Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

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Many variables remain up in the air as we contemplate what Obamacare would look like without functioning exchanges, but the failure of the exchanges in some states might provide an opportunity to amend and improve upon the ACA, and move the American health care system towards a freer market system where individuals are free to enroll in any health insurance plan that is for sale, and where insurers have the freedom to sell the plans that are the most appealing to potential buyers. Treating markets where the ACA has failed as opportunities rather than crises might be the first step in achieving sustainable health care reform.

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South Carolina became the fifth state to have only one company offering health insurance through its Affordable Care Act exchange.

The South Carolina Department of Insurance announced on Tuesday that Blue Cross Blue Shield of South Carolina will be the sole provider for South Carolinians looking to get covered through the ACA, better known as Obamacare, according to The Post and Courier.

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The Affordable Care Act hasn’t done much to change trends of low-income people seeing changes in their health insurance coverage, a new study finds.

About a quarter of low-income adults in three states have experienced a change in their health insurance coverage, known as “churning” under the Affordable Care Act, according to a study released today by the Harvard T.H. Chan School of Public Health in the journal Health Affairs. Maintaining insurance coverage over time can remain difficult under the law, the researchers found.

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The 18- to 34-year-olds who helped elect Barack Obama could consign his signature domestic policy achievement to failure.

That’s because not enough millennials have signed up for Obamacare to make it work well. Despite repeated outreach — including entreaties from all manner of celebrities, including NBA stars and Obama himself — young people make up less than 30 percent of Obamacare customers. he White House had set a goal of 40 percent in that age bracket to sustain a healthy marketplace because millennials tend to be healthier and, therefore, balance the costs of sicker, older customers.

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Former President Bill Clinton attacked President Barack Obama’s signature health care legislation Monday, calling it a “crazy system” that “doesn’t make any sense” during a Michigan campaign event for Hillary.

“It doesn’t make any sense. The insurance model doesn’t work here,” Clinton said about the government-run marketplaces Obamacare set up. Clinton said that Obamacare “works fine” for people with “modest” incomes or who are eligible for government subsidies, or Medicare. But he added that, “the people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies.”

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Federal auditors ruled on Thursday that the Obama administration had violated the law by paying health insurance companies more than allowed under the Affordable Care Act in an effort to hold down insurance premiums.

Some of the money was supposed to be deposited in the Treasury, said auditors from the Government Accountability Office.

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If policy makers want to instigate more competition in the ACA, they can start by broadening “credibility adjustments” to make it easier for new plans to get started. The exemptions should cover all new carriers that enter the exchanges. They should be deeper and apply for an extended period over which a new carrier faces high startup costs.

A far better alternative would be to scrap the caps on health plan operating margins altogether, and make it easier for new plans to channel revenue into startup costs and investors to turn profits off these investments. The law already provides some flexibility toward these ends. It states that the HHS Secretary can adjust the individual market cap if “the Secretary determines that the application of the 80% may destabilize the individual market in such State.” So long as consumers have transparency (and reliable metrics) on the value of the benefits that different plans offer, the exchanges would benefit from giving new health plans far more flexibility on how they allocate their capital.

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A majority of American adults oppose a potential “bailout” of the insurance industry, according to a poll released today by Freedom Partners.

Of those surveyed, 55 percent of adults said they were opposed to the administration using taxpayer money to direct funds to insurance companies reporting losses on the Affordable Care Act markets.

President Obama says his signature domestic policy, the Affordable Care Act, needs some fixes.

“In my mind the [Affordable Care Act] has been a huge success, but it’s got real problems,” Obama said in an interview with New York Magazine published Sunday.

The Affordable Care Act, or Obamacare, created a new marketplace, known as the exchanges, which many insurers have struggled to adapt to. Several insurers have said they won’t offer marketplace plans next year, and the retreat of major insurers including UnitedHealth, Aetna and Humana in recent months have highlighted some of the shortfalls of the law.

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