Reason 24/7ReasonWhen last we tuned in to this ongoing drama that is Obamacare, one of the authors, Senator Max Baucus, suggested that it had turned into a "huge train wreck" and maybe it's not ready for prime time. Why would the good senator say such an unkind thing about his legislative baby, even if he did have to pass it to find out what was in it? Well, there are actually quite a few reasons, but lately, people are saying that Obamacare will have damned little to offer most people, even if state and federal officials can get the much-touted exchanges up and running.

From Stateline:

The White House sums up the central idea behind the health care exchanges in the new federal health law with a simple motto: “more choices, greater competition.”

But even some stalwart supporters of the Affordable Care Act worry that in many states, people won’t have a lot of health insurance choices when the exchanges launch in October. ...

Individuals and businesses with up to 100 employees will be able to shop on the exchanges, and people who can’t afford coverage on their own will get government subsidies to help them. About 26 million Americans are expected to purchase health insurance through the exchanges.

But it is unclear how many insurance carriers will decide to seek approval for selling their products through these online marketplaces. Insurance companies have been mostly silent about their plans, with some citing uncertainty about federal and state rules as a reason for holding back.

Some fear that any uptick in competition will bypass those states where doctors are in short supply and the number of hospital systems is limited. A recent analysis by the American Medical Association found that a single insurance company held 50 percent or more of the market in nearly 70 percent of local markets nationwide. 

On top of this lack of competition, some of the new federal regulations may push up premiums, at least in the short term. For example, under the health care law insurers will have to cover everyone, including people with pre-existing health conditions. Insurers are likely to raise their premiums to cover the cost of insuring these people who are less healthy.

The mandate that everybody must have insurance is intended to balance this new cost by adding a huge number of young, healthy people to the risk pool. Many of these people, figuring they wouldn’t need health care, have been taking their chances without coverage. But because the federal penalties for not having insurance are so small, especially before 2016, many of the healthiest people may continue to decline coverage.

So ... The latest concern, building on earlier concerns about bureacratic delays, regulatory missteps, economic impossibilities and a fundamental failure to understand how people respond to incentives, is that many health insurers will simply say, "no thanks, we'll sit this one out." That will leave the exchanges, over which so many political battles have been fought, as the equivalent of butcher shops in the old Soviet Union, with open doors, and empty shelves.

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