Megan McArdle, Columnist

How to Break an Obamacare Exchange

Start with a rural state where hospitals aren't competing. Sign up relatively few policy holders and insurers. Add one $12 million patient.

Lovely state. Not a lot of hospitals competing to drive down prices.

Photographer: Justin Sullivan/Getty Images
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If you live in Iowa, and you buy insurance on the Obamacare exchange for individual plans, you might want to make sure you’re near an emergency room when you check the rates for 2018. Because you might well have a stroke.

Iowa is scheduled for the largest premium increases in the land next year, a whopping 69 percent according to health care consultancy Avalere. The average premium on the benchmark “silver” plans will rise to $1,000 a month.