I see you point about taking the penalty. Hadn't thought of that.
I believe it DOES matter why Aetna may pull out. If they pull out because they can't pay their stockholders, it means there is not enough profit in the system. If they are holding us hostage because they can't merge, than that is a very different reason. 
Non-profit providers are doing much better because they are not trying to make a profit off of the backs of the low-income. 
People say the system can't work for insurers because they are losing money. Sure seems to have benefited a few locals when they made millions on the sale of Agate: "Eleven Agate executives and directors became millionaires over night [from the sale], the documents show. "

As far as the Pelosi quote: Even though I don't like her methods, that short (2010!) decontextualized statement is a half-truth - amounting to a lie about the meaning. http://www.mediaite.com/tv/the-context-behind-nancy-pelosis-famous-we-have-to-pass-the-bill-quote/