ACA exchange bare spots re-emerge in Virginia following Optima Health's pullback

Virginia is set to have 63 counties without an ACA exchange insurer next year. (Getty/FotoMak)

The Affordable Care Act’s “bare county” problem is back.

Just weeks after CareSource stepped in to cover the last U.S. county without an on-exchange coverage option, a different insurer said (PDF) it will reduce its individual plan offerings in Virginia.

Optima Health’s decision increased the number of bare counties from zero to 63, per the Kaiser Family Foundation, which estimates there are 70,356 enrollees in those counties. Since insurers began making their filings for 2018, the highest number of projected bare counties at any one point has been 82.

In a statement about its ACA exchange participation next year, Optima Health said the exit of three major carriers—Anthem, Aetna and UnitedHealth—from Virginia’s marketplace, plus the uncertainty in Washington, “presented unprecedented circumstances.”

“The decisions we made were challenging ones given the recent changes and ambiguities in the marketplace,” said Michael M. Dudley, Optima Health’s president and CEO. “The only other alternative would have been to completely exit the exchange, and that goes against our mission,” he added.

Since insurers have until Sept. 27 to finalize the marketplace participation filings, it’s possible that Optima Health could still change its mind, or that another insurer could step up to fill the coverage gap. However, bare spots could appear during the coming weeks in other parts of the country—especially if it appears unlikely that Congress can guarantee funding for cost-sharing reduction payments.

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Anthem, for example, continues to announce marketplace exits—though its two most recent pullbacks haven’t increased the number of bare counties. The insurer said Wednesday that it will reduce its individual plan offerings in Kentucky to 59 counties next year, down from 120 this year. Last week, it said it would exit 17 of the 85 counties in Missouri where it sold individual plans this year.

For 2018, Anthem plans to completely exit the exchanges in Virginia, Nevada, Wisconsin, Indiana and Ohio. In addition to Kentucky and Missouri, it will also reduce its on-exchange presence in California and Georgia.