Obamacare’s last bare spot filled by insurer in rural Ohio

The final county in the U.S. that was at risk of not having an Obamacare insurer next year will have one, meaning that the most dire predictions about some Americans not being able to access plans under the law won’t come true.

Ohio announced Thursday that health insurer CareSource will offer Affordable Care Act coverage next year in Paulding County. The county, in the northwest corner of the state, had been left without ACA coverage for 2018 after Indianapolis-based Anthem Inc. said in June it would pull out.

While people in places without Obamacare plans would have been able to buy health insurance, they wouldn’t have access to the subsidized coverage that’s available under the law. Ohio’s insurance regulators have found insurers to cover about 20 counties that could have been left without Obamacare coverage after other plans pulled out.

“There is a lot of uncertainty facing consumers when it comes to health insurance and these announcements will provide important relief,” Ohio Department of Insurance Director Jillian Froment said in a written statement.

Earlier this year, well over 40 mostly rural counties faced the prospect of having no options for their exchanges. Insurers who withdrew cited steep losses and uncertainly over the future of President Barack Obama's Affordable Care Act.

Insurers have been pulling back from the exchanges after getting stung by heavy losses and struggling to attract enough young, healthy customers to balance all the claims they get from people who use their coverage.

In Ohio alone, 20 of 88 counties lost insurers. State officials had previously announced coverage in the 19 others.

Rural counties, in particular, have been particularly uninviting for them because they usually have a smaller, older customer base and a care provider like a hospital system with a dominant market position. That can make it difficult to negotiate payment rates.

While insurers have made preliminary plans to sell coverage on the exchanges next year, they still have about a month to back out.

Insurers are worried, in particular, about the fate of billions of dollars in payments from the government to cover cost-sharing reductions for customers with modest incomes. These payments reimburse insurers for lowering deductibles and other out-of-pocket expenses for customers. They are separate from the income-based tax credits that help people buy coverage.

The federal government announced last week that it will make these payments for this month, but their future is unclear. President Donald Trump has repeatedly threatened to end them, and insurers say premiums will soar for some of their plans if this happens.