The ACA Is Like A Game Of Jenga

I love to play Jenga! There’s something about seeing your opponent carefully strategize which game piece they will carefully slide out of the tower - and then watch them end up collapsing the whole thing and scattering blocks all over the tabletop.

The more we report on the Affordable Care Act and its effect on the marketplace, the more I think the whole thing is like a giant game of Jenga – an unstable tower of blocks ready to topple over.

The latest block to be picked out of the tower is Aetna, which announced it is pulling out of exchanges in 11 out of the 15 states in which it sold ACA plans. Aetna claimed it lost about $400 million on the exchanges since 2014.

Aetna’s announcement followed similar news from UnitedHealth Group in April. UnitedHealth said it would leave all but a handful of exchanges. Adding to the blocks sliding out of the tower was news that Anthem and Humana would lose about $300 million each on their exchange policies, and Humana would leave eight of the 19 states in which it sold coverage on the exchanges.

As we approach the fourth open enrollment period under the ACA, the news is that consumers in most areas of the country will face higher premium prices and fewer choices of carriers. The Kaiser Family Foundation reported last week that as many as one-quarter of the counties in the U.S. will have only one carrier selling coverage on the exchanges.

The November election could either prop up the ACA or knock it over completely. Donald Trump said he wants to get rid of the ACA but he hasn’t been specific about what would replace it. Hillary Clinton favors allowing people 55 and older to buy into Medicare. President Barack Obama has revived the idea of a public option.

Thanks to the ACA, the nation’s uninsured rate has hit a record low, with 20 million people previously uninsured now having coverage. But how many of them can continue to afford to keep the coverage they now have at the rate in which premiums are going up?

The ACA already survived a botched rollout and a number of legal challenges. But the law is turning out to be a major money loser for the nation’s leading health insurers. And that might turn out to be the piece that finally topples the tower.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at Susan.Rupe@innfeedback.com.

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