ACA hangs tough, just one U.S. county lacks a coverage option

Written on Aug 23, 2017

President Trump has said the ACA is “dead,” but residents of all but one county in America will be able to get an ACA health plan next year.

Poised for their fifth enrollment cycle this fall, the ACA insurance markets are proving more resilient than many anticipated, with insurers jumping in to cover regions other companies fled, undercutting GOP predictions of widespread market collapses.

Bare counties that had been abandoned by health plans once posed a significant threat to a small segment of the ACA market as national and regional insurers suffering heavy losses withdrew. More than 80 counties with 92,000 enrollees at various times this year have been at risk of becoming ACA deserts in 2018, according to the Kaiser Family Foundation.

The Trump administration showcased those places as evidence of the ACA’s failure as it sought to build momentum for the floundering GOP repeal effort in Congress. But in a sign of how embedded the health law has become — and why Republicans have struggled to unwind it — officials in red and blue states hustled to win back reluctant health plans to ensure constituents wouldn’t be shut out of coverage.

And in the weeks since repeal legislation flamed out in the Senate, typically risk-averse insurers have rushed in to serve those small pockets of the country both to save the ACA — and because they saw a chance to make money.

The danger period for the ACA markets is not over. Insurers could pull out of the marketplaces in coming weeks if President Trump pulls cost-sharing subsidies, which help insurers pay medical bills for low-income Obamacare customers. Most insurers have until late September to sign contracts committing to the marketplaces in 2018.

Competition in the ACA markets is still weak. National insurers like Aetna and UnitedHealth Group have largely abandoned the markets, while the largest Blue Cross Blue Shield plan, Anthem, is pulling out of multiple states. Nearly half of counties nationwide have just one insurer selling plans, essentially giving consumers a take-it-or-leave-it proposition.

Ohio was facing the prospect of having 20 counties without insurers, largely because of Anthem’s decision to exit the state. But Ohio officials eventually reached agreement with five health plans to cover all but one county – Paulding. The Ohio Department of Insurance is hopeful it can still attract a company to cover Paulding.

Ohio isn’t alone. Missouri, Tennessee and Washington also had categorically “bare” exchanges with multiple counties having no insurance coverage options in place for 2018. The Kaiser report indicates that some counties in Nevada currently do not have health insurance options in place for 2018.

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