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This is what the start of a death spiral looks like.

Three states have announced preliminary 2019 premium-rate requests for Obamacare individual-market policies, and the numbers don’t look good.

In Virginia, the first state out of the gate, insurers requested hikes as high as 64.3 percent. Across all insurers, and weighted for current enrollment, the average increase is likely to be “only” 13.4 percent, according to calculations from health care analyst Charles Gaba.

In Vermont, one of its marketplace insurers requested an average 7.5 percent increase, and the other a 10.9 percent average annual rate increase.

In Maryland, insurers have also proposed double-digit increases. There, price hikes average 30 percent, with one plan penciling in an astonishing 91.4 percent jump.

Again, these numbers are preliminary; further negotiations with state regulators lie ahead and could materially reduce what premiums will look like in 2019. That is especially true in Maryland, where the governor and state legislators are feverishly working to stabilize the market through a “reinsurance fund,” which would require a waiver from the federal government.

Even so, the numbers are troubling. And they’re a preview of what we should expect nationwide, as more states announce premiums over the next few months.

It is not hard to see why prices might spike. Thanks to Republican efforts to sabotage Obamacare, the pool of individual-market enrollees is getting smaller and sicker — and, as a result, much more expensive.

A formal Obamacare repeal famously bombed last year, of course. Americans stormed town halls and jammed lawmakers’ phone lines in the name of saving the Affordable Care Act. The once-toxic law received a bump in popularity, and surpassed 50 percent favorability for the first time since passage in 2010.

After many unsuccessful attempts at legislative “repeal and replace,” Republicans gave up and moved on. Or so it seemed.

Behind the scenes, they quietly continued their demolition project.

Perhaps most significant, the GOP tax law passed in December repealed the individual mandate. This freed healthy people to drop their insurance plans without penalty. The Congressional Budget Office has projected that eliminating the mandate alone will increase individual-market premiums by about 10 percent in most years over the next decade, relative to prices with the mandate in place.

Meanwhile, the Trump administration has been working to make it easier for people to buy insurance that doesn’t comply with Obamacare’s consumer protections, such as required coverage of prescription drugs and mental-health care, or no bar to people with pre-existing conditions.

Additionally, Trump officials made it harder in general for people to enroll in Obamacare-compliant plans, for example, by shortening the open enrollment period this past fall, and reducing outreach and advertising.

Meaning that only people already super-motivated to purchase non-junk insurance ended up enrolling.

The net effect of all these changes: Younger, healthier and cheaper enrollees are getting siphoned out of the Obamacare marketplace. Older, sicker and more expensive people are sticking around, because they actually need coverage.

This pool of remaining enrollees raises average costs for insurers, who then raise premiums, which drives out additional relatively healthy people, which pushes premiums up further. And so on.

Or, as Maryland’s insurance commissioner, Alfred W. Redmer Jr., put it in a call with reporters: “I believe we’ve been in a death spiral for a year or two.”

Maryland has already seen its marketplace numbers plummet. In March 2017, 243,000 people enrolled in individual plans, Redmer said; a year later, enrollment has fallen to about 211,000.

The share of Americans overall who have health insurance of any kind has also been falling since President Trump took office — and is expected to fall further, thanks not only to individual-market sabotage but also some states’ new restrictions on Medicaid eligibility.

What’s especially depressing about these trends is that, before Republicans started monkeying with things, it looked as though the individual marketplaces were stabilizing.

“With insurers now mostly profitable in the ACA individual insurance market, I would have expected single-digit premium increases for 2019 reflecting health-cost growth,” says Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. “With repeal of the individual mandate and expansion of short-term plans, double-digit hikes are now likely.”

Such blatant public-policy malpractice should come with consequences. But what all this means for the coming midterm elections remains an open question. As a share of the total insurance market, the individual markets are small. Most exchange enrollees will be shielded from premium increases thanks to income-based subsidies, and despite Democratic fever dreams, voters don’t seem all that motivated by health care.

Still, it couldn’t hurt Republicans to actually try to get this stuff right.

Catherine Rampell’s email address is crampell@washpost.com. Follow her on Twitter, @crampell.

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(19) comments

Rick Czeczok

Obama care was a failed system from the start, High rates no choices in Dr's. and in the end no insurance companies wanted to touch it. Poorly planned from the get-go, just like the billions handed to the Iranians in that great plan (give everything they wanted upfront). Question for Oldmans "GANG"; How come nothing is ever reported on your leaders (Polosi) ignorant comments? Like stop the border crossing by mowing the grass, Taking Trumps animal comment totally out of context or, well you get the idea She is your leader, and after all this is a liberal media. Seven more years to go of your misery. HAHAHAHAHAHAHHA. Now everyone watch for the attacks by these 6 morons on this opinion page ref; Homies GANG.......I never read there rebuttal's as it's always the same garbage.......BLAH BLAH BLAH. There still giving me a free paper Homer.

kingman10

oh rick the russian bot, while not perfect, Obamacare helped insure 30 million more people, thus saving many lives. No choices in Dr's is a lie, and you know it, well maybe you don't. Rates were based on income so lots of people got a good deal. So where is your dear leaders plan to replace it with something cheaper and better? Come on you right sing cons artists, where is that plan? Comparing the Iranian treaty and obamacare is idiotic, one has nothing to do with the other. Glad you get the paper for free, you sure must be proud of such a huge achievement in your life.

