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Obamacare Will Be Available in Every Single County in the United States in 2018

August 24, 2017, 9:43 PM UTC
Photograph by KAREN BLEIER AFP/Getty Images

Every American who needs to will be able to buy an insurance plan off of Obamacare’s marketplaces in 2018 thanks to a last-minute flurry of insurer participation. But this patch-up, temporary approach may prove to be unsustainable barring a more comprehensive strategy to shore up the Affordable Care Act’s health insurance exchanges.

The final hole in Obamacare’s “bare” counties problem was plugged Thursday as Ohio’s regional CareSource insurer agreed to offer plans in Paulding County next year. This region, like many others, was at risk of having zero individual health plan options after insurance giant Anthem announced it would pull out of the market in 2018. (To be clear: the kinds of private plans offered under Obamacare make up just a tiny slice of the market—the vast majority of Americans are either covered by government programs like Medicare and Medicaid or through their employers, and those with no available options would likely receive exemptions from Obamacare’s requirement to carry health insurance.)

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Insurers get to decide whether or not they want to do business inside of the Obamacare marketplaces, where private coverage is subsidized by the federal government for people who make less than four times the federal poverty line. There’s been a deluge of exits by big-name insurers like UnitedHealth, Aetna, and others from certain markets over the past year.

Several factors have been driving this trend. For one, some of the companies exiting the marketplaces aren’t ones that have historically been focused on individual insurance plans; new enrollees under Obamacare have also been sicker than expected in certain areas, creating insurer losses. And ongoing threats by President Trump to cut off insurer payments (and the general threat of repealing Obamacare) have prompted many firms to head for the exits, citing uncertainty.

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For all the noise, however, most Obamacare marketplaces have been doing alright and were even projected to approach profitability next year, according to the nonpartisan Kaiser Family Foundation. The notable exception has been in more rural and secluded regions—which have always had to grapple with a lack of insurance options, even before Obamacare.

These regions are now accounted for in 2018. But that doesn’t mean the status quo is sustainable. Governors and insurance commissioners have had to plead with insurers like Centene in Nevada and CareSource in Ohio to fill in the gaps. And without more sturdy guardrails for the companies—including guaranteed insurance subsidies and general predictability surrounding health policy—it’s entirely possible that the bandaid could be ripped off in a year.