Only 1 rural county still at risk of having no ACA insurer

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Less than a month ago, CMS reported 40 counties were in danger of having no insurer offering coverage through the Affordable Care Act (ACA) exchange. As of Aug. 21, that number had shrunk to just one: Paulding County, Ohio.

According to the Kaiser Family Foundation, an unnamed insurer has stepped in to cover the other potentially bare county, Menominee County, Wisconsin, which had only 47 exchange enrollees in 2017. Paulding County, Ohio, had 334 and is one of many counties affected by Anthem scaling back its ACA participation.

The number of potentially bare counties has steadily dwindled, with pockets of Indiana, Missouri, Nevada, Ohio, Tennessee and Washington once at risk of having no ACA insurer, a possibility the law didn’t consider. Centene stepped in to cover many of the at-risk areas, including a recent expansion in rural Nevada.

Competition has decreased, however. CMS said 1,486 counties—more than 45 percent of all U.S. counties—will have only one insurer on the exchange in 2018. Eight states—Alabama, Alaska, Iowa, Mississippi, Nebraska, Oklahoma, South Carolina and Wyoming—could be limited to a single marketplace insurer statewide.

“As Obamacare continues to collapse, the administration is considering its options on how to address the challenges Americans are facing by canceled plans, higher costs, and failing markets,” HHS spokeswoman Alleigh Marré said in a statement to POLITICO.