re: 70% of the counties in the US have only 1 or 2 choices in the ACA

From the link you would have benefited from reading:

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In February 2016, Alaska’s Insurance Commissioner, Lori Wing-Heier, presented lawmakers with a summary of the state of the health insurance market in Alaska. Wing-Heier explained that the small group market was doing well, but that the individual market was struggling. In addition to the possibility of a state reinsurance program, Wing-Heier also floated the idea of combining the individual and small group markets into a single risk pool (this is allowed under the ACA, but only Massachusetts and Vermont have done so thus far). She also mentioned the possibility of creating a regional exchange in partnership with other states in the western US, or drafting a 1332 waiver proposal to implement the ACA in an Alaska-specific way (1332 waivers are available to every state, but most have not pursued them; Alaska did ultimately submit a waiver proposal, along with Vermont, California, and Hawaii. But California withdrew theirs and Vermont stopped working towards the single-payer program they had planned to implement under a 1332 waiver. Hawaii’s waiver was approved, and Alaska’s is still pending)

In an effort to address the problem caused by the very small individual market in Alaska, legislation was introduced in March 2016 to implement an assessment on all health plans in the state (not just the individual market) to fund a supplemental reinsurance program for Alaska that would help to cover the individual market’s largest claims. The legislation was passed in June by the Republican-dominated legislature, and Governor Bill Walker signed H.B.374 into law in July 2016.

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Although it had the effect of shoring up Obamacare in the state, lawmakers were quick to point out that they’re still opposed to the ACA ACA, but considered the legislation to be the best way to avoid having the state’s individual health insurance market collapse altogether.

H.B.374 uses an existing assessment that was being sent to the general fund, and directed it instead into a reinsurance fund for the individual market. Prior to 2014, the Alaska Comprehensive Health Insurance Association—a high-risk pool—was the only way people with serious pre-existing conditions could get coverage in the non-group market; instead of funding ACHIA, the money is now used to fund the reinsurance program. Insureds whose claims end up being covered under the reinsurance program are still covered by the same individual market coverage as everyone else; they are not enrolled in separate plans, so this is different from the way ACHIA used to work.

H.B.374 is a temporary program, and is only funded by the state for 2017. But lawmakers hope to develop a permanent solution during that time. For now, the reinsurance program will use $55 million of the $64 million that was collected in 2015 to cover claims for high-cost insureds in the individual market. Those funds are generated via a 2.7 percent premium tax on all insurers (not just health insurers) in Alaska, and lawmakers appropriated $55 million for the reinsurance program for 2017.

In an effort to garner long-term funding from the federal government (as opposed to taxing Alaska insurance companies), in November 2016, the state posted a draft proposal of a 1332 waiver, and opened a one-month public comment period. The official waiver proposal was sent to HHS in late December 2016. The waiver requests five years of federal funding for the Alaska Reinsurance Program, with an option to renew after that.

The state is proposing that the federal money that would otherwise be used for premium subsidies (to offset the higher premiums that would apply without the reinsurance program) be funneled instead into the reinsurance program. They note that 1,485 additional people will have coverage in Alaska’s individual market from 2018-2022 with the reinsurance program. But the cost of the program is substantial. Their waiver proposal states that the reinsurance program will result in a $51.6 million reduction in premium subsidy payments from the federal government in 2018, and Alaska wants to use that money to fund the state reinsurance program, with supplemental funding appropriated by the state.

In January 2017, just before Trump took office, then-Secretary of HHS, Sylvia Burwell, wrote to Alaska Governor Bill Walker, noting that the state’s 1332 waiver was complete and under review. The letter indicated that the 1332 waiver was likely to be approved, although the state would need to pass additional legislation first in order to ensure ongoing state funding for the reinsurance program beyond the end of 2017. Tom Price has since taken over as Secretary of HHS. The state’s 1332 waiver proposal is still pending, and the future of the ACA is up in the air. But a Trump Administration HHS is likely to be fairly lenient in terms of approving 1332 waivers.

Alaska lawmakers and the state Division of Insurance spent months considering possible fixes to the impending “death spiral” in Alaska’s individual health insurance market. Although subsidies offset the high premiums for those who are eligible for subsidies, they do nothing for the people whose income puts them just a little over the subsidy-eligible level (the average premium in Alaska’s exchange was $863 per month in 2016, versus a nationwide average of $396; the average subsidy in 2016 in Alaska was $750 per month, compared with an average of $291 per month nationwide; the dramatically higher subsidy amount is necessary in Alaska in order to bring premiums down to the same level as the rest of the country).

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Alaska lawmakers and the state Division of Insurance spent months considering possible fixes to the impending “death spiral” in Alaska’s individual health insurance market.

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You lose by your own link

I've been telling you this for months and you kept denying it. Thanks for proving me right yet again

Alaska spent 55 million of their own money to save the exchange.

You're welcome

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But I'm glad we can both agree that the ACA is now stable in Alaska

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It's not.

We both agree that the ACAfailed and a State program bailed it out.

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But it is. Alaska stabilized it, and applied to the federal government to continue to keep it stabilized.

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There's one player in the exchange. They lose money this year and Alaska will have to provide it's own program at a very high cost.

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Last year the state faced an emergency with the individual health insurance market with Moda’s impending exit and a possible 42 percent rate hike on the table from Premera, and the state administration and Legislature acted fast to create a temporary backstop by using assessments collected from every policy sold in the state.

Alaska has had reinsurance for years, a subsidy for health insurance coverage for individuals with serious medical problems who couldn’t get coverage, under the state-created Alaska Comprehensive Health Insurance Association, or ACHIA.

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[link=(www.alaskajournal.com/2017-04-05/insurance-officials-hope-federal-waiver-will-cover-reinsurance-costs#.WQKZJveIbqB)]LINK[/link]

The ACA failed, Alaska saved it be redirecting an old program, and Alaska has no assurances it will have support next year.

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There's one player in the exchange. They lose money this year and Alaska will have to provide it's own program at a very high cost.

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Not really a very high cost, it's just shifting the money around. The money they asked for is the premium credit savings from the fed govt due to the lower premiums in the state because of the guarantee of a reinsurance program.

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Alaska has no assurances it will have support next year.

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The lack of assurances is on Trump - Obama's HHS did all they could to approve the waiver. Trump's HHS could approve it, if he wants.

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The ACA failed.

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Then why is it stabilized in Alaska?

So if trump's tax cuts cause massive deficit but some other funding measure bails it out, that means the tax cuts were stable?

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Because the State bailed it out.

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Before or after it had collapsed?

But did they leave?

So it didn't actually fail?

Thanks.