CareSource steps in to cover last U.S. county without any ACA exchange coverage option in 2018

The “bare county” problem on the Affordable Care Act exchanges is no more—at least for now.

The Ohio Department of Insurance announced Thursday that CareSource will offer coverage in Paulding County, which was the sole remaining U.S. county without any on-exchange option in 2018.

The number of projected bare counties has fluctuated considerably since insurers began making filings to indicate their plans for individual market participation next year. At one point, it was as high as 82, per the Kaiser Family Foundation, but it has fallen thanks to insurers stepping in to fill the gaps in coverage—often following negotiations with state regulators.

Centene and CareSource have played a particularly large role in erasing bare counties, as the Kaiser Family Foundation’s Cynthia Cox pointed out on Twitter:

Centene, for example, announced in mid-August that it would step in to fill the 14-county coverage gap projected in Nevada. And in June, the insurer said it would cover several bare counties in Missouri.

CareSource, meanwhile, was one of five insurers that announced in July that they would collectively cover 19 of Ohio’s 20 projected bare counties.

The fact that all counties are expected to have at least one ACA exchange insurer next year is a blow to the oft-used Republican talking point that the marketplaces are “collapsing.”

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Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., meanwhile, tried to offer a solution for the possibility of bare counties by introducing a bill that would have let consumers without any on-exchange option use their tax credits to buy off-exchange coverage.

Despite Thursday’s announcement from Ohio, however, the exchanges are not out of the woods. Insurers have until Sept. 27 to finalize their plans for exchange participation, and there could be last-minute exits if steps aren’t taken to ensure the individual market is stable.

To that end, the Senate’s Health, Education, Labor and Pensions committee will hold four hearings in September to hash out a package for marketplace stabilization. The first two hearings are set for Sept. 6 and 7, and will feature testimony from governors and state insurance commissioners, respectively.

The governors set to testify include Republicans Charlie Baker of Massachusetts, Bill Haslam of Tennessee, and Gary Herbert of Utah, as well as Democrats Steve Bullock of Montana and John Hickenlooper of Colorado, according to an announcement.

As for what such a stabilization package will look like, a senior Democratic aide said Thursday during a breakfast hosted by the Alliance for Health Care Policy that while nothing is settled, members on both sides of the aisle have indicated that they want to address funding for cost-sharing reduction payments. Insurers have indicated in their preliminary filings that they could raise their rates or exit the marketplaces next year if they don’t receive clarity on funding for the subsidies.