Next year, dozens of counties across the country could be left with no insurance companies offering insurance in the Affordable Care Act marketplaces based on where things currently stand.
Nationwide, that could leave 35 thousand marketplace enrollees living in a county with no way to purchase affordable individual health coverage. (As it stands, people who receive ACA subsidies can use them only to purchase coverage in the marketplace.) In addition, 2.4 million could be left with just one insurer to choose from. That’s out of more than 10 millionenrollees total.
Since the ACA marketplaces opened in 2014, no county has ever been bare, although it briefly looked last year as if Pinellas County, Arizona, would lack any ACA insurer.
NUMBER OF INSURERS, 2014 TO 2018
What’s changing for 2018
Centene enters three states, expands in others
Insurers have until early summer to decide whether they’ll remain in the marketplace next year, though deadlines vary by state. So these numbers are still in flux, and more counties could end up bare, or new insurers might join some marketplaces.
NUMBER OF INSURERS LOST 2017 TO 2018
In Iowa, for instance, 94 of 99 counties appear at the moment to have just one insurer, Medica — and that company has also threatened to leave. In response, the state has asked the federal government for permission to restructure its marketplace and jettison certain elements to keep insurers in place. Wellmark, which previously announced it would not sell ACA plans in Iowa in 2018, has said it would stay if federal officials grant the state’s request.
Insurers across the country have cited uncertainties created by the Trump administration as a reason for ending their participation in the ACA marketplaces.
For months, the Trump administration has been silent on whether it will continue to pay “cost-sharing reductions” (CSRs) to insurance companies. These payments subsidize about 7 million consumers’ copays and deductibles, as opposed to other subsidies which that defray the costs of insurance premiums.
Eliminating subsidies could leave insurers to foot the bill
HOW AN EXAMPLE DOCTOR VISIT IS PAID FOR UNDER THE ACA
The patient, government subsidy and insurance contribute
HOW IT WOULD WORK WITHOUT COST-SHARING REDUCTIONS
The insurance company has to make up the difference
more of cost
The above visualization is an example to demonstrate the cost-sharing reduction scenario. Areas are not representative of the share that each source would pay, which varies by patient, plan and medical procedure.
If the Trump administration were to stop paying the CSRs, consumers would still be entitled under the ACA to those reductions. Insurance companies would be forced to absorb those costs.
Some companies already have decided to hike up their 2018 premiums more than they would otherwise to position themselves for an adverse decision by the administration. Others have left the market entirely.
Where insurers are leaving for 2018 so far
About this story
2017 marketplace insurers and announced 2018 exits are from the Robert Wood Johnson Foundation. 2017 marketplace enrollment and 2014-2016 insurer participation are from the Kaiser Family Foundation; data for state-based exchanges are estimates. Because 2018 exits are based in part on compiled news reports, exit data may be incomplete. See something we missed? Email firstname.lastname@example.org.