Who's Gaming Obamacare? Better to Ask: Who Isn't?

Last week, I outlined eight possible futures for Obamacare. By curious coincidence, few of them looked like the paradise of lower premiums and better care that the law’s supporters had promised. In the best case scenarios, they looked more like what critics had warned about -- "Medicaid for all," or fiscal disaster, or a slow-motion implosion of much of the market for private insurance as premiums soared and healthy middle-class people dropped out.

What I did not explore was why we seem to have come to this pass -- which is to say, why insurers seem suddenly so leery of the exchanges and why premiums are going up so much for Obamacare policies. No one really seems to know exactly why insurers are having so much trouble in the exchanges. Insurers may know, but they have generally issued vague statements about “worse than expected experience.” The closest we’ve gotten to an assessment was a statement from a big insurer last year to the effect that people who were signing up outside of the normal enrollment period seemed to have higher-than-expected bills, while paying fewer than expected premiums. Which tells us something, but doesn’t necessarily explain double-digit premium increases.