"The biggest thing that needs to be done is figuring out some way to attract young, healthy people" to exchange plans, Perlman said. But HHS, under Price's leadership, seems unlikely to try to improve the law. And "purposefully sabotaging the exchanges and the ACA probably isn't difficult," said Perlman. And for that matter, HHS is "probably the only game in town right now" that can do it.


Health insurers "need a stable market, stable rules and a broader pool -- none of which has been fixed yet, nor does it seem likely it will be in time," Sheryl Skolnick, Mizuho Securities' director of research and senior health-care analyst, told MarketWatch in early February.


Then there are the ACA subsidies, which make exchange plans affordable to middle and low-income individuals. If HHS declined to appropriate them, it would "immediately destroy the exchanges," Perlman said. It's also possible, though unlikely, that tax reform -- Republicans' next project -- could reverse the subsidies, he said.

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