In the wake of Aetna’s recent announcement that it was pulling up stakes in 11 of 15 states where it had been selling insurance on Obamacare exchanges, there are more alarming signs that other major insurers are struggling to remain in the game.

On Tuesday, three of the major players in Tennessee — Cigna Health Insurance, Humana and Blue Cross Blue Shield — were granted huge double-digit premium increases for the 2017 season beginning in January amid a warning from the state’s insurance commissioner that the Obamacare markets were “very near collapse.”

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The tanning salon industry is feeling burned by “Obamacare.”

Business owners around the country say the little-noticed 10 percent tax on tanning in President Barack Obama’s health care overhaul has crippled the industry, forcing the closing of nearly 10,000 of the more than 18,000 tanning salons in the U.S.

Experts say the industry is overstating the effects of the “tan tax” and that it has been hurt by other factors, too, including public health warnings about the dangers of tanning and the passage of laws in dozens of states restricting the use of tanning salons by minors.

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Since I last wrote about it, Aetna’s withdrawal from the Obamacare exchanges has ginned up even more drama.

Jeff Young and Jonathan Cohn of the Huffington Post published a letter in which Aetna told the Justice Department that it would reduce its exchange participation unless Justice allowed the merger with Humana to go through. This has naturally triggered a firestorm of accusations about “extortion” and renewed calls for a public option that can protect people against the threat of insurance-less insurance exchanges.

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Election Day 2016 will raise the curtain on the final act in the nation’s long-running political drama over President Barack Obama’s health care overhaul.

If Republican Donald Trump wins, the unraveling begins.

“We have an obligation to the people who voted for us to proceed with ‘repeal and replace,'” said Sen. John Barrasso, a Wyoming Republican.

If Democrat Hillary Clinton goes to the White House, it gets very difficult for Republicans to keep a straight face about repealing “Obamacare.”

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As insurers push large premium increases for 2017 Obamacare plans, some of the steepest hikes have been requested by insurers in crucial swing states that could determine control of the Senate.

In nine of 11 states with competitive Senate races, at least one insurer seeks to hike rates for Obamacare customers by at least 30 percent next year: Highmark Blue Cross Blue Shield in Pennsylvania wants to jack up average premiums by more than 40 percent. In Wisconsin, three insurers have asked for rate hikes of more than 30 percent. In New Hampshire, two of the five carriers want to sell plans with rate increase above 30 percent.

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As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions (under rules referred to as guaranteed issue and modified community rating, respectively). These aspects of the Affordable Care Act (ACA) – along with tax credits for low and middle income people buying insurance on their own in new health insurance marketplaces – make it easier for people with preexisting conditions to gain insurance coverage. However, if not accompanied by other regulatory measures, these provisions could have unintended consequences for the insurance market. Namely, insurers may try to compete by avoiding sicker enrollees rather than by providing the best value to consumers. In addition, in the early years of market reform insurers faced uncertainty as to how to price coverage as new people (including those previously considered “uninsurable”) gained coverage, potentially leading to premium volatility. This brief explains three provisions of the ACA – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.

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The Affordable Care Act enrollment period doesn’t begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums.

But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services.

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State insurance officials say they are feeling pressure to approve large ObamaCare premium increases to prevent more insurers losing money from dropping out of the market altogether.

Tennessee’s insurance commissioner, Julie Mix McPeak, this week announced the approval of premium hikes of 62 percent, 46 percent and 44 percent, respectively, for the three insurers on the state’s marketplace.

She said her department’s actuaries had found the rate increases to be justified.

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Three years ago, health economists believed Obamacare’s soon-to-launch marketplaces would grow to replace much of America’s fractured, complex employer-based health insurance system.

Predictions for the employer-sponsored insurance system’s collapse ran rampant. The question around companies shifting workers to the new public marketplaces was often framed not as if but when. University of Pennsylvania’s Zeke Emanuel pegged it at 2025. MIT’s Jonathan Gruber estimated 2050.

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Recently, Avalere worked with the Council for Affordable Health Coverage to examine enrollment trends for the Affordable Care Act (ACA).

Avalere projects that 10.1 million individuals will be enrolled in an exchange plan by the end of 2016. To date, exchange enrollment has not reached original projection numbers. In March 2010, the Congressional Budget Office predicted enrollment figures for 2016 to be at 21 million. Their projections have decreased since then- in January 2016 it was 13 million and in March 2016, it was 12 million. The Obama administration projects 10 million in enrollment for 2016.

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