Obamacare cannot continue as it is currently structured.

The planned exodus of Aetna from 11 of 15 states follows on the heels of retreat announcements by United Healthcare and Humana. In many places, the only insurer left next year will be Blue Cross. Like the commercial insurers, however, Blue Cross plans across the country are also hemorrhaging red ink. Texas Blue Cross, for example, is asking for a 60 percent rate increase.

A study by Avalere predicts that next year more than one-third of the exchanges will have only one insurer left. More than half the exchanges will have two insurers, at most. We were promised competition. What we are getting instead is monopoly, at best duopoly.

As premiums soar, the choice of doctors and hospitals is dwindling. The Blue Cross offering in Dallas originally looked like a high grade employer plan. But like two thirds of the plans nationwide, the insurer has now switched to HMO coverage only. There is not a single exchange plan in Dallas that currently covers the highly prestigious Southwest Medical Center or the equally renowned Children’s Medical Center. Ominously, the only plans that appear to be avoiding losses are ones that look like Medicaid and are run by Medicaid contractors.