Next year, they’re likely to be even bigger, according to Marilyn Tavenner, the former chief of the Centers for Medicare and Medicaid Services under President Barack Obama and current head of the insurers’ main trade group — America’s Health Insurance Plans.

There are less costly ways to make sure that all Americans have access to coverage — and that they can afford it. They’re called “high-risk pools” and they can protect those with pre-existing conditions without jacking up premiums for everyone else.

Obamacare was supposed to ensure affordable health coverage through two related provisions — “guaranteed issue” and “community rating.” The first forbids insurers from denying anyone a policy, and the second prevents them from charging anyone any more than three times what they charge anyone else.

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