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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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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When open enrollment in Obamacare starts next month, enrollees in four states will be able to choose plans from only one insurer.

Alaska, Alabama, Wyoming and Oklahoma have confirmed to the Washington Examiner that they will have only one insurer offering Obamacare plans for 2017. The revelation comes in the wake of defections from some major insurers that have left Obamacare exchanges due to financial losses.

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Vermont has received tentative approval from the Obama administration to establish an all-payer reimbursement system for healthcare providers in the state starting in January.

Maryland long has had an all-payer system, but it covers only hospitals. Vermont plans to use an accountable care organization-type structure that would cover all providers. All-payer systems require all insurers, whether private, Medicare or Medicaid, to pay similar rates for services.

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Minnesota’s commerce commissioner called for reforms to strengthen the federal marketplace Friday after announcing monthly premium increases of at least 50 percent for 2017.

“While federal tax credits will help make monthly premiums more affordable for many Minnesotans, these rising insurance rates are both unsustainable and unfair,” Minnesota Commerce Commissioner Mike Rothman said in a statement. “Middle-class Minnesotans in particular are being crushed by the heavy burden of these costs. There is a clear and urgent need for reform to protect Minnesota consumers who purchase their own health insurance.”

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Proposals to make changes to the Affordable Care Act from both sides of the political aisle show that President Obama’s health care law will almost certainly needs changes to survive.

The president, Hillary Clinton, and nearly one-third of the Senate have endorsed a new government-sponsored health plan, the so-called public option, to give consumers on Obamacare exchanges an additional choice. A significant number of Democrats, for whom Senator Bernie Sanders spoke in the primaries, favor a single-payer arrangement.

Donald Trump and Republicans in Congress, on the other hand, would go in the direction of less government, reducing federal regulation and requirements so insurance would cost less and no-frills options could proliferate. Mr. Trump would, for example, encourage greater use of health savings accounts, allow insurance policies to be purchased across state lines and let people take tax deductions for insurance premium payments.

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