2 Maps Show The Big Obamacare Crisis Republicans Keep Citing Isn’t Actually That Big,

It’s a real issue for some parts of the country. But it’s not so hard to fix.

The supposed implosion of the Affordable Care Act’s private insurance markets looks more and more like a manageable, geographically limited problem ― one that policymakers could fix pretty easily, if only some of them weren’t trying so hard to undermine the program.

The latest development comes out of Nevada, where until last week 14 counties had no options lined up for the state’s insurance exchange in 2018. Centene, which already offers policies in parts of Nevada, announced on Tuesday that it would expand next year to offer policies statewide ― which means roughly 8,000 exchange customers in those 14 counties will have a way to buy the Affordable Care Act’s regulated, subsidized policies.

Those thousands of people would have been stuck looking for some other source of insurance had their counties remained “bare,” with no carriers on the exchange. And because people buying policies through the exchanges don’t typically have access to employer-sponsored plans or qualify for government programs, most of those people would have ended up with no coverage at all.

The problem of bare counties has gotten a lot of attention in the last few months. Many insurers have scaled back their presence in the new Obamacare markets, citing their inability to make a profit because they can’t attract a stable mix of healthy and sick customers. Republicans have repeatedly said this exodus is a sign of the program’s collapse, and a reason to repeal the health care law.

House Speaker Paul Ryan (R-Wis.) once called repeal an “act of mercy” because, he said, the program’s new markets would fall apart without intervention.

But even as most of the big, commercial carriers like Aetna and Cigna have beat a hasty retreat from Obamacare, carriers like Centene have filled in the gaps. At this point, only two counties nationwide have no carriers lined up for next year. One is in Ohio, the other in Wisconsin. Together they account for roughly 400 customers, and it’s not too late for those counties to get insurers, too.

ACA marketplaces work well in densely-populated liberal areas. The marketplaces require more care and feeding to really succeed in Wyoming, Iowa or Oklahoma.

That doesn’t mean everything is hunky-dory. Centene’s business model relies on narrow physician networks to keep premiums down, which isn’t what all consumers would prefer. And although the number of truly bare counties has now shrunk to nearly zero, there are still many that only have one insurer. Roughly 40 percent of all counties will have just one exchange insurer in 2018, according to the latest figures from the Department of Health and Human Services.

But even that number is a little misleading, because those counties are disproportionately rural. In other words, not that many people live in them.

This isn’t surprising. Rural counties are inherently difficult for insurers to manage, because the low numbers of customers make it difficult to get that ideal mix of healthy and sick enrollees ― and because the relative paucity of doctors, hospitals and clinics makes it impossible for insurers to play providers off of one another to get lower prices. This was true before the Affordable Care Act was passed.

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