Insurer participation and competition in Obamacare declined again in 2018 at both the state and county levels. In 2017, nearly one-third of counties (32.8 percent) had only one insurer offering exchange coverage. In 2018, more than half (51.3 percent) of all counties face that situation. Many insurers have exited the exchanges; ones that remain offer higher premiums and narrow network plans. The emerging norm appears to be one in which major metropolitan areas have two or three insurers offering exchange coverage, while less-populous areas have only one. A health insurance monopoly offering overly expensive coverage that pays for only a very limited set of providers is deeply unattractive, especially to customers who previously enjoyed choice in both their insurance and medical care. Not surprisingly, consumers are looking to Congress and the President for help in escaping the soaring costs and shrinking choices that characterize the ACA exchanges.

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New analysis from Avalere finds that plans with more restrictive networks, including health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), continue to dominate the exchange market, with 73% of the 2018 market comprised of restrictive network plans, up from 68% in 2017 and 54% in 2015. Avalere analysis also found that deductibles for the most popular type of plan on the exchange—silver plans—will climb in 2018, to an average of $3,937, up from $3,703 in 2015, and each following year they will increase.
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People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states. “Members have difficulty finding–and in many cases cannot find–medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.

“People signed up for insurance and they ‘discovered there were no doctors,”’said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.

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“The Trump administration’s action today is cruel,” said Democratic Congressman Frank Pallone Jr. of New Jersey. The new policy is “the latest salvo of the Trump administration’s war on health care,” according to a health-care advocacy group. “The pain is the point” of the policy, wrote columnist and economist Paul Krugman.

They were attacking the Trump administration’s decision last week to allow states to impose work requirements on Medicaid beneficiaries. But far from being a “cruel” action designed to inflict “pain” on the vulnerable, the administration’s decision is completely reasonable.

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The Trump administration is estimating there are now only 700 issuers in the individual and small group markets, which is down from 2,400 in an earlier estimate.

The CMS cited the updated figure in an information collection notice posted Jan. 8. The agency is seeking permission from the White House’s Office of Management and Budget to continue collecting data annually from exchange plans about their enrollees’ risk profiles.

In an earlier version of the request submitted to the executive branch last month, the agency estimated there were 2,400 issuers in the individual and small group markets.

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Anthem’s membership in the Affordable Care Act marketplaces will decline by 70% in 2018, executives told investors Wednesday on the insurer’s third-quarter earnings call. About 1.4 million people had ACA-compliant plans with Anthem as of Sept. 30, 900,000 of whom bought coverage on the exchanges.

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Anthem announced Friday that it would fill Virginia’s 63 counties that were slated to have no ObamaCare insurers on the exchange next year.

Anthem initially announced it wouldn’t sell plans in Virginia in 2018, but backtracked Friday to cover the so-called bare counties.

“Since learning that 63 counties and cities in Virginia would not have access to Individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in the state,” Anthem said in a statement Friday.

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New Mexico Health Connections, a not-for-profit insurance co-op funded through the Affordable Care Act, is a month overdue in filing its second-quarter financial paperwork. And the co-op’s most recent documents, as well as federal ACA documents, show potentially large financial problems that could force New Mexico to shut the company down. This could be another potential black eye for the ACA’s co-op program, in which 19 of 23 companies have already gone under.

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This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.

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Half of Virginia’s counties now are on track to have no health insurers offering Obamacare plans in 2018 after an insurer reversed a decision to sell individual health coverage in much of the state.

The pullback by Optima Health in Virginia ends a brief, two-week period in which every county in the United States was projected to have at least one Obamacare insurer next year.

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