But Obamacare isn't in a "death spiral," and although Trump can take steps to weaken it, he'll be unable to destroy it the way he and other Republicans would like.
The article mentions three specific problems, however:
High Premiums
Health insurance premiums saw a huge spike in 2016, rising an average of 22 percent. Were these sky-high price increases a regular occurrence or a one-time course correction? Trump hopes it's the former, and that rising premiums will turn people against Obamacare.*
"Empty Shelf Counties"
The other big headline from open enrollment was the lack of insurer choices in some counties. Unlike with high premium increases, this doesn't seem to be a one off. One-third of counties have only one insurer offering individual & family plans, and 16 counties in Tennessee have no insurers at all thanks to Humana exiting the market.*
Low Millennial Enrollment
Insurance works by pooling risk, and sharing the costs to cover that risk. Young people are less likely to use their health insurance, but they're still paying for it, helping to spread out the costs. Having more people enrolled helps stabilize a carrier's risk pool and lower the overall premiums.*
It is my impression that states such as California and Washington that set up their own system that the ACA is working well with lots of health care insurers to choose from. It is in the states that opposed participation in the ACA where the Federal government set up plans that are the problem.
Kentucky
Kentucky, which has the unhealthiest county in America, that set up its own exchange, may be having trouble as the current Republican governor is trying to repeal it (see figure), however, problems exists largely because of poverty (quotes in italics):**
From 2014 to 2015, 85% of the increase in premature deaths was attributed to a rapid increase in deaths among people aged 15 to 44. The report notes that many issues contributed to the increase, but the drug overdose epidemic is a "clear driver of this trend" among those 25- to 44-year-old.**
Of the 30 factors RWJF [Robert Wood Johnson Foundation] considered when ranking counties — including housing and education — Breathitt County in eastern Kentucky was ranked dead last in health outcomes and Clay County was last in health factors. **
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"The eastern Kentucky counties have a lot of problems that they have to overcome, starting with high poverty levels," says Ben Chandler, CEO of the Foundation for a Healthy Kentucky. "We've got a lot of work to do in the eastern part of the state."**
* http://www.cnbc.com/2017/03/29/trying-to-kill-obamacare-now-will-haunt-trump-later-commentary.html
** http://www.usatoday.com/story/news/politics/2017/03/29/suburban-drug-overdoses-fuel-spike-premature-death-rate/99728380/?utm_source=feedblitz&utm_medium=FeedBlitzRss&utm_campaign=usatoday-newstopstories
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