Obamacare is hard to kill

Some states, like Minnesota, where some carriers are proposing to lower prices up to 12%, are implementing a reinsurance program like the one that was discussed but not adopted at the federal level. Maryland is awaiting federal approval for a similar program that could drastically reduce prices in the state.

In Washington State, lawmakers have failed in their attempts to create a reinsurance program, said Kreidler, the regulator. "We have encountered the same problem as other states – it is hard to find the money," he said.

Other states may restrict the sale of policies that compete with A.C.A. plans or develops its own version of the individual mandate.

But insurers are becoming more comfortable with the current state of the market. In Iowa, Medica was the only insurer remaining in 2018 after the dramatic release of the state's Blue Cross plan. The insurer has increased its prices by nearly 60% this year. For next year, he is considering increases in single digits, and Wellmark, Blue Cross plan, said he would return to the Iowa market in 2019 after talking with officials. of the state.

Citing relative stability in the environment, Medica also plans to expand into two more states in 2019. He says he's able to account for continued uncertainty over the influx of new competing plans. "We needed to be pretty agile and very flexible," said Geoff Bartsh, Medica executive.

Most insurers believe that Republicans will not succeed in their legal efforts to defeat the law, and they refrain from doing dramatic moves. But that could change if the courts rule in favor of the Trump administration and Republican attorneys general. "The big game changer would be the Texas lawsuit," Bartsh said.

Despite the harshness of the market, insurers discover that their customers are loyal. "The last time they tried everything," said Michael Neidorff, CEO of Centene, including the elimination of subsidies to reduce pocket costs if they were low-income and reduce awareness efforts. But Neidorff said the vast majority of people remain registered. "People want insurance," he said.