Texas, like much of the country, is halfway through the fifth enrollment period for the Affordable Care Act — and as in years past, the occasion serves as a reminder that the law is in critical condition.

That the ACA is ailing is uncontestable. Insurers are fleeing the exchanges, enrollment is shrinking, and premiums are skyrocketing — even while U.S. taxpayers substantially increase subsidies to insurance companies.

The latest reports confirm that insurers are abandoning ship at breakneck speed. This year, one-third of all counties in the U.S. had just one insurer willing to participate in government-sponsored exchanges. Next year, it’s expected that as many as one-half of all counties will find themselves in this health care desert.

Fewer insurers means fewer choices — and that lack of competition is spurring stagnation and decline, as evidenced by falling enrollment. The number of people expected to sign up for health insurance next season will drop by at least 1.1 million, according to data from the Health and Human Services (HHS) department.

Of course, the law’s defenders have tried to pin the enrollment decline on the Trump administration’s reduction on spending for outreach and education. But this begs the question: Is a lack of funding or poor design behind the law’s demise? After all, if a horde of special “navigators” are still needed to walk people through the law’s basics — it’s been almost a decade since it was passed — then it’s no wonder that consumers are avoiding it.

Though the root cause of the ACA’s enrollment problem may be up for debate, what is not in dispute is the fact that premiums are skyrocketing.

According to a new HHS report, the average monthly premium for benchmark silver plans will increase by 37 percent, growing from $300 in 2017 to $411 in 2018. Premiums for the lowest cost plan will jump by 17 percent. To what extent consumers are slammed by these double-digit increases is yet to be seen, since almost 80 percent of those who buy plans on the exchanges are subsidized — but it’s fair to say that all U.S. taxpayers will take a hit.

Combined, these symptoms — fewer insurers, falling enrollment and soaring premiums — signal a much larger truth. That is, the ACA is terminally ill — and some big, new ideas are needed in Congress and at the statehouse to move Texas in the right direction.

At the federal level, the first and best thing policymakers can do is to fully repeal the ACA — including the Title I federal mandates and regulations — and give states more control over their health care systems. State legislatures, not the federal government, are best positioned to craft health care policy for constituents and govern over the factors that influence supply and demand.

At the state level, the next Texas Legislature, which convenes again in January 2019, should seek a waiver to give the state’s Medicaid program the flexibility to innovate in all components of the program, including eligibility standards, insurance structure, work requirements and care delivery methods. Freeing the state from the shackles of federal regulations and mandates is the surest way to secure the best results, even if they are only somewhat temporary.

This month’s open enrollment period is a stark reminder that the ACA has not delivered on a host of important health care outcomes. Americans — and especially Texans — should take this opportunity to reflect on the big, bold changes that our country needs to move forward, especially those that restore statehouses to their rightful place. There’s no better medicine for what ails our nation’s health care system.