Counties at risk of having no ACA insurers shrinking

On July 26, CMS said 40 counties in the U.S. were projected to have no insurers offering coverage on Affordable Care Act (ACA) exchanges. By July 31, that number had shrunk to 19 after five insurance companies announced plans to participate in parts of Ohio.

Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Health Care of Ohio and Paramount Health Care said they will offer exchange plans in 19 of the 20 Ohio counties that were at risk of having no insurer. According to the Ohio Department of Insurance, about 11,000 people are covered through the ACA exchanges in those counties.

“We are pleased to expand Ambetter from Buckeye Health Plan from nine to 27 Ohio counties in 2018,” said Bruce Hill, president and CEO of Buckeye Health Plan. “Working in partnership with the state to include three of the bare counties helps ensure that Ohio residents will continue to have access to high-quality, comprehensive healthcare.”

The ACA doesn’t address the possibility of having no participating exchange insurers, which would leave customers searching for plans to which ACA subsidies could not be applied. This scenario was avoided in 2017, though there was a significant increase in the number of counties with only a single insurer offering plans.

For 2018, the Ohio announcement and Medica’s commitment to cover all 99 counties in Iowa have shrunk the number of at-risk areas, but Ohio’s Paulding County, along with four counties in Indiana and 14 in Nevada. These gaps were caused by the withdrawal of insurance giant Anthem from the exchanges in 14 states for next year. Combined, however, these counties account for just 12,000 enrollees, or 0.1 percent of the total population covered through the exchanges, according to the Kaiser Family Foundation.

Participation by insurers could still change, however. Former American Medical Association lobbyist Julius Hobson Jr., told HealthExec that moves from the Trump administration, like not paying cost-sharing reduction subsidies to insurers, could lead to more exits. Chris Brock, spokesperson for the Ohio insurance department, said even the newly-announced participants in Ohio could pull out due to uncertainty.

“Nothing is really final, final until these contracts are signed at the end of September,” he said to the Columbus Dispatch. “There are things at the federal level that could change this.”