Health care and the politics of disruption.

Author:Suderman, Peter

AT THE BEGINNING of May, the insurance giant Aetna announced that it would cease selling health coverage in Obamacare's insurance exchanges entirely.

The individual market created by the law relies on the participation of both individuals and insurers. But Aetna is arguing that the system is fundamentally flawed. The company said it was projecting losses of about $200 million this year, "the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration."

The insurer's exit provided yet another reminder of the instability that exists within the system created under Obamacare, which is built around a series of exchanges run by states and the federal government. Most of the non-profit insurers --called co-ops under the law--have failed, and many of the nation's major insurance companies have scaled back participation in the exchanges. In states such as Maryland, Virginia, and Connecticut, insurers put in requests for double-digit rate hikes for the coming year.

In parts of the country, there's only one company selling health plans through the exchanges. Next year, some states or counties may be left with zero participating insurers: Shortly afterAetna's exit, Medica, currently the only insurance company to sell Obamacare plans in Iowa, said that it might not stay in the market. Later that month, Blue Cross and Blue Shield of Kansas City said it would pull out of the Missouri exchange, which will leave 25 counties without any participating insurer unless another company decides...

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