One way or the other, the next president will have to deal with the burgeoning cost of insurance on the Affordable Care Act's exchange plans.
Republican Donald Trump says he'd dump the plan entirely. Democrat Hillary Clinton says she's sure she can make some adjustments to make it work better.
What ratepayers in Tennessee, at least, are facing are up to 62 percent hikes in premiums because of the losses insurance companies have incurred on the exchange plans. BlueCross BlueShield of Tennessee is seeking the 62 percent rise, while Cigna is asking for 46.3 percent and Humana 44.3 percent. Since June, Cigna's request has more than doubled, and Humana's has risen more than 50 percent.
All three insurance companies will have to defend their numbers before state regulators, but their requests are little different from those in other states.
Some companies are doing what Aetna did Monday night - pulling out of 70 percent of the counties in which it offers coverage under the Affordable Care Act, also known as Obamacare.
"This population dynamic, coupled with the current inadequate risk-adjustment mechanism, results in substantial upward pressure on premiums and creates significant sustainability concerns," Aetna Chief Executive Officer Mark Bertolini said in insurance-speak.
In other words, the $300 million in pre-tax losses it was sustaining annually simply was not worth the business.
United Healthcare and Humana have made similar announcements.
No one is pressing Clinton over her plans to stem the steep rises - she'd like to provide government-run competition - but every rate rise request makes the Affordable Care Act look less and less affordable than it already was.