Progress in reducing the number of people without health insurance in the U.S. appears to be losing momentum this year even as rising premiums and dwindling choice are reviving the political blame game over President Barack Obama’s health care law.

The future of the Affordable Care Act hinges on the outcome of the presidential election, and it’s shaping up as a moment of truth for Republicans.

. . .

Enrollment in the insurance exchanges for President Obama’s signature health-care law is at less than half the initial forecast, pushing several major insurance companies to stop offering health plans in certain markets because of significant financial losses.

As a result, the administration’s promise of a menu of health-plan choices has been replaced by a grim, though preliminary, forecast: Next year, more than 1 in 4 counties are at risk of having a single insurer on its exchange, said Cynthia Cox, who studies health reform for the Kaiser Family Foundation.

. . .

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.

. . .

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.

. . .

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.

. . .

Last November, when UnitedHealth Group said it expected to post big losses on its Obamacare policies in 2016, rivals such as Anthem and Aetna signaled their Affordable Care Act businesses were doing fine. The Obama administration used that as evidence to refute claims that systemic problems were brewing in its landmark insurance program.

Now, there’s no denying it. The four biggest U.S. health insurers admit they’re each losing hundreds of millions of dollars on their Obamacare plans. Rather than expand coverage, many are pulling out of the exchanges that were set up by the ACA so people can shop for insurance plans, often with the help of government subsidies.

. . .

Donald Trump and other Republicans Tuesday cast a decision by a major insurer to sharply cut back participation in Affordable Care Act exchanges as evidence that the new system is collapsing and should be replaced.

Democrats continued to defend the law as much better than the old system, but said the news that  Aetna Inc. will withdraw from 11 of the 15 states where it currently offers plans could create an opening for changes proposed by Hillary Clinton, such as her proposal for a government-run option to compete with private insurers.

. . .

The decision by the nation’s third-largest health insurer to pull out of the Affordable Care Act’s exchanges in nearly a dozen states is a double whammy to President Barack Obama’s signature health law, increasing financial strains on the program while dragging the debate over its merits into the presidential campaign.

Republicans opposed to the law immediately pointed to  Aetna Inc.’s decision, which followed similar moves by other major insurers, as evidence that the law isn’t working as intended and sought to rally voters. Donald Trump’s presidential campaign labeled the Aetna move a sign that “this broken law…is slowly imploding under its regulatory red tape.”

. . .

Aetna’s pullback from the Affordable Care Act’s (ACA) Insurance Exchanges is another bad omen in a growing list. Throughout the controversial history of Obamacare, Aetna has been a stalwart continuing to voice confidence in the future of the program.

Until we are willing to have a conversation about how to fundamentally change a failing program Obamacare is just going to continue to deteriorate. That won’t happen until supporters end their denial and Republicans admit they can’t turn back history.

 

. . .

It is all about the price.

Millions of people buying insurance in the marketplaces created by the federal health care law have one feature in mind. It is not finding a favorite doctor, or even a trusted company. It is how much — or, more precisely, how little — they can pay in premiums each month.

And for many of them, especially those who are healthy, all the prices are too high.

. . .