Cassandra2

Russian bots like Czercock are only interested in sowing dissent and spreading lies. Facts simply don't matter.

Cyn

"junk insurance" - ha, ha, ha ha!!!!

oldhomey

Perhaps you could explain for the rest of us what you find so funny about junk insurance, Cyn.

new2Lax

Obama care, even with the stealing from the young and healthy could not succeed. The mandate was viewed as unconstitutional and that was that. Americans certainly do not want to step on the Constitution, illegal immigration will ultimately go by the wayside as well, it's just not legal. Talk about mandates, here is one for you, if you favor letting illegals in, Democrats should be made to adopt and support an illegal, then you will see this nonsense of allowing illegal immigration finally ending, Democrats will only agree to something like this, if someone else is paying for it.

oldhomey

new2, the man who says he was a crack HR executive for a Fortune 300 company, tries to tell us how insurance works. Did his Fortune 300 company want their younger, entry level employees to enrol in the company health insurance plan, or did he, as a crack HR executive, wisely counsel the young employees that it was nonsensical for them to be paying health insurance premiums on policies that they probably would not need to call upon for years? And what, pray tell, does illegal immigration have to do with this discussion? If we want to mandate responsibilities on American citizens for illegal aliens, perhaps we should mandate that businesses that hire illegal aliens must provide health insurance for the illegals they hire and their families. They already seem to be otherwise supporting the illegals, presumably by paying them wages for their labor. And most of those employers would probably identify themselves as stalwart Republicans, not Democrats.

oldhomey

new2, that paragon of righteous principles, doesn't seem to want to answer my questioning his principles in my 6:43pm comment. It figures. The man is a windbag.

new2Lax

We allowed our employees to make their own choices and counseled them to use private counseling to help them make the best choice for them. The company had many choices for insurance options and all were made available to every employee, including counseling if they so desired. All had retirement health care as well, this included union employees also, every employee. Union workers all had a 30 year and out defined benefit plan which topped out at 3K per month.

oldhomey

So tell me, new2, did that private counseling encourage young new workers not to enrol in insurance plans, thus making your insured cohorts in the company pay more for their coverage? That must be the case, since you find it almost criminal that the Obamacare plan pushed hard for young, healthy uninsured people to get signed up for the Obamacare plan. But in the end, new2, how does insurance work, if not having a healthy majority paying in to cover the costs of those whose luck runs out and they are confronted suddenly with impossible healthcare costs due to serious illness or injury? You claim you were a bigshot in the very area of corporate life that embraces the theory of health insurance, so tell us.

Cassandra2

Newt, does your twisted logic extend to the idea that if you oppose abortion you should be required to adopt an unwanted child?

new2Lax

No, this is twisted logic, supporting abortion and not the death penalty. Kill babies but not murders etc.

kingman10

no this is twisted logic, being a so called prolifer but supporting taking away little children from their parents at the border as a deterrent to their parents, or cutting food stamps for the working poor or disabled, or cutting medical care for those who need it. Talk about twisted. And by the way, no one supports abortion, but the right for the women, not you or politicians, to make that choice.

Cassandra2

How many unwanted kids have you adopted?

mocha1

These are the same profiteers that were big obama donators, and received huge bribes in taxpayer money from Obama to support Obamacare. This thing was doomed from the start as unsustainable. Remember other Obama promise, would not add one thin dime to deficit. I am amused by the people who support the Socialist Bernie Sanders Medicare for all slogan. They do not understand the structure and cost of this senior limited system.

Cassandra2

The latest cash grab by the profiteers of the insurance industry just proves why we need single-payer, Medicare for all.

oldhomey

Oh Cassie, don't be so cynical. The insurance industry has absolutely no interest in making big profits for themselves. They have decades of recent history showing how they are dedicated to making sure every American has healthcare. If you don't believe me, just ask mocha or new2. They will straighten you out pronto.

lostinparadize

Cassandra, profits from insurers aside, could you please tell us how your version of Medicare for all would work? Would it be the current coverage if 80% of the usual and customary charges? Or, would it cover 100% of all medical charges? Would it be for medical only or also cover vision, dental, hearing, etc? Would each individual pay the same premium, as in dad, mom, and all minor children being charged the same premium as a single person. And here's the biggy, how will it be payed for? No more Medicaid just Medicare for all and everyone pays the same ? Just curious as no one ever gives any detail when they say " Medicare or all " .

oldhomey

It would be paid for the same way universal healthcare is paid for by every other major, modern industrial society in the world, lost. We are the only nation with the same economic means as they have that does not consider basic healthcare to be a basic human right. Their economies thrive and people get the health care they need, while nobody faces the nightmare of being bankrupted and losing their means of self-sufficiency because of major healthcare expenses to keep a loved one alive and healthy.

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