This is not a surprise, as the enrollment of younger, more healthy customers has been below expectations. In addition, the overall level of enrollment in the exchanges is about half of what was projected when the law was drafted. Finally, the % of customers who are receiving subsidies is higher than originally projected (something like 85% vs an expectation of closer to 60). So, the make-up of the exchanges is not as expected, and it points to a more expensive customer base.

The companies that are doing better on the exchanges are in states with a lot of competition (California, for instance) and they're used to dealing with a Medicaid-like customer. I think companies that are used to dealing with employer-provided group insurance aren't as set to deal with the exchanges. Also, there are few employers who are ending their group health and booting employees onto the exchanges.

So, around the country, there are states and areas with only 1 insurer on the exchange, i.e., not much choice for potential policyholders. Also, 2017 is a year where some risk sharing provisions of ACA are sunsetting. So, some carriers are pulling back and/or getting out.

I don't think this all means that the exchanges will collapse. But there are big problems going forward. I'm afraid the only way to shore this up is to have much stronger penalties for people who don't buy health insurance, and to provide more flexibility on the types of plans that are offered. However, there's no political will to do that. So, we're liable to see more big premium increases in the future, and maybe fewer insurers participating in the exchanges.