Mend it, don’t end it

Starting Tuesday, millions will have President Obama to thank — and curse — when they sign up for 2017 health insurance coverage under the Affordable Care Act. Thank, because but for Obamacare they would likely have no insurance at all. Curse, because premiums are growing at an intolerable rate, 22% over this year’s for mid-level plans, with some insurers pulling out entirely.

Though only a small fraction of voters enroll, Obamacare is on the ballot Nov. 8 as much as Hillary Clinton and Donald Trump — and will live or die by the actions of the victor.

The main culprit behind soaring insurance premiums is no mystery. Whether they live in a state that set up its own enrollment marketplace or rely on the federal exchange, those signing up are likelier to be older and have existing medical conditions than those who decide not to.

In droves, younger, healthier people are opting to forego coverage and accept a tax penalty of $695 — far less than they would spend on premiums.

Without enough healthier people to share the cost of treating those who use doctors more heavily, insurers have no choice but to raise rates sharply, or bow out of Obamacare — or suffer the fate of New York’s now out-of-business Health Republic, which pretended none of the above mattered.

That is, unless and until the next President and next Congress act to rescue a health law that in many respects has worked as intended — bringing coverage to 20 million Americans previously without, barring exclusion for pre-existing conditions and slowing out-of-control costs.

Desperate to revive his flagging campaign, Trump seized on the Obamacare rate hikes as reason for nuclear attack on the entire law. Wrong!

For her part, Clinton promises to bring premiums and deductibles down if elected. She skirts the not-so-little matter of how.

Two oft-discussed mechanisms, higher penalties and stiffer enforcement, are likely to be tough sells. Expanding subsidies to ease the cost pain of buying into plans could have high budgetary cost.

A so-called public option to compete with private insurers, which Clinton has expressed willingness to consider, has its own serious risks.

More ideas, from both sides of the aisle, are needed.

It will take remarkable presidential bargaining powers to make saving the Affordable Care Act a winning alternative to its needless demise.