An argument, loudly proclaimed by advocates of the Republican congressional effort to do away with "Obamacare," is that it is in a "death spiral" due to the exit of certain insurers from state exchanges, resulting in loss of access to insurance coverage. This has been offered as proof of the program's fatal defect.

An analysis in the current New England Journal of Medicine shows this to be false. According to the study, those companies exiting the program because of financial losses are those whose participation has been more likely limited to administering programs for self-insured corporations than actually assuming and managing risk. Companies with histories of actual assumption of risk have done better financially and are staying in the exchanges. Also, the study cited insurers entering the market with such experience, offering premiums that tend to be lower than those of at least some existing insurers. Thus the dreaded "death spiral" is no such thing. Rather it seems that we are experiencing a shift in participation in the market as a normal development.

As usual, a look at carefully acquired facts dissolves the fog of politically motivated hysteria.

Dr. Herbert Ross

Lyme