Obamacare Choices Could Go From One to Zero in Some Areas 2
MIAMI, FL - DECEMBER 15: An Obamacare sign is seen on the UniVista Insurance company office on December 15, 2015 in Miami, Florida. Today, is the deadline to sign up for a plan under the Affordable Care Act for people that want to be insured on January 1, 2016. (Photo by Joe Raedle/Getty Images)

Parts of the country are in jeopardy of not having an insurer offering Obamacare plans next year.

Many counties already have just one insurer offering health plans in the Obamacare marketplaces, and some of those solo insurers are showing signs that they are eyeing the exits.

Humana announced this year that they’d be leaving the markets altogether next year. That means there are parts of Tennessee that will have no insurance options unless another insurer decides to enter.

And Anthem, which operates in 14 states, is getting nervous, an industry analyst told Bloomberg News this week. Its departure would be a much bigger problem. According to an analysis of government data by Katherine Hempstead at the Robert Wood Johnson Foundation, Anthem is currently the only insurance carrier in nearly 300 counties, serving about a quarter of a million people.

As you can see on our map of those counties, an Anthem departure could leave coverage gaps in substantial parts of Georgia, Missouri, Kentucky, Ohio and Colorado, as well as smaller holes in other states. In places where no insurance company offers plans, there will be no way for Obamacare customers to use subsidies to buy health plans.

Without an option for affordable coverage, they would become exempt from the health law’s mandate to obtain coverage. A result could be large increases in the number of Americans without health insurance.

The Affordable Care Act set up new markets for people who don’t get insurance through work or the government. About 11 million people bought coverage on those state markets last year. But the system depends on the voluntary participation of private insurance companies. And some parts of the country have proved more popular for insurers than others.

In the last year, several large commercial insurance companies decided to stop offering insurance in the markets. And some carriers that continued to offer Obamacare plans scaled back on the number of counties they served. In general, the places without much remaining insurance competition tend to be rural and expensive. (These areas tend to have fewer hospitals and doctors to choose from, reducing the ability of insurers to negotiate lower prices.)

There are a number of solo-carrier counties served by other companies, but none by as many as Anthem, Ms. Hempstead’s analysis shows. Cigna, the company with the next-largest potential impact, is the only carrier in 14 counties, containing about 100,000 insurance customers.

Anthem could well stay in the markets. It may simply be floating the option of departure to improve its negotiating position with the Trump administration over various regulatory requests. Or it may be expressing anxiety about the future. Insurers around the country are worried about the policy environment surrounding the Affordable Care Act. Mr. Trump has said that the health law “will explode” — a comment that may suggest he will do little to help the markets, or could even set the fuse.

When insurers left communities in recent years, the Obama administration and local officials worked hard to recruit replacements. The Trump administration might not do the same. So far, no carrier has come forward publicly to say it will serve the counties in Tennessee that Humana is leaving.

Insurers are making initial decisions about where to sell their products and how much to charge. But the final lineup of insurers is still several months away. Some states require companies to file initial requests this month, and the Trump administration has asked for price proposals in late June. If, after that, insurers decide the political or regulatory outlook looks less favorable, they will still have several months to leave the markets.

Correction: March 31, 2017
Because of a data error, an earlier version of the map accompanying this article showed Rhode Island as a state with only one carrier serving its Obamacare market. Rhode Island customers have a choice of two insurers.

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