The individual market shrank by 15% between March 2016 and March 2017, including a 25% decline among unsubsidized policyholders.  The individual market is not “sound.”  Because of rising premiums, millions of people who are not receiving subsidies can no longer afford to buy individual policies, and millions more may forfeit their policies in the next round of rate hikes.

Relinquishing at least some regulatory authority to the states might produce more functional markets where insurers can offer consumers the coverage they want at a price they can afford.

. . .

U.S. health insurer Anthem Inc said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

. . .

After 20 of the 24 Obamacare non-profit health insurance cooperatives collapsed, despite the influx of $2.4 billion in taxpayer funds, it shouldn’t surprise anyone that its trade association would also fail.

The National Alliance of State Health Cooperatives (NASCHO), the Obamacare co-op health insurance trade association, has quietly closed its doors, The Daily Caller News Foundation Investigative Group has learned.

NASCHO once represented as many as 24 Obamacare non-profit co-ops that were intended to compete with for-profit commercial health care insurers and perhaps even drive them out of business. The Obama administration underwrote the experiment with $2.4 billion in long-term, low-interest loans.

. . .

Arguably the most significant data point in the entire debate about the Senate health care bill has been the CBO’s claim that in 2026, 22 million fewer people would have health insurance under the Senate bill than under Obamacare.

Democrats have seized on this number to stoke fears about the bill’s impact; moderate Republicans, intimidated by the negative headlines, have been reluctant to support the bill.

But buried within the CBO’s reports is a key fact: the vast majority of those coverage “losses” occur because the GOP bills repeal Obamacare’s individual mandate. In its July 20 estimate of the most recent version of the Senate’s Better Care Reconciliation Act, or BCRA, CBO says that in 2018, 15 million fewer Americans will have health insurance under the bill, two years before its repeal of Obamacare’s insurance subsidies takes effect.

Why? It’s “primarily because the penalty for not having insurance would be eliminated.”

. . .


Minuteman Health of Massachusetts and New Hampshire announced it is withdrawing from the Affordable Care Act exchanges in 2018, leaving only four co-ops in operation. The co-op will stop writing business on January 1 and organize a new company, Minuteman Insurance Company, instead.

The company cited issues with Obamacare’s risk-adjustment program, which is the program that shifts money away from those with healthier customers to those with sicker enrollees. Minuteman Health said that the negative impact of this program had been “substantial.”

. . .

The Congressional Budget Office says 15 million people will lose medical coverage next year if the Senate GOP’s health-care bill becomes law. That’s not quite accurate. CBO doesn’t believe that millions will “lose” their insurance in 2018. Instead, the agency thinks that millions will happily cancel their coverage—even those who get it for free. The reason: The Senate bill would repeal the Obamacare tax penalty on the uninsured, known as the individual mandate. If CBO is to be believed, 15 million people didn’t want health coverage in the first place. They enrolled only to keep the IRS off their backs.

. . .

On Monday the Congressional Budget Office released its cost estimate of the Republican Senate Better Care Reconciliation Act.  CBO calculated that the proposed bill would reduce the deficit by $321 billion over the next decade. That is welcome news.

Less welcome, however, was CBO’s conclusion that the Senate bill would result in an additional 15 million uninsured in 2018 due to a lack of penalties. By 2026, CBO reports 22 million more Americans would be uninsured, primarily due to lower Medicaid coverage.

No matter that the number of Americans on the Obamacare exchanges is shrinking due to higher prices and fewer companies offering coverage.

Dave Hoppe, former chief of staff to House Speaker Paul Ryan, asked me in an email, “If there are few insurance companies offering insurance through the exchanges in 10 years, how are people without insurance losing anything?”

. . .

Health insurance cannot really be insurance because human health is un-insurable: human beings are not machines or buildings whose function or condition can be ascertained objectively. Yet, an objective assessment of damages and costs is essential for any contractual arrangement to function in a sustainable manner.

Consider, for example, that medical care is based on the legal principle of “medical necessity.” Medical necessity is invoked when, presumably, there is an impairment in the patient’s health that could be remedied by a medical intervention. But medical necessity is a perniciously elastic concept that cannot possibly satisfy the precise contractual requirements of insurance.

. . .

The new Senate bill  1) Reduces the number of people eligible for subsidies, reduces the values of the premium subsidies, and lowers the cap on total subsidy expenditure;  2) Eliminates the individual and employer mandates;  3) Restricts coverage for abortion;  3) Ends the cost-sharing reductions — but not before paying insurers back for the money they’ve already laid out;  4) Gives states a great deal more flexibility in the waiver program;  5) Gets rid of a lot of Obamacare taxes;  6) Provides market stabilization funds;  7) Winds down the Medicaid expansion funding, but not as fast as the House bill; and  8) Converts Medicaid to a per-capita allotment rather than an open-ended entitlement.

To estimate the impact of the AHCA, the CBO had to compare it to predictions of coverage under the current law, the ACA. If the prediction for the current law is incorrect the prediction of lost coverage will be too.Yet the CBO has consistently overestimated future ACA coverage gains. In 2012 it predicted an additional 28 million would gain health insurance by 2017. The actual figure is 20 million. It forecast 25 million would gain coverage on the ACA exchanges and 10 million would gain Medicaid coverage. Less than half as many actually enrolled on the exchanges and not all of them gained coverage – many were replacing non-exchange policies they lost after ACA passage. Conversely, about 14 million – 40 percent higher than predicted – newly enrolled in Medicaid. The CBO prediction that 5 million would lose employer coverage was also wrong – employer provided coverage was stable.

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