ACA’s ‘bare’ county problem is back

63 cities and counties and more than 70,000 enrollees in Virginia are now at risk of having no insurer participating in their Affordable Care Act (ACA) exchange for 2018, a problem which had appeared to be solved in other parts of the country just two weeks prior.

The new batch of potentially “bare” counties is thanks to Norfolk, Virginia-based Optima Health scaling back its participation for 2018. In a press release, the company pinned their departure from markets on the exits of national insurers Anthem, Aetna and UnitedHealth, along with “uncertainty” created at the federal level.

“Healthcare is an ever-changing landscape. While this is not the outcome we had hoped, it will allow us to continue to serve 80 percent of our existing members and provide an option for another 70,000 Virginians who are losing their current insurance plan,” said Optima President and CEO Michael Dudley. “We believe it is important to continue serving as many people as we can and fulfill our mission to improve health every day. The only other alternative would have been to completely exit the exchange, and that goes against our mission.”

Optima will remain in the individual market in the Hampton Roads and Harrisonburg areas and expand to Charlottesville area, Halifax County and Mecklenburg County. These locations all have hospitals and practices under Sentara Healthcare, Optima’s parent company, which the press release said would allow the insurer to better manage the health of members with chronic conditions.

For those remaining in Optima plans, it requested an average increase in premiums by 81.8 percent next year. About a quarter of that hike is attributed to uncertainty about the Trump administration continuing to make cost-sharing reduction subsidy payments to insurers.

Ken Schrad, spokesperson for the state’s bureau of insurance, said to CNBC said officials are in “serious discussions” with insurance carriers to cover those bare counties, but wouldn’t make any prediction as to whether those efforts would be successful.

In other states, those efforts worked. Through July and August, companies filled in the gaps in potentially bare counties in Ohio, Wisconsin, Indiana and Nevada, with Centene and CareSource stepping in to cover many of them. What’s working against Virginia regulators now is time, as Sept. 27 is the deadline for insurers to finalize contracts to offer coverage through the federal site.