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Significant spikes in premiums, insurer dropouts and persistently low enrollment numbers are combining to make this fall’s sign-up period a crossroads for the Obama administration’s signature health law. Federal officials characterize the turbulence as temporary. At the same time, the administration is making a push in its final months to shore up the law by trying to sign up healthy people who are critical to the law’s sustainability but have so far rejected insurance. That push will take place against a backdrop of elections that will shape the law’s future. (Radnofsky and Armour, 9/7)

Blue Cross Blue Shield of Arizona will offer plans on the Affordable Care Act exchange in Arizona’s Pinal County next year, resolving a situation that drew a national spotlight because it represented a major challenge to the mechanics of the health law. When Aetna Inc. announced last month that it would withdraw from the exchange in Arizona, among other states, it left Pinal at risk of becoming the first U.S. county without a single insurer selling exchange plans. Aetna had been expected to sell exchange plans in Pinal County, where approximately 10,000 people had signed up for ACA plans. (Wilde Mathews, 9/8)

Nearly 10,000 Pinal County residents now enrolled in an "Obamacare" plan will have at least one option in 2017 after Blue Cross Blue Shield of Arizona officials confirmed the insurer will offer health plans there next year. Pinal County faced the prospect of no Affordable Care Act plans in 2017 when Aetna last month said it would exit the marketplace in Arizona and 10 other states. The fast-growing county became the only known U.S. county without a marketplace option — as well as a national symbol of the Affordable Care Act's struggle to retain health-care insurers for the upcoming year. (Alltucker, 9/7)

Arizona’s Pinal County will have an insurer offering ObamaCare coverage after all, as Blue Cross Blue Shield of Arizona announced Wednesday that it will step in to offer insurance there next year. The move averts what would have been an unprecedented situation for a county in the United States: having no insurer offering ObamaCare coverage, depriving people there the ability to sign up. (Sullivan, 9/7)

An Obamacare provision designed to inject a protective extra layer of competition into fledgling insurance markets fell into near-oblivion — and its failure has made Obamacare’s mounting challenges even more acute. Under the unwieldy name of the Multi-State Plan Program, the federal government was supposed to contract with two private health plans, at least one a nonprofit. Each is required to offer coverage in all 50 states by next year. But it’s fallen short, reaching fewer states than anticipated, and offering plans that mirror options people already have. (Pradhan and Demko, 9/7)

A group of Republican senators on Wednesday introduced a bill to exempt people from ObamaCare’s individual mandate if they live in a county with one or no options for coverage. The lawmakers, led by Sen. John McCain (R-Ariz.), argue that it is wrong for people to face ObamaCare’s financial penalty for lacking insurance if there is only one insurer offering coverage in their area, or none at all. (Sullivan, 9/7)

President Obama and his Democratic allies are seizing on the exodus of private insurers from ObamaCare markets to renew their push for a so-called "public option" -- but Republicans say more "government intervention" is not the answer to the latest Affordable Care Act woes. (Chakraborthy, 9/7)

The prospect of massive premium hikes in Minnesota's individual market has policymakers scrambling for solutions, but there's no agreement on a simple fix. Enrollment in individual health insurance policies, particularly through government-run exchanges like Minnesota's MNsure, has fallen far short of expectations. (Snowbeck, 9/7)