by Mish

Mississippi, Alabama, South Carolina, Oklahoma, Alaska, and Wyoming are states where there is only a single provider for the entire state. Iowa is likely to be covered by a single provider next year. Most of North Carolina, Florida, Missouri, and Arizona are also in a single-provider situation.

Enrollment for 2018 starts in November. Will the problem be fixed by then? If not, What Happens if Places Have No Obamacare Insurers?

The markets created by the Affordable Care Act have always relied on the voluntary participation of private companies. If the government set up the right conditions for the market, the thinking went, insurers would want to jump in. But, as Sarah Kliff at Vox.com has reported, the law contained no real backup plan if that vision didn’t work out.
So far, there are parts of Tennessee where none of this year’s insurers want to sell insurance next year. Other counties have only one carrier, and in some of them, that carrier is looking shaky.
If insurers do all decide to exit a market, no one is exactly sure what will happen next. Some experts have brainstormed about possible workarounds, but all would entail uncharted legal territory.
Senator Lamar Alexander of Tennessee, the state currently at greatest risk of bare counties, has introduced a bill that would create options for customers shut out of their Obamacare market. But even if Congress passed such a law, regulators would have to work very fast to make anything happen before next year’s enrollment period, which begins in November.

No Backup Plan

Vox asks What if Obamacare Insurers Falls to Zero?

Multiple sources tell me that White House staff held a meeting today to discuss cost-sharing reduction subsidies — that $8 billion Obamacare program whose fate still hangs in limbo. Ending these payments could “blow up” the health law’s marketplaces, but President Trump has so far waffled on what he’ll do about the issue. The meeting didn’t include any outside advisers or industry officials, only administration staff.
Right now there are 16 counties in Tennessee where no health insurer wants to sell Obamacare coverage. Iowa could be next: Half its Obamacare insurers announced this month that they would no longer participate in the marketplace. That leaves 94 of the state’s 99 counties with just one insurer — and regulators there aren’t totally sure that plan, Medica, will stick around.
“We don’t have any commitment from the two carriers that remain that they will be there,” says Doug Ommen, Iowa’s insurance commissioner. “They’re not required to file with us until June. Certainly we’re hopeful, but unless Congress acts, our market will continue to be very unstable.”
What happens if no one wants to sell coverage? Does the law have any fallback plan? The short answer is no. There is no backup plan for places where no insurer wants to sell Obamacare coverage.
Even before the election, some big insurers had decided that the Obamacare marketplaces were not good for their bottom lines. Aetna and UnitedHealth mostly withdrew in 2016, leaving lots of places with just one insurer.
Since the election, health insurers have only gotten more skittish. Humana announced in February that it would no longer participate. That left those 16 Tennessee counties without any plans, and many more counties with just one option.

Ryan’s Folly

The articles mentioned that Trump could call up providers and bully them into offering coverage. But does that make any sense from a party that wants to Kill Obamacare?

The system is set up to implode and there is no point to doing anything until it does. After an implosion, there will be bipartisan support to do something. Right now there is no bipartisan support to do anything.

The folly of House Speaker Paul Ryan’s ill-fated attempt to fix the problem is readily apparent.

His poor decision to attempt to fix the unfixable accomplished nothing useful, but it did move partial ownership of the problem to Republicans.

Mike “Mish” Shedlock

Obamacare Death Spiral: Insurers to Drop Plans Unless Premiums Rocket, “Something’s Got to Give”

“Something’s Got to Give” Fresh on the heels of an unbelievable CPI report that suggests healthcare costs only rose 3.6% in the past year, comes news that insurers want big premium hikes or they will get out of the Obamacare business.

Major Court Ruling Against Obamacare, Insurers Will Scream; Potential End of Obamacare

Healthcare insurers are already taking it on the chin. Some insurers got out of the healthcare business entirely, others stopped coverage in multiple states due to mounting losses.

Anthem Drops Obamacare in Ohio: 300,000 Without Insurance? Gruber Strikes Again

House Speaker Paul Ryan’s attempt to replace Obamacare was sheer madness. Left alone, Obamacare was imploding anyway. Republicans should have waited for Democrats to beg them to “do something”.

Move to Repeal and Replace Obamacare Underway: Only 50 Senate Votes Needed

At long last, Republicans have unveiled a plan to replace Obamacare. To do so, they will need nearly every Republican vote.

Obamacare Replacement an Impossible Nut to Crack

Obamacare replacement looks all but dead in the Senate. If by some magic it passes the Senate, it will still have to meet House approval.

CPI Shows Sharply Rising Medical Costs; Huge Obamacare Hikes Planned

The CPI came in exactly in line with the Bloomberg Consensus option today.

Aetna Admits Obamacare in “Death Spiral”: Can Trump Fix This Mess?

Earlier this week, Aetna’s CEO admitted something most of us knew long ago: Obamacare Markets are in a ‘Death Spiral’.

Obamacare on Death Bed as Enrollment is Half the Expected Rate (the Unprofitable Half)

Obamacare is facing the hard knocks of reality. Selling overpriced insurance to the healthy and underpriced insurance to the sick is not a good model for insurance companies.

Obamacare Repeal Dies Again: What the Hell is McCain Up To? Cruz?

Last week, Senator John McCain revived the Obamacare repeal idea with a declaration he would vote for repeal if the governor of Arizona backed the idea. The Governor backed the idea but Mccain reversed.