ACA is in trouble and could be on course for a death spiral

[zipplewrath]

50. The co-op thing is about cash flow

The co-op thing is entirely about cash flow. Most of them didn't exist before this started. They had no money in the bank. They'd be making payments to the health care industry before they had collected more than a couple of months of premiums. They needed cash up front. Until they could build up some capital to absorb fluctuations in their costs, they were going to need help in the form of credit/loans. Nonprofit co-ops have trouble getting that kind of credit. The government helped them out the first couple of years, but that is ending and the GOP has no interest in continuing/renewing that.

And yes, 2/3 or so are "losing" money, but that is not unusual in new markets. Most of them charged premiums they knew they couldn't sustain. They just wanted to get their market share first. The real problem now is determining in the long term what they need to charge to cover their costs, including profit. No one knew for sure, and there was hope they'd do somewhat better on the "young and health" crowd. Maybe if we had a better employment picture, that would have happened. But we have a terrible employment problem with the "young and health" crowd, and they are overloaded with education debt. Of course this could have been moderated somewhat with a public option, but that wasn't important enough.