And even with the mandate in place, some people appear to be gaming the system. A top actuary for insurer Highmark told the Times that in Pennsylvania, roughly 250 of its beneficiaries on had already incurred more than $100,000 in expenses this year. "People use insurance benefits and then discontinue paying for coverage once their individual health care needs have been temporarily met," he said, driving up the cost of coverage for everyone. Last year, UnitedHealth also indicated that individuals buying coverage and dropping it was driving losses.
As all this is happening, of course, insurers are bailing on the system, unable to make the numbers add up.
It's not an exact replica of the Washington state experience, but there are certainly similarities. The underlying point of all of this is that if the law's exchanges remain on their current wobbly trajectory, its dysfunction is nearly certain to grow. And the rough negotiations between Aetna and the administration may make insurers who are already losing money even more wary of further participation in the system.
That means that the prospect of significant further reforms may soon be on the table—which will likely include everything from poorly conceived state-based single-payer plans to poorly conceived federal health insurance systemsto, ah, poorly conceived conservative reforms. If anything, reforming health reform will be even more difficult than the initial project.
https://reason.com/blog/2016/08/17/the-return-of-the-obamacare-death-spiral
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