A potential shakeup in Arizona’s Affordable Care Act marketplaces is resurrecting President Barack Obama’s 2010 health-care law as a political issue in this year’s U.S. Senate race.

The developments mean customers will have fewer subsidized plans to pick from next year, and in some rural counties, they could have no options at all. UnitedHealthcare, the national insurance giant, on Tuesday signaled that it intends to abandon Arizona’s Affordable Care Act marketplace in 2017. Blue Cross Blue Shield of Arizona, the only other insurer to offer plans in all of Arizona’s 15 counties, also is considering pulling out of some areas.

Arizona voters could face a stark choice on the issue in November.

. . .

UnitedHealth is withdrawing from most of the 34 ObamaCare Exchanges in which it currently sells, citing losses of $650 million in 2016. A recent Kaiser Family Foundation report indicates UnitedHealth’s departure will leave consumers on Oklahoma’s Exchange with only one choice of insurance carriers.

Michael Cannon of the Cato Institute explains five results of UnitedHealth’s withdrawal from the exchanges:

1. UnitedHealth’s departure shows ObamaCare is suffering from self-induced adverse selection.

2. UnitedHealth’s departure is bad news for other carriers.

3. UnitedHealth’s departure shows ObamaCare premiums will continue to rise.

4. There will be more exits.

5. UnitedHealth’s departure shows quality of coverage under ObamaCare will continue to fall.

. . .

 

Donald Trump’s healthcare plan is a “whipsaw of ideas” and an “incoherent mishmash that could jeopardize coverage for millions of newly insured people,” according to conservative health policy experts. Mr. Trump’s health care platform “resembles the efforts of a foreign student trying to learn health policy as a second language,” according to AEI’s Tom Miller. AEI’s Jim Capretta adds that replacing the ACA would require a “herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.” Trump must “discard some of his ideas, like the importation of prescription drugs, because they would be damaging and unworkable,” according to Grace-Marie Turner. “And he has to flesh out his other proposals with much more detail if he hopes to persuade voters that he has a credible plan to replace Obamacare.” Robert Laszewski, a former insurance executive, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”

Obamacare created a system that actually made insurance more expensive, decreasing access to the poor and sick, while pricing out average Americans from affordable health care coverage. Millions more have been added to Medicaid, millions have seen double or triple their annual premiums and millions have opted not to be insured at all.

In the March 8 rule, the Department of Health and Human Services (HHS) stated that Health Savings Account (HSA) eligibility was not a meaningful distinction for health plans because consumers can determine whether a plan is HSA-qualified by examining a plan’s cost-sharing amounts. Therefore, it will not require HSA-qualified plans to be designated as such.

Two main reasons why HSA-qualified plans will not survive is because plans must cover services below the deductible that are not considered “preventative care.” And the plans must apply specific deductibles and out-of-pocket limits that are outside the requirements for HSA-qualified plans.

Most of the remaining non-elderly uninsured people in the U.S. likely won’t gain coverage, a new study released this week suggests.

The study, from the Urban Institute says that while some higher-income people who are uninsured will surely gain coverage as the penalties for not having insurance increase, the possibility for increased coverage is actually lower among those who have higher incomes than those who are eligible for financial assistance to cover insurance.

The Obama administration is trying once again to address a criticism that has dogged the president ever since his health care bill passed six years ago: they need to sell it better.

On Tuesday, the US Department of Health and Human Services is rolling out a new promotional video, which was provided to STAT first, to explain the changes the administration is making to the health care delivery system through the law.

It’s a three-minute, rapid-fire, visually driven attempt to make terms like “care coordination” and “electronic health records” something that an average person who is getting his or her knee operated on can actually understand.

Enrollment in exchange coverage increased from 6.3 million at the end of 2014 to about 8.8 million, according to figures released by the administration at the end of last week.

But Obamacare’s coverage gains have also been more modest than expected, particularly when it comes to the exchanges. And part of the problem seems to be that people who sign up for coverage at the beginning of the year don’t always follow through to keep their coverage effective at the end of the year. It’s a problem that seems to be larger than the administration knew.

Along with releasing end-of-the-year 2015 enrollment data for the Affordable Care Act exchanges last Friday afternoon, the Department of Health and Human Services also released data for the 2016 open enrollment period. Just like the end-of-the year 2015 enrollment data, which I discussed on Monday, a close look at the 2016 open enrollment data reveals that the ACA is significantly underperforming initial expectations.

The big story is how little has changed from 2015 to 2016. The number of 2016 exchange enrollees is up only slightly from last year, and the make-up of the risk pool—as proxied by income and age of enrollees—is virtually identical.

The co-ops represent a modest component of the sweeping 2010 health law that put new coverage requirements on insurers and required most Americans to have health insurance or pay a penalty. The co-ops were included to foster nonprofit health insurance providers to compete in the individual and small group markets.

The report will be released in advance of a Senate Finance Committee hearing on Thursday. It is likely to spur more questions about prospects of the Obama administration’s $2.4 billion co-op program.

Thousands of doctors, hospitals and providers in some states still haven’t been paid for health services given to members insured by the co-ops. More than half a million people signed up for health insurance under the ACA lost coverage or had to get new insurance because their co–op had folded.