The letter to the editor from Mary Priske of Coralville [Many are one call away from financial ruin, June 29] unknowingly brought up a fact that highlights the reason why the Affordable Care Act is having problems, why insurers are leaving the health coverage marketplace in Iowa and why the rewrite of the health care law is proving to be so difficult. In her letter she states that she and her husband are “… in need of health care coverage for one month.”

No insurance plan of any kind, whether it is health insurance, auto insurance, homeowners insurance or even life insurance, can survive if the insureds only buy coverage when there is a specific need or an upcoming event. All insurance plans survive through the law of large numbers — hundreds of thousands of insureds who pay premiums, while only a few at a time need payments from the insurance. Without this pool of people, generating sizable reserves from which the insurance company pays out, insurance companies would have to charge extremely high premiums. One doubts if any premium would be high enough to keep the programs solvent. Some health care companies have determined that there isn’t and are opting out.