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Obamacare keeps refusing to implode

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In his Twitter feed, President Donald Trump often paints the Affordable Care Act as on the verge of collapse and implosion. The actual landscape looks significantly different — it's a mostly functional marketplace with a few trouble spots.

Those trouble spots are increasingly few and far between.

One of them shrank today with news from Ohio, where insurance regulators announced they had found plans to cover 19 of the 20 counties that had zero insurers signed up to sell 2018 Obamacare coverage.

Meanwhile, in Minnesota, premiums may actually decline in 2018 if the federal government approves a proposal to create a fund to offset the costs of especially sick enrollees. (The Trump administration recently approved a similar plan in Alaska.)

Obamacare keeps refusing to implode.

Ohio is a particularly instructive example of how the health law can avoid failure if states want it to. When Anthem pulled out of the marketplaces nationwide, it left tens of thousands of Ohioans with zero plans signed up to sell 2018 coverage.

So the insurance department got to work recruiting health insurance plans already selling in other parts of the state to take on a few more counties. It wasn't a terrible pitch, either. Seventy-five percent of Ohioans purchasing coverage on the individual marketplace do so with subsidies from the government, which limit how much the individual is expected to pay out-of-pocket. This meant that insurers could raise premiums significantly, if they felt it was necessary, while still retaining a good chunk of their membership.

Ohio recruited at least one plan to sell in 19 of its 20 empty counties (and, in the case of Hancock County, got two insurers to sign up). There is now one county, Paulding, in the Western part of this state, that is home to 380 Affordable Care Act enrollees and has zero health plans. The insurance department says it's continuing to work on the issue.

In Minnesota, the state announced that it expects premiums to decline or rise slightly in 2018 if the Trump administration allows the state to redirect some federal funds to offsetting the costs of especially sick patients.

Minnesota has proposed what is called a reinsurance program, which essentially funnels money to the health plans that end up with the most expensive patients. If insurance plans know that they won't get stuck with those bills, they tend to price their plans significantly lower.

Minnesota is following in the footsteps of Alaska, which had its reinsurance plan approved by Health and Human Services last month. Alaska will get $48 million in federal funds to help insurers with really high medical bills. It expects, however, that the program won't cost the federal government a dime. Instead, the Trump administration will recoup all that money in the form of less spending on Obamacare subsidies because premiums in the market would decline.

Minnesota has essentially asked for a similar arrangement, although we're waiting to see whether that application will be approved.

The lesson of Minnesota and Ohio is similar: Obamacare can work when the people running it want it to work. The two states saw problems with their marketplaces that you see in a lot of the country right now: a lack of competition and rising premiums.

Their insurance departments did not throw up their hands and declare Obamacare a failure. They took concrete, specific steps to address those problems and make Obamacare work better. Today, we're seeing the result.

Map of the Day

Here's what the Obamacare map looks like right now. The news from Ohio today means that there are now 19 counties with zero plans signed up to sell 2018 coverage. Fourteen are in Nevada, four in Indiana, and one in Ohio. Altogether, they are home to approximately 15,000 Obamacare enrollees — about 0.1 percent of all those who rely on the marketplaces for coverage.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “Republicans try to move forward”: “There may still be more moves to come on the personnel front, but on the agenda front -- despite Senate Majority Leader Mitch McConnell declaring in the early hours of Friday morning that it is "time to move on" after the failed vote on health care -- the President hardly sounds ready for a reset.” —Eric Bradner, CNN
  • “Centrist lawmakers plot bipartisan health care stabilization bill”: “A coalition of roughly 40 House Republicans and Democrats plan to unveil a slate of Obamacare fixes Monday they hope will gain traction after the Senate’s effort to repeal the law imploded.” —Heather Caygle and Paul Demko, Politico
  • “Bernie Sanders To Propose New Rule Requiring Fair Prices For Taxpayer-Funded Drugs”: “Sen. Bernie Sanders (I-Vt.) plans to propose a new rule Monday that would require pharmaceutical companies to charge fair prices for drugs developed with taxpayer-backed research.” —Alexander C. Kaufman, Huffington Post

Analysis and longer reads

  • “It’s not impossible: Four ways Republicans could still take action on Obamacare”: “There are a few ways Congress could restart its efforts to repeal the ACA, or Obamacare, but most would exact a serious cost on Republicans' agenda, their popularity and the health insurance markets.” —Amber Phillips, Washington Post
  • “Why the ACA markets could actually collapse — with Trump's help”:“Now that the Republican push to partially repeal the Affordable Care Act has fallen apart, industry groups desperately hope Congress can move quickly to patch the problems in the ACA marketplaces. The highest priority, by far, is funding the law's cost-sharing subsidies — the payments to insurers that help reduce deductibles and other out-of-pocket costs for low-income people.” —Bob Herman, Axios
  • “Outside Of Washington, There Is A New Vital Center In Health Care Reform”: “Republican public officials continue to spotlight what they perceive as the disappointment of Americans with ACA coverage, but the reality is that the most dissatisfied are those who lack government insurance. In fact, most Americans (including Republicans) who benefit from government insurance are content with their coverage.” —Lawrence R. Jacobs and Suzanne Mettler, Health Affairs

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