Advocates fear 'crisis in rural counties' if Affordable Care Act marketplaces aren't stable in 2018

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Rural areas, which already have fewer options than urban areas under the Patient Protection and Affordable Care Act, could "be hit particularly hard if Congress and the Trump administration don’t send clear signals that they’re committed to helping keep Obamacare’s insurance marketplaces stable next year," Rachel Roubein reports for The Hill Extra. Alan Morgan, CEO of the National Rural Health Association, said "a 'crisis in rural counties' is possible without more clarity." He told her, “Without any intervention, this is going to be a mess.”

In 2017 about 41 percent of rural counties had only one Obamacare health insurer, Roubein notes. There is fear that "without certainty, insurers could exit marketplaces, leaving rural areas without any carriers," she writes. "Rural hospitals could then be tasked with providing care to a population that could be increasingly uninsured." Cynthia Cox, associate director of Kaiser Family Foundation’s Program for the Study of Health Reform and Private Insurance, told Roubein, "It really does all come down to that one company's decision about whether to stay or go."

House Republicans are trying to revive their bill to repeal and replace Obamacare, which fell apart last month. "Meanwhile, insurers are readying their rates for plan year 2018 and want to know that they’ll continue to receive payments for providing their consumers with cost-sharing reduction subsidies," Roubein reports. "The White House hasn’t been particularly clear on what it will do, as Trump floated the possibility of ending the payments to force Democrats to the healthcare negotiating table. Health executives met a top Trump health official on Tuesday but came out with no assurances."