The Independent View: Every County in U.S. Will Have an ObamaCare Option

Every County in the U.S. will have at least one ObamaCare Insurer on the Exchanges next year after CareSource announced Thursday it would fill the last remaining “bare” County in Ohio. It’s an important Political win for Advocates of ObamaCare who argue the Exchanges are functioning in spite of efforts by the Trump Administration to let it implode. “Trump and Republicans in Congress have been rooting for healthcare to fail. With today's announcement, their talking points continued to evaporate,” Protect Our Care Campaign Director Leslie Dach said.

At one point or another over the past year, more than 80 Counties have been at risk of having no ObamaCare Insurer on the Exchanges in 2018. Republicans have pointed to this as Proof that ObamaCare is Failing and needs to be Repealed. But that number slowly trickled down over the last few months as other Insurers stepped in to fill these spots, and then on Thursday, that number dropped to zero.

The Trump Administration downplayed the News, arguing that competition is lacking on the Exchanges with many Counties slated to have only One Insurer next year. “On ObamaCare’s exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country, and choices continue to vanish,” HHS spokesman Matt Lloyd said in a statement. “Nearly half of counties across the nation only have one health insurance option which, by definition, is not a choice. Under ObamaCare, Americans were promised access to a wide variety of high-quality, affordable coverage options. ObamaCare has failed to deliver — an unfortunate reality for the American people who are required to buy Washington-approved health insurance or pay a fine.”

Insurers have withdrawn from markets and requested Double Digit Premium increases in response to uncertainty over how the Trump Administration will handle the Law. But smaller Insurers like Centene and CareSource saw a Business Opportunity when larger companies like Anthem and Humana fled the Exchanges.

CareSource announced Thursday it would sell Plans on the Exchanges in Paulding County, Ohio, the last Bare County in the U.S. The Insurer has now covered 13 Bare Counties: Nine in Ohio and Four in Indiana. Centene, on the other hand, agreed to Fill more than Half of the Counties that were at risk of having No Insurers next year, including 25 in Missouri. Centene’s Nevada Health Plan announced last week it would sell Plans in 14 of Nevada’s Bare Counties in 2018. Earlier this Summer, Blue Cross Blue Shield filled a 16-County void left by Humana.

“At the end of the day, this is a business decision for them. They see this as an opportunity to expand and be profitable in the market,” said Cynthia Cox, an Insurance Expert with the Kaiser Family Foundation. Many of the Counties at Risk of having no ObamaCare Insurers next year were Rural. And it’s always been difficult to attract Insurers to Rural Areas because they don’t want to compete with another Company for a small number of Enrollees, Cox said.

For example, Menominee County in Wisconsin, one of the last Bare Counties to be filled Wednesday, only had 47 People on its Exchanges in 2017. But when there’s no Competition in an area, Companies might see it as worthwhile to sell Plans there. “As long as they aren’t having to compete for the business of a handful of enrollees, it could be a good opportunity for one company to come in,” Cox said.

It’s still possible that there could be Bare Counties in 2018. That’s because Insurers don’t have to Sign Contracts for next year until the end of September. And they’re still waiting for more certainty on whether the Trump Administration will continue Funding Key ObamaCare Insurer Payments known as Cost-Sharing Reduction Subsidies, which Reimburse Insurers for offering Discounted Deductibles and Co-Pays to Low-Income Patients.

“There’s definitely still a lot of uncertainty about 2018. There’s always a chance some health plans decide to pull out,” said Chris Sloan, a Senior Manager at Avalere, a D.C.-based Healthcare Consulting firm.

The Senate’s Health Committee will hold Bipartisan Hearings on a Market Stabilization Bill once it returns from Recess, which could include Funding the Subsidies. Chairman Lamar Alexander (R-TN) has indicated he hopes to have the Bill passed by the end of September. But that’s cutting it close for Insurers, who have to Sign Contracts by Sept. 27th. “I don’t think we’re at the point of no return, but it’s coming up,” Sloan said. “There’s a time crunch of not only passing something by that time, but passing something in enough time that health plans could factor it into their premiums. The window is shrinking and shrinking more every day. If Congress wants to do something that has an impact on 2018 in terms of premiums, they need to act very quickly.”