Obamacare Death Spiral: First 2018 Coverage Map Reveals At Least 47 Counties With No Coverage

Earlier today the Centers for Medicare and Medicaid Services (CMS) released the first projected county-by-county map of Obamacare coverage for the 2018 plan year which depicts at least 47 counties, with 35,000 active Obamacare exchange participants, that will have no health insurance options next year.  Meanwhile, another 2.4 million people are expected to have only 1 option for coverage. Per CMS:

The Centers for Medicare & Medicaid Services (CMS) is releasing a county-level map of 2018 projected Health Insurance Exchanges participation based on the known issuer participation public announcements through June 9, 2017. This map shows that insurance options on the Exchanges continue to disappear. Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.


The CMS map displays point in time data and is expected to fluctuate as issuers continue to make announcements on exiting or entering specific states and counties. It currently shows that nationwide 47 counties are projected to have no insurers, meaning that Americans in these counties could be without coverage on the Exchanges for 2018. It’s also projected that as many as 1,200 counties - nearly 40% of counties nationwide – could have only one issuer in 2018. Currently, for 2018 at least 35,000 active Exchange participants live in the counties projected to be without coverage in 2018, and roughly 2.4 million Exchange participants are projected to have one issuer.  It’s expected that the number of consumers with no coverage choices will rise.


Of course, insurers are still in the process of determining which markets they'll serve in 2018 so the map above could theoretically get much worse.  As our readers are acutely aware, the overwhelming trend has been toward more withdrawals rather than less.  Here are just a couple of our recent notes on the topic.

As CMS Administrator Seema Verma points out, CMS and insurance commissioners around the country are working to slow the collapse of Obamacare but unilateral actions are by no means a "long-term solution" for a system which has clearly failed.

“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all. CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the Insurance Exchanges,” said CMS Administrator Seema Verma.

Meanwhile, as Credit Suisse analyst Scott Fidel points out today, Obamacare attrition levels continue to deteriorate year after year...which is probably not terribly surprising given the exponential premium increases.

Paid exchange members are down ~15% from 2017 OEP sign-ups: This afternoon the Centers for Medicare & Medicaid Services (CMS) released the February Effectuated Enrollment Snapshot. Effectuated enrollment (after premiums paid and any attrition) ended February at 10.3 million, or -15.4% below the 2017 Open Enrollment Period’s (OEP) ending number of plan selections of 12.2 mln. These attrition levels are slightly worse than the effectuated enrollment levels one-month following the 2016 and 2015 OEPs, which were down -12.6% (or -14.6% using revised 2016 data per below) and -12.8% respectively.


CMS provides updated & complete 2016 effectuated enrollment: In addition to the February 2017 data, CMS also provided updated and complete 2016 effectuated enrollment data. Recall, the prior administration stopped provided the quarterly effectuated enrollment updates after March 2016. As a result, we estimate that effectuated enrollment ended December 2016 at 9.1 mln, or -28.1% below the 2016 OEP ending plan selections of 12.7 mln. This attrition was worse than the 2015 effectuated enrollment at year-end which was 8.8 mln at December 2015, or -24.9% below the 2015 OEP plan selections of 11.7 mln.

Of course we suspect this stark reminder of the 'health' of the exchanges will have a minimal impact on Democrats who will continue to hail the 'great accomplishments' of Obamacare while the system literally, and quite tangibly, collapses in epic fashion all around them.  The ability to blindly and shamelessly support a partisan cause irrestpective of overwhelming facts proving the ineffectiveness of that cause is truly a talent reserved only for politicians.