By Reed Abelson and Margot Sanger-Katz for The New York Times
Republicans say a big reason the Affordable Care Act needs to go is that it fosters weak competition and limited choice in insurance marketplaces. But their replacement bill could actually make the problem worse in the rural counties that are struggling the most.
People living in rural counties in states like Arizona and Missouri have tended to have only one choice of insurer when shopping for a plan on the state marketplaces. Several states were down to a single insurer after national carriers like Aetna exited. And as more companies leave the Obamacare market, dozens of counties currently have no insurance carrier willing to offer Obamacare coverage in 2018.
Nevada became just the most recent example of a state with so-called “bare counties” after Anthem, the for-profit insurer that sells Blue Cross plans, said it was leaving 14 sparsely populated counties next year. The company’s departure, along with another insurer that also dropped out, leaves more than 8,000 people with no option — at least for now.
State officials say they are “strongly” encouraging the four carriers offering coverage in the more populated areas of Nevada to consider expanding into these other markets. The bare-county threat has become a political rallying cry among those trying to repeal the health law. The White House and other Republicans are fond of pointing to the places without insurers as an argument for reform.
“America faces an urgent crisis in its health care system,” Tom Price, the Secretary of Health and Human Services, wrote in The Wall Street Journal this week. “Costs are skyrocketing and choices are disappearing on the individual and small-group markets. Many people now confront the real challenge of having no choice in their health coverage.”
