Affordable Care Act Marketplaces Look Bleak for Some Areas in 2018

The Centers for Medicare & Medicaid Services (CMS) recently released a map of the projected participation in Affordable Care Act (ACA) marketplaces.

The findings show the consequences of numerous insurer withdrawals announced thus far. The CMS reported that a large portion of counties are left with 1 insurer selling plans in 2018, while numerous counties have been left with no insurers selling plans.

The CMS also found that there are fewer plan options offered in 2018 compared with 2017, according to a press release. The map was based on public announcements made before June 9, 2017.

The 2018 map shows only insurers who have made announcements regarding participation thus far, but the numbers are expected to change as more insurers choose to exit or enter specific marketplaces, according to the release.

Currently, 47 counties are expected to have no insurers, which can result in those residents not obtaining coverage. The CMS found that nearly 40% of US counties will be left with only 1 insurer for 2018 based on current data. These findings suggest that many Americans will be without health insurance if measures to bolster insurer participation are not successful.

The CMS projects that more than 35,000 individuals who have current ACA coverage are expected to be without coverage in 2018, while 2.4 million will only have 1 insurer, according to the release. The CMS expects that more consumers with no insurer options will continue to increase.

The CMS is now working with state insurance departments and insurance companies to seek coverage for Americans living in counties with no options for 2018. Additionally, the Department of Health and Human Services is taking action under the current law to provide patients with relief from the consequences of the exchanges to stabilize the market, increase options, and lower costs, according to the release.

In 2016, the CMS issued new standards in the proposed annual Notice of Benefit and Payment Parameters for 2018. These standards were released early to provide additional certainty to the marketplace. Much uncertainty has resulted from the recent Aetna withdrawal that left many counties with few insurers offering plans for the future.

The rule would strengthen the risk adjustment program to protect consumer access to affordable health insurance options.

This latest map suggests that additional efforts are needed to stabilize the marketplaces.

“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all,” said Seema Verma, CMS administrator. “CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the Insurance Exchanges.”