Nearly a third of U.S. counties look likely to have just a single insurer offering health plans on the Affordable Care Act’s exchanges next year, an industry retreat that adds to the manifold challenges facing the law. A new study, by the nonpartisan Kaiser Family Foundation, suggests there could be just one option for coverage in 31% of counties in 2017, and there might be only two in another 31%. Companies including UnitedHealth, Humana and Aetna have cited their losses in withdrawing from ACA marketplaces, as have smaller insurers. Those that remain are in some cases seeking sharp premium increases for next year, a demand made much easier when there is no competition. And at least one county is at risk of having no insurers offering marketplace plans next year, a problem especially for lower-income Americans who are generally required to buy ACA plans to qualify for federal subsidies.Left unsaid in that paragraph: this is exactly what the conservative and libertarian opponents of the ACA predicted during the debate preceding its passage. In other words, not only was this predictable – it was actually predicted (and by more than a few people).
What happens as the ACA (aka ObamaCare) spirals down into complete meltdown is far less predictable than the death spiral itself. Personally, I suspect the most likely outcome is massive taxpayer subsidies. I fully expect to collect zero dollars of the Social Security I paid at max rate for over 30 years, and I am expecting my savings and investments to be taxed (or at least concerted attempts made to do so). I can't imagine where else the federal government would find the money they need, short of a politically unpopular VAT or something of that sort. Other outcomes are of course possible, and some of them I'd be very happy with. For instance, a repeal of ObamaCare and a return to a conventional insurance market would suit me just fine – I'd be signing up for an old-fashioned major medical policy in a flash!
Meanwhile, we're facing a more traditional insurance issue, albeit one greatly exacerbated by ObamaCare's mandates and homogenization. Our insurance company has denied coverage for a drug that Debbie's doctor wants to prescribe. It's an expensive drug, and her doctor warned us to expect the denial. They're now appealing the decision, and we await the outcome. If they continue to deny coverage, we'll foot the bill ourselves – luckily, we have the wherewithal to do so. But this drug costs more each month than most people pay for their mortgage – so there must be quite a few people being denied coverage who cannot possibly afford to buy the drug themselves. This is what happens when the insurance companies have incentives to not offer premium policies. Despite paying a premium price for our insurance policy, we're getting a crappy one – but because we can afford to do so, we'll end up with better healthcare anyway.
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