�鶹Ů��

UnitedHealth Group, the country's largest health insurer, says it might stop selling plans on state insurance exchanges, citing higher-than-expected costs. This news would be mostly unremarkable except for the fact that those state exchanges are part of Obamacare, and it doesn't take much to get people hyperventilating about the imminent death of Obamacare and speculating about its ramifications for the 2016 presidential campaign. Sorry to disappoint, but UnitedHealth's decision -- which is tentative -- doesn't mean much. The company covers less than 6 percent of the exchange population; if it does pull out, those people will be able to get other coverage. (11/19)

Will the company really quit the individual insurance market? Most experts I spoke with said this would be unlikely. "They're probably just sending a message," said Timothy McBride, a healthcare economist at Washington University in St. Louis. "They may be saying that to stay, they want to see higher premiums." If so, people buying insurance on Obamacare exchanges can look forward to paying more for coverage and being able to afford only policies with huge deductibles. That would be good for insurers and bad for patients, and it would represent yet another roadblock to creating a system that guarantees everyone access to affordable medical care. (David Lazarus, 11/19)

Stephen Helmsley, the CEO of UnitedHealth, expressed concerns that the exchanges were seeing adverse selection anyway. Not just that the Obamacare insurance pool is sicker and more expensive than expected, which we already knew. But that the pool is experiencing adverse selection over the course of the year, as healthy people stop paying their premiums, and sicker people buy in. ... This is potentially extremely bad news for Obamacare. It may be that UnitedHealth simply had an especially bad experience, but with more than 500,000 people covered, that doesn’t seem actuarially likely. Which raises the worrying possibility that only two years in, people have figured out how to game the special enrollment process so that it’s safe for them to go without insurance, and then sign up for coverage if they get sick. (Megan McArdle, 11/19)

The Affordable Care Act has already accomplished a great deal -- slashing the uninsured rate and providing millions with consumer protections like the guarantee of coverage regardless of preexisting conditions. But enrollment could stagnate. So what would happen then? It's impossible to be certain, but many experts think the subsidies would function as a built-in safeguard against a severe market collapse -- “the news about United does not presage a death spiral,” [Jon] Kingsdale said .... But the law’s architects and supporters had hoped enrollment would continue growing beyond where it is today .... If enrollment stalls, the law would still be helping millions of Americans, but it would also be coming up short of expectations. (Jonathan Cohn and Jeffrey Young, 11/20)

United’s move follows data showing that the commercial insurers have largely scaled back their offerings, and taken significant price increases on their Obamacare plans, to offset losses that they’ve been taking on the exchanges. ... Meanwhile, it’s the Medicaid managed care companies that are growing the number of plans they market on the exchanges. They are also offering the best prices. The cheap health plans that they end up selling on the exchanges mirror what they offer in Medicaid – in terms of the skinny doctor networks, the closed drug formularies, as well as the basic design of the austere health coverage. In short order, Obamacare is evolving into a Medicaid marketplace. (Scott Gottlieb, 11/19)