Health care choices choked further

More than 2 million people could be bumped from insurance plans in 2017

“What if the dominoes begin to fall? There’s been no answer to that question.” Wayne Goodwin, North Carolina’s insurance commissioner

Up to 2.1 million people will probably have to change plans for 2017 because of insurers leaving states’ Affordable Care Act mar- ketplaces, up from more than 1.2 million who had to find new insurers last year. That doesn’t include the millions who bought new plans because they found a better deal.

The new estimates, from data expert Charles Gaba of ACASignups. net, came as an analysis showed five states are likely to have just one insurer on the 2017 Obamacare exchanges. Consumers in most counties in nine other states won’t find any competition for their exchange business either, according to the Kaiser Family Foundation.

These latest assessments show how leery insurers are of the costs and rules associated with selling on the ACA exchanges — the centerpiece of the health law — and the risks this reticence present to their future. Insurers including Aetna, UnitedHealthcare and many smaller insurers and cooperatives have either decided to leave states and counties or have failed. Julie McPeak, who was appointed Tennessee’s insurance commissioner by Republican Gov. Bill Haslam, told The Tennessean that the ACA marketplace for the state was “very near collapse.”

The turmoil puts intense pres-

sure on federal regulators to stabilize the system, lower costs for consumers and reduce risks for insurers — often conflicting challenges that create a Catch- 22. Among other changes, the Centers for Medicare and Medicaid Services proposed Monday to have its risk adjustment program factor in prescription drug usage and the people who drop their coverage before 12 months are up.

Insurers need healthy people to buy insurance to offset the companies’ costs of covering sicker ones, but healthy consumers who don’t qualify for high subsidies won’t sign up unless the prices are more affordable, says Paul Howard, health policy director of the free market Manhattan Institute.

“It’s important that enrollment continue to grow,” so the ACA sign- up period that starts Nov. 1 will be critical, says Kaiser Family Foundation’s Gary Claxton.

Although the health law hasn’t become the hot button issue it was in the past presidential election, the Obama administration must make changes against a backdrop of fierce partisan opposition to Obama’s signature law. No one expects solutions requiring congressional action before the elections in November.

“This is probably the most frustrating public policy dilemma we’ve got right now in the country,” says Wayne Goodwin, North Carolina’s Democratic insurance commissioner. “Businesses and health insurance companies have invested so much into the ACA, there is a tremendous urgency to having Congress and whoever the new president is fix the law.”

South Carolina and Alabama are grappling with what will probably be no competition for the first time in 2017 after insurers Aetna and United Healthcare announced plans to leave the states. The Kaiser analysis shows 31% of counties will probably have just one insurer in 2017 and another 31% just two.

Kevin Counihan, CEO of HealthCare. gov, which handles the exchanges for 38 states, emphasizes insurers are adjusting at different rates to selling on the exchanges. After Aetna announced this month it would stop selling on the exchanges for 11 states, he said, “The future of the marketplace is strong.”

Arizona faces one of the country’s most dramatic swings in in- surer participation on the ACA exchange: 80% of the counties are served by just one insurer. Pinal County is the only county in the USA without an insurer on the exchange for 2017.

Multiple insurers are discontinuing “off- exchange” plans.

Arizona’s upheaval ensnared Leah Sondergeld, whose daughter, Kate, was diagnosed in 2015 with epilepsy. Kate’s condition made her family’s need to change insurers for a third time this fall all the more upsetting now that Aetna is leaving the state. Sondergeld dreads the thought of possibly having to find a new neurologist to treat Kate. After her first exchange insurer went out of business in late 2015, the Sondergelds switched to UnitedHealthcare but quickly dropped the plan when it wouldn’t cover a test and Kate’s drugs.

“We are a good family. It’s not that we’re not trying,” says Sondergeld, a former nail salon owner whose husband is self- employed. “It’s a struggle.” How other states fare:

In North Carolina, where the Kaiser analysis shows 90% of the counties will have just one insurer, Goodwin is bracing to find out whether even that insurer will leave the state.

Charlotte pet sitter Margaret Brawner pays the tax penalty and out- of- pocket for doctor visits rather than the “unaffordable premium and ridiculously high deductible” she faced in 2015. She’s in good health but says it’s “people who need frequent access to medical care with no subsidy that it really hurts.”

In Kentucky, Aetna and UnitedHealthcare will not offer plans on the exchange next year. Sarah Halfacre, 35, an occupational therapist and single mom of two, worries that after struggling to find a UnitedHealthcare plan and working out an arrangement with her student loan lender to afford the $ 340 premium, her only choices may cost more.

In Iowa, 2017 is shaping up to be fairly stable. Mara Deaton of Des Moines will keep her Aetna policy as hers is one of the four states the company will remain in. Deaton, 61, says the exchanges are “having growing pains,” but she is grateful to have insurance as she was treated for a lifethreatening breast cancer more than a decade ago.

The insurance changes have left others in Arizona nervous.

Claburn Niven Jones, who owns a Scottsdale home and San Mateo, Calif., condo, said the insurance shakeout forced a decision to relocate full time to California in 2017. The 63- yearold cancer patient and retired accountant said he doesn’t think there will be enough insurers and doctors for the 126,000 Maricopa County residents who will need plans. “If you add them all up and throw them into a network, you’ll never see a doctor,” he said.

North Carolina’s Goodwin told Health and Human Services in February that he worried some residents would have “no access to health insurance at all.”

“What if the dominoes begin to fall?” Goodwin said Friday. “There’s been no answer to that question.”