A new survey from Oliver Wyman Health, a health industry consulting organization, finds that most insurers "remain committed to the ACA exchanges, but with some adjustments in strategy and continued watchfulness." In other words, no "death spiral" yet.

This survey, along with our continued conversations with the market, reveals that payers are approaching 2018 cautiously; yet the vast majority of those surveyed intend to stay. Just one respondent in our survey said it plans to exit the exchanges. (However, we note that payers may withdraw from the market at any time prior to final agreements with the public exchanges and new information or policy developments could change their assessment of the situation.) Of the payers surveyed that intend to participate in 2018, 70 percent are carrying on as is, with no major shift in strategy. The other 30 percent are adjusting and pulling the levers they can to stabilize their ACA lines of business. Strategic recalibrations include changing the number of plans offered (eliminating gold-level plans, for example), or shifting to plans with tighter controls, such as narrower network plans or HMOs.

The "watchfulness," however, is an important caveat. With popular vote loser Donald Trump making threats left and right about how he's going to sabotage the law, insurers are going to tread lightly—the don't know if they're going to get paid!

Despite the fact that Trump and congressional Republican continue to claim the law is "exploding" and "failing," the insurers' confidence is justified. The Center on Budget and Policy Priorities reports on the latest analysis from Standard and Poor's Global Ratings which "show that major individual-market insurers made significant progress toward profitability in 2016." That suggests that the premium hikes in 2016 were an adjustment, and now their income is in line with costs. So they are likely to break even or profit this year, and should be moving into a more stable environment.

"Should be" being the operable words here. Any uncertainty that exists right now for most insurers isn't about the viability of participating in the exchanges. It's about whether Trump and his merry band of nihilists are going to blow the whole thing up.