The ongoing American health care saga is as confusing as it is consequential. While cable TV covers the ongoing developments surrounding the Affordable Care Act, it’s easy to forget people’s lives hang in the balance. The political fights carry on in the Trump presidency, and Americans know one thing for sure: They want health care coverage.
And they want it to be affordable and accessible. But political gas-lighting, mass confusion about what these laws do, and the reality television-style hoopla involved all make it very difficult to know what’s going on.
The Affordable Care Act has been the law of the land since 2010. It’s been far from perfect. Some folks have seen their costs increase dramatically. But there are now 20 million more people with insurance than there was before, and many have had their lives saved due to some of the law’s coverage mandates.
Still, there is a lot of resistance to the law. Some of it is ideological, and some of it comes from industry groups, such as insurance companies and hospitals. It’s difficult to provide plans for everyone in America, especially given that the population is so spread out, diverse, and, in some places, sick.
Many states are seeing insurers flee, leaving people with no choices and no health care coverage. Instead of working with the existing law, President Donald Trump has threatened to withhold federal funding and let those in troubled markets suffer. It’s difficult to explain exactly what’s going on. But there are issues that need to be resolved, and certain policymakers are reluctant or outright refusing to deal with it.
If Trump holds fast to his promises (or threats) and insurers continue to flee certain states, these 15 states (in no particular order) could be hit the hardest.
An analysis from Vox, which worked in concert with a specialist from the Robert Wood Johnson Foundation, looked at what would happen if four of the nation’s largest insurers (Anthem, Centene, Cigna, and Molina) left each state. Iowa could face a crisis as 94 of its 99 counties could soon be without any Obamacare plans. Again, this isn’t a foregone conclusion, but it is a peek at what could happen very soon if fixes aren’t made.
Another state we pulled from the Vox analysis, Missouri could also see a significant portion of its counties without any insurers. Like in Iowa, the majority of these counties are places that aren’t really attractive to insurers, meaning it would be hard for them to turn a profit in these regions. Low or sick populations are the primary reasons, and even though Americans are now facing a mandate to purchase coverage, people in these areas could find themselves with nowhere to turn.
Kentucky has been at the front and center of the health care debate since the beginning. Portions of Kentucky have seen the insured rate climb higher than anywhere else in the country, yet the state overwhelmingly supported Trump and Republican policymakers in 2016 — those who want to strip their coverage away by repealing Obamacare and replacing it. The Vox analysis said 59 counties could be without an insurer if Anthem left.
Kentucky’s neighbor, Tennessee, has also had a very turbulent time in the past several years in trying to adapt to new health care rules. And like Kentucky, there’s the potential for disaster if fixes aren’t implemented. The Vox analysis shows huge swaths of the state are left with only one insurer, and things could get worse. If Cigna exited the state, it would leave 14 counties with no insurers.
There’s one more state specifically mentioned in the Vox analysis: Mississippi. Mississippi, of course, is a Southern state that, like many others on this list, primarily votes Republicans into office. That might come back to bite the state’s residents as they face a shortage of insurers. Only one company, Centene, serves the state under Obamacare. But if it leaves, Mississippi could end up in a bind.
6. South Carolina
There’s a fairly common theme among most of the states constituting this list: Their residents voted for Trump, who promised to repeal Obamacare. This, of course, is going to hurt them if they lose coverage, and the story is the same in South Carolina. South Carolina is one of a handful of states mentioned in an analysis from the Kaiser Family Foundation, where the number of insurers could drop to one, making coverage harder to get and more expensive.
Sooners might find themselves in a health care crisis sooner rather than later. Oklahoma is another one of the states pointed out by the Kaiser Family Foundation’s analysis, saying at some point in 2017, all of the state’s counties could have only one insurer. That’s bad news for those who want the exchange to work by promoting competition for better care and prices.
It doesn’t get much bigger and much more rural than Alaska. And that can make offering health care coverage a logistical nightmare. Because hospitals and doctors are few and far between, health care costs can be much higher than in other states. For that reason, insurers aren’t exactly lining up to offer plans. Alaska could also end up with only one insurer for the whole state in 2017.
Another deep red state, Alabama is another mentioned by the Kaiser Family Foundation’s analysis. And like the preceding states, Alabama could soon only have one insurer offering marketplace options in all of its counties unless some changes are made. If nothing is done, then people could lose coverage or see prices increase.
10. North Carolina
Like is neighbors to the south and east, North Carolina is also facing a health care scare. Those in the state who are looking to buy coverage through the marketplace are seeing higher premiums and fewer options. And, as you might have guessed, if nothing is done about it the problem will get worse. If Republicans eventually manage to repeal the Affordable Care Act, the situation could get even uglier.
Arizona faces a number of logistical hurdles. It’s largely rural, though there are a few major population centers. And prices have been going up steadily over the past couple of years, with some plans doubling in price this year alone. But insurers are exiting. Some have left the state, leaving people with fewer marketplace options. That makes for hundreds of thousands of people with few, if any, options.
12. West Virginia
Again we have a rural, Republican-leaning state that could run into some real problems very quickly. West Virginia has two insurers in its marketplace, according to the Kaiser Family Foundation, but it might lose them. Things could get worse in the state if Obamacare eventually collapses. As many as 184,000 people in West Virginia would lose coverage, and the state would lose $164 million in federal funding.
You know the archetype by now: a large, rural, Republican-leaning state with thousands of people benefiting from the Affordable Care Act. And yet, the majority of them supported candidates promising to repeal it. The story’s the same in Nebraska. As of 2017, it has seen the number of insurers in the state cut in half from four to two, according to the Kaiser Family Foundation.
Ohio is an incredibly important state politically. Its large population has assured there are many insurers willing to play ball, but there are still issues to be worked out. Although the state is in fair standing overall, certain counties could run into trouble in the near future as insurers flee. Again, they would be mostly rural counties with sicker, older populations.
Georgia is the final state on our list, and like many others it’s a Republican-leaning Southern state. According to the Kaiser Family Foundation analysis, three insurers left the fray in 2017. And like Ohio, the state’s real issues lie in a set number of counties that could lose more insurers. That, naturally, would mean higher premiums and fewer options. Georgia isn’t in as much danger as its neighboring states, Alabama or South Carolina, but a good number of people could see a disruption.