Old and busted: ObamaCare will bring real choice to millions of people buying insurance on their own! New hotness: “ObamaCare orphans.” With insurers backing away from ObamaCare exchanges across the country, many Americans — forced into the markets in the first place by government mandate — will have little or no choice for health insurance, other than a Hobson’s choice of a single insurer. CBS News prepares a primer for ObamaCare orphans that essentially boils down to … bend over:

With other mega-insurers including Humana and UnitedHealth also edging away from the federal health program, that will leave five U.S. states with only a single insurance carrier offering coverage through the exchanges. More specifically, a report from consulting firm Avalere Health says 36 percent of the approximately 500 rating regions in the U.S., most of those in the rural south, may have just one insurer in 2017. Another 19 percent could have just two carriers. …

Prepare to incur out-of-pocket health care costs. They are rising for just about everybody. If you find out from your doctor you’ll need to be going out of network to continue care, try to estimate how much more that will cost you in terms of higher premiums for a flexible plan and higher co-pays. Also, take a look at the medicines you take. Will those still be covered by your limited choice of plans? If not, how much will you be paying for prescriptions? Finally, with fewer choices you may need to move to a higher deductible plan, again costing you more out-of-pocket. Budgeting now for these costs can help make the coming year’s health care costs less of a surprise.

Amusingly, CBS News tries to assure its readers that “[t]his isn’t a death blow for the Affordable Care Act.” No? It certainly is for those “orphans” locked into a single plan (or no plan at all), with astronomical deductibles and premiums. As we have pointed out many, many times in the past, it’s the worst of both worlds — a high-priced catastrophic-care plan. If nothing else, it’s a death blow for the “Affordable” in the Affordable Care Act.

And not all ObamaCare enrollees are created equal in the orphanage, either. Earlier this week, The Hill’s Peter Sullivan noted that ObamaCare seems to do better on the coasts and in the Northeast, but orphans abound in the Midwest and the South. It’s A Tale of Two ObamaCares:

Increasingly, there are two ObamaCares.

There’s the one in coastal and northern areas, where the marketplaces include multiple insurers and plans. And there’s the one in southern and rural areas, where there is often little competition, a situation that can lead to higher premiums.

“There’s really two kind of stories that are playing out,” said Cynthia Cox, who studies insurer competition at the Kaiser Family Foundation.

The trend is likely to be accelerated by the departure of Aetna and UnitedHealthcare from ObamaCare marketplaces in 2017. The loss of those insurers won’t affect all parts of the country equally, experts say.

“The combined effect of these exits is mostly concentrated in southern states and particularly rural counties within those states,” Cox said.

It was the worst of times, it was … the most expensive of times. All of this was predictable, and in fact predicted over and over again. Younger and healthier people do not want to pay for expensive comprehensive-care insurance, especially with high deductibles, and would rather pay the fine and deal with routine care out of pocket. That only leaves the sicker and older consumers whose utilization rates skyrocketed once insurance covered part of their costs. Insurers couldn’t keep up with the costs of the utilization, and premiums have gone through the roof in four short years.

Ironically, this might be a good moment to break the health-maintenance model of care in favor of a retail-market approach to routine care. It’s a certainty, though, that this administration won’t learn that lesson from its own abject failures, and instead will continue beating consumers and insurers (who deserve a large share of the blame for ObamaCare) until morale improves. Get ready for a Dickensian experience, ObamaCare orphans!