insurance.

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Moving beyond “Obamacare,” political activists are looking to state ballot questions to refocus the nation’s long-running debate over government’s role in health care.

This fall, California voters will decide whether to lower some prescription drug prices, while Coloradans will vote on a state version of a “single-payer” government-run health system, similar to what Vermont Sen. Bernie Sanders proposed in his unsuccessful bid for the Democratic presidential nomination.

Sanders supports both the California and Colorado initiatives, said spokesman Michael Briggs.

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