One teenager in Iowa who costs $12 million a year to insure perfectly encapsulates the successes and failings of Obamacare

According to Blue Cross Blue Shield insurer Wellmark, there was a patient in the state's Affordable Care Act (Obamacare) exchanges who required $1 million a month in care.

This staggering $12 million in care each year was distorting the insurer's exchange business and forcing it to raise premiums across the exchange rapidly.

While the identity of the patient has not been revealed — rightfully so — a Wellmark executive did tell a Rotary club meeting that the person was a teenage boy with hemophilia, a genetic disorder that prevents blood from clotting, according to the Des Moines Register.

The story is heartbreaking, but it also has implications for the insurance market in the state.

The Wellmark executive told the meeting that the high costs were causing the insurer to raise premiums for the broader system, and the case reportedly was one of the reasons that Wellmark decided to pull out of the Iowa exchanges for 2018.

On a broader scale, this one case also shows why Obamacare's exchanges are facing problems — and why they have been saviors for many sick Americans.

Needed changes

The Iowa case also fits in with the trend of an increased number of older and sicker people signing up for ACA plans than originally expected since the exchanges came online.

In turn, premiums increased dramatically and insurers suffered substantial financial losses. Losses were so great at some insurers — especially those who mismanaged their plan structures — that they decided to leave these markets.

Levitt also said that a smaller market like Iowa's is even more problematic because there are fewer healthy people in the risk pool to offset the cost for an insurer such as Wellmark.

While these issues certainly need to be fixed in order to provide a more stable market for everyone in the exchanges, the story also gives a strong example for why Obamacare has been a success as well.

Success story

It is apparent that, from the insurer's side of things, the structure of the Obamacare markets presents a substantial issue when facing such high expenses. From the patient's side of things, however, the ACA is likely a godsend.

As pointed out by Levitt, some of the regulatory changes in Obamacare most likely saved the patient's family from serious financial stress and possibly serious health consequences.

"

The community rating, a provision of Obamacare, obligates insurers to price premiums the same for people of the same age in the same area. This prevented people with preexisting conditions from being charged more than healthy people and getting priced out of the market.

Without that provision, an insurance company could raise premiums for a sick patient substantially to offset some of their costs, but the price could be so high that it would be financially crippling for the patient's family.

Additionally, the ACA eliminated lifetime limits for insurance plans. Before the ACA, insurers could set a cap on how much they would pay out to a patient over the course of their life.

"