�鶹Ů��

Political uncertainty isn't the only threat to the Affordable Care Act's future. Cracks also are spreading through a major pillar supporting the law Health insurance exchanges created to help millions of people find coverage are turning into money-losing ventures for many insurers. The nation's largest, UnitedHealth Group Inc., could lose as much as $475 million on its exchange business this year and may not participate in 2017. Another major insurer, Aetna, has questioned the viability of the exchanges. And a dozen nonprofit insurance cooperatives created by the law have already closed, forcing around 750,000 people to find new plans. (Murphy, 2/26)

The head of Aetna Inc., the nation’s third-largest health insurer, said he supports insurance exchanges, even though he questioned their sustainability earlier this month and lost money in the marketplaces last year. Aetna Chief Executive Mark Bertolini said U.S. Health and Human Services Secretary Sylvia Burwell called him Feb. 1 shortly after he made critical remarks during an earnings conference call. Before then, Aetna had struck a more upbeat tone compared to some rival insurers. (Terhune, 2/29)

An H.M.O. by any other name is still an H.M.O. Once emblematic of everything wrong with health insurance, the health maintenance organization is making a grudging, if somewhat successful, comeback. ... Insurers are already promoting H.M.O.s on the state exchanges created under the federal health law, and many are trying to persuade more companies and their employees to sign up. ... In October, Blue Cross and Blue Shield of Illinois teamed with the state’s largest health system, Advocate Health Care, to offer a new H.M.O, BlueCare Direct, to individuals and small businesses buying coverage on the state exchange. ... But a close look at Blue Cross of Illinois’s experience shows just how complicated a comeback will be. (Abelson, 2/28)

Experts say the California exchange uses more of its powers as an “active purchaser” than the vast majority of other states. That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price. The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design. (Bartolone, 2/29)