When Do You Start Making Contingency Plans?

At Forbes Seth Chandler suggests, in reaction to the news that Aetna is ending its operations under the Affordable Care Act in the majority of markets in which they’re presently operating, that we should be figuring out what we should do when some markets have no ACA insurance carriers:

People joked for a while about how insurers were pulling out of Obamacare markets so fast we might end up with areas in which there were no insurers at all. It’s no joke anymore: with Aetna’s massive withdrawal yesterday from the Affordable Care Act marketplace, Pinal County, Arizona, the third most populated county in that state, currently has no insurers selling policies on the Exchange.

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The answer to the question posed in the title of this article is “Yes.” It would be far more productive to acknowledge what had been painfully obvious to many and what is likely now painfully obvious to those just dumped by Aetna. When you see the rapid contraction of the marketplace, when you see gross premiums increasing by more than 20%, and when you yourself are calling for the federal government to spend considerably more on Obamacare, it is time to admit that the existing Obamacare spaceship is passing the event horizon of the adverse selection black hole.

There are several barriers to adopting measured, considered reforms to the law. The emphasis by Republicans has not been on reform but on “repeal and replace” and to that end they’ve voted six times to repeal the ACA in its entirety since it was shoved down their throats in 2010. However, there have been scores of attempts to amend the law or repeal portions of it, nearly all of which have been opposed by Democrats for whom the ACA has become a sacred cow.

Additionally, there are both Republicans and Democrats who believe that the ACA’s becoming inoperative through the attrition of carriers facilitates their own, preferred solution whether that’s repealing the ACA in its entirety or replacing it with a single-payer plan. They can’t both be right but the belief alone in effect bronzes the ACA.

My own view is that dispassionately debating contingency plans in the event of a major fraction of counties having no insurance carriers or only one under the ACA would finding the best, most acceptable solution to the plan. Governing by crisis rarely results in the most effective policy.