Optima’s Virginia exit reignites Obamacare’s bare county problem

A Virginia insurer revived Obamacare’s “bare county” headache late Wednesday by announcing it will exit a huge swath of the state next year.

Gov. Terry McAuliffe said Optima’s withdrawal will leave 62,000 people in 63 of the state’s 95 counties without an option on the Affordable Care Act’s marketplace in 2018, unless another company steps up to fill the void.

Most of the affected consumers live in rural areas, where access to doctors and care is “already limited,” he said.

Optima said it decided to exit certain markets because three national insurers — Aetna, Anthem and UnitedHealthcare — already withdrew, and because uncertainty in Washington “presented unprecedented circumstances.”

The company said it will only remain in parts of the state with a specific nonprofit chain of hospitals and doctors, where they feel they can adequately manage consumers’ care and resulting costs.

Insurance regulators across the country worked around the clock in recent months to fill counties after a string of insurers, fed up with diminishing financial returns, decided to flee the marketplace set up by President Obama’s signature law.

Nearly seven dozen counties covering over 90,000 people had at some point faced the prospect of having zero options next year, fueling President Trump’s claim the law was “imploding” and needed to be replaced.

Obamacare’s champions declared victory in late August, when Ohio regulators said they convinced a nonprofit insurer to cover the final bald spot in the nation — Paulding County — though Optima’s announcement will reintroduce the problem and a scramble to fix it.

Exiting insurers have blamed both the law itself — it failed to attract enough young and healthy customers to balance out an influx of sicker, costlier ones — and the uncertainty instilled by Mr. Trump’s wavering commitment to “cost-sharing” payments for insurers and the individual mandate that requires people to get health insurance or pay a tax.

Mr. McAuliffe, a Democrat, drew a straight line between the company’s decision and Mr. Trump’s wavering commitment to the law.

“This and other recent departures by insurers are avoidable if the president and Congress would simply follow the law and implement the Affordable Care Act as written,” he said in a statement.

The Senate Health Committee launched a politically ambitious effort Wednesday to pass a bill that stabilizes Obamacare’s markets. Bipartisan leaders want to give states more control over their markets, a priority for Republicans, in exchange for funding the cost-sharing payments that Mr. Trump has threatened to withhold.

“We need action to sustain the Affordable Care Act and we need it now,” Mr. McAuliffe said.

Optima said seven out of every 10 of its remaining customers in Virginia will see a minimal rate hike in 2018, due to taxpayer-funded subsidies that rise with premiums.

However, the 30 percent who don’t qualify for assistance will see a whopping 80-percent increase. The company said 20 percent of the rate hike is due to the uncertainty around the cost-sharing payments that reimburse them for picking up low-income customers’ costs.