For years, President Donald Trump has repeatedly said the Affordable Care Act is on the verge ofcollapse. As he puts it last week, the health care law is“exploding.”

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Is Obamacare really about to fall apart? The short answer is no-- there are areas of the country where the ACA’s markets areworking well. In others, though, it’s struggling. Meanwhile, theTrump administration holds many of the levers that will determinewhether the Affordable Care Act lives or dies.

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Obamacare, as the ACA is often called, has helped 20 millionpeople get insurance, mainly by expanding the Medicaid healthprogram for the poor and by creating markets for individualinsurance where many can buy plans. Medicaid is relatively immuneto collapse, since it’s funded almost entirely by state and federalgovernments, though some lawmakers would like to limit itsspending.

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When people say Obamacare is disintegrating, they’re usuallyreferring to its individual markets. Premiums have shot up on theexchanges, and choice has declined for many. Sign-ups for exchangeplans this year, at 12.2 million, were down modestly from2016.

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Attractive subsidies

For consumers, one of the most attractive features of the ACA’splans is that government subsidies help offset costincreases, and about half of those who buy individual plans areeligible. However, people who make too much to get subsidies --about $48,000 for an individual -- have to pay full freight.

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A 50-year-old, for instance, would spend an average of $574 amonth for a mid-level silver plan this year, according to datacompiled by HealthPocket. That’s 17 percent more than in 2016, andthe policy would have a deductible of about $3,500.

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Plan choice is also a growing problem. While theCongressional Budget Office said the ACA’s markets are “stable inmost areas,” about 42 percent of those buying coverage onObamacare’s exchanges had just one or two insurers to pick from forthis year, according to the Kaiser Family Foundation. There areparts of Tennessee where there may not be any exchange insuranceoptions for 2018. And Oklahoma’s insurance regulator warned lastweek that his state’s lone carrier may quit the market.

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“This isn’t one market, this is really 51 markets,” said ChrisJacobs, a health policy analyst who runs Juniper Research Group.“That’s something that defies simple slogans.”

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Tennessee’s troubles

While insurer choices wane, premiums rise: Across the country, premiums forso-called benchmark plans climbed 25 percent for this year. InArizona, the benchmark premium jumped 116 percent, a fact oftenrecited by Trump as a sign of the ACA’s failure. In Indiana, on theother hand, where Vice President Mike Pence was governor, premiumsdeclined 3 percent.

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Something still needs to be done for 230,000 people on exchangeplans in Tennessee, Senator Lamar Alexander, a Republican fromthe state, said Friday after the ACA replacement was pulled beforea scheduled House floor vote.

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“Unless Congress and the President act soon, these Tennesseans-- some of the most vulnerable citizens in our state -- are likelyto have zero choices of insurance in 2018,” he said.

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Insurers, by and large, are still losing money after three yearsof selling coverage in the program, according to an analysis fromBloomberg Intelligence. That’s pushed some of the big players --Aetna Inc., UnitedHealth Group Inc. and Humana Inc. -- to pullback. Higher premiums may give insurers better results this year,according to an analysis from S&P Global Ratings. That is, solong as the administration’s actions don’t undermine themarket.

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Why take risk?

That’s where the difficulties emerge. Trump, on Friday and againover the weekend, said Obamacare was collapsing. “It’s implodingand soon will explode and it’s not going to be pretty,” hesaid.

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Price and Congressional Republicans have made similarstatements. That could undermine the desire of insurers to sell inthe market. If regulators aren’t willing to make it work, whyshould they take a risk?

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“Market participants need faith in their regulator. When theirregulator says market is ‘exploding,’ it has an influence,” AndySlavitt, the former head of the Centers for Medicare and MedicaidServices under President Barack Obama, said Monday on Twitter.

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“Can you imagine investing or offering stock as a company in thestock exchange if the head of SEC called it a ‘disaster?”’

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Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.

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