A few months ago, it looked as if large swaths of the country might end up without any insurers willing to sell Obamacare insurance in 2018. But in the last few weeks the “bare county” problem, which President Trump had cited as a sign the markets were failing, has nearly solved itself.
On Tuesday, Gov. Brian Sandoval of Nevada announced that Centene would offer insurance in 14 rural counties of Nevada that had been bare. That leaves only two counties in the country without insurers saying they will sell coverage; fewer than 400 Obamacare customers live in those counties.
The bare county problem had been a sort of unplanned policy hole in Obamacare, which depends on private companies to provide insurance to people who don’t get coverage through a government program or work. The federal government provides subsidies on a sliding scale to help middle-income Americans pay their premiums, but it doesn’t do anything to force insurers to offer coverage if they don’t want to. For a while, it seemed there would be a smattering of mostly rural places in the country where no company saw a reason to participate in 2018.
Economists argued that the bare county problem didn’t make much sense, at least in theory. It’s typically easy for a company to make money as a monopoly, especially if the government will pay most of the bills. But as some large insurers shifted away from the Obamacare markets, and others worried about policy uncertainty, vacancies started to mount.
Mr. Trump, who has been pointing to Obamacare’s weaknesses in attempts to marshal support for a health care overhaul, began seizing on the bare counties, frequently noting that Obamacare was set to “implode.” Republicans in Congress also often made note of the bare spots. The Centers for Medicare and Medicaid Services, the government agency that runs the marketplaces, has been periodically updating a map of insurer moves, marking potential bare counties in red.
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