It doesn’t matter whether Republicans can repeal Obamacare or not. The program as currently architected is going to fail. Humana just announced they are pulling out of all of the exchanges for 2018. Aetna’s CEO, Mark Bertolini says that Obamacare is in a death spiral as healthier consumers are driven out of the exchanges by higher premiums, which in turn makes the premiums go up. For 2017, Aetna already scaled back the number of states where they are participating in the insurance exchanges. I expect that unless Congress implements a new plan, the insurance exchanges as currently architected will be toast by 2019. Seems like a long ways away, but since payers have long lead times to decide whether to participate, I expect we will know for sure sometime in the spring of 2018. That’s little more than a year away.