A new study from the Kaiser Family Foundation shows that the dwindling number of insurers participating in public exchanges set up under the Affordable Care Act (ACA, also known as Obamacare) is much harder on people in rural communities than on city dwellers. Larger urban areas are more likely to have at least two insurers to choose from, giving those payers an incentive to offer lower rates. However, insurers often have a monopoly by default in rural areas—if there are any companies offering coverage at all. Overall, consumers buying health insurance for the first time on a public exchange this fall (as well as those re-enrolling for existing coverage) will have fewer choices, regardless of the environment they live in. Come 2017, 62% of enrollees will have a choice of three or more insurers, compared with 85% this year. Worst of all, 19% of enrollees could have just one insurer accessible. The biggest contributor to the problem, according to Kaiser, is United Health’s decision to drop out of most markets; the company will offer coverage under ACA only in New York, Nevada, and Virginia next year, down from 34 states in the most recent enrollment period. Aetna is also cutting way back on its participation in public exchanges. Both companies say participating in most ACA exchanges is simply not profitable. Foreboding as the trend is for the public, it could signal an opportunity for urgent care to step in and provide high-quality care that costs less than the emergency room for cash-paying patients.

Rural Areas Suffer Most When Insurers Drop Out of Public Exchanges
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