Lawmakers are pressuring the Obama administration to figure out what to do for people with no Obamacare options next year.
That’s the situation for residents of Pinal County, a low-income area just south of Phoenix, where no insurers are planning to sell coverage through the online marketplace set up under President Obama’s healthcare law.
That presents a major problem for those without employer-sponsored coverage, many of whom could buy federally subsidized plans through the marketplace. As things stand now, they won’t have any marketplace options when enrollment begins Nov. 1, even though the law requires most Americans to have health coverage.
Pinal is the only county where officials know no insurers have filed to sell marketplace plans, although shoppers in many other areas of the country will have fewer options this year as insurers have pulled out. But the Obama administration’s response to the situation could have broad effects, if more counties lose Obamacare insurers down the road.
Republican Arizona Sen. Jeff Flake plans to introduce legislation this week aimed at the problem, although a spokesman said he is still considering a number of approaches and hasn’t settled on one.
“Sen. Flake won’t be waiting on the administration to clean up its mess in Pinal County,” Flake spokesman Jason Samuels said. “Residents can expect him to introduce a legislative solution soon.”
At least two insurers have filed to sell individual plans off the marketplaces in Pinal County, according to Arizona’s insurance commissioner. But that doesn’t solve the problem, as low and mid-income consumers can collect subsidies only through marketplace-sold plans.
The vast majority of Obamacare customers in Pinal, about 88 percent, qualified for federal assistance last year, receiving an average $230 per month to apply toward their health plans. Without subsidies, insurance is likely to be out of reach for many of them.
Last year, Aetna and Blue Cross Blue Shield of Arizona sold plans in Pinal County. But both insurers are pulling out of the upcoming enrollment season, citing unsustainable losses.
Arizona’s other senator, Republican John McCain, wrote the Centers for Medicare and Medicaid Services last week, asking the agency whether it has any contingency plan in place for Pinal residents and whether they’ll be exempt from the mandate to buy coverage.
“This potential gap in coverage is especially concerning as nearly 10,000 citizens are enrolled in the [Affordable Care Act] in Pinal County,” McCain wrote. “As a predominantly rural county in which 18 percent of the population lives below the poverty line, the impact will be felt particularly hard.”
Democrats representing Pinal County say they have been prodding the Centers for Medicare and Medicaid Services to come up with a solution for residents there and anywhere else with no marketplace options.
A spokeswoman for Rep. Ann Kirkpatrick said her boss spoke recently with CMS acting administrator Andy Slavitt and has called on Blue Cross Blue Shield of Arizona to keep selling marketplace plans in Pinal County, as it did last year.
“Congresswoman Kirkpatrick is working hard to ensure that Pinal County residents have health insurance options on the federal exchange for 2017,” said spokeswoman Jennifer Johnson. “This includes pushing elected officials and agencies at the federal and state levels to work together and find solutions.”
But it’s not clear what that solution might be. The Obama administration has said only that it’s working with Arizona to ensure residents have coverage next year, without clarifying whether any marketplace coverage will be available in the county.
“A number of steps remain before the full picture of this year’s marketplace competition is known,” Department of Health and Human Services press secretary Marjorie Connolly told the Washington Examiner.
The deadline for insurers to submit healthcare.gov plans for federal review was last month, so HHS presumably would have to waive the deadline for any additional plans to apply.
If no insurers can be persuaded to enter the marketplace for next year, approaches could include allowing Pinal residents to shop for plans offered in neighboring counties, a possible component of a Flake bill, or waiving their penalty for being uninsured. But it could be hard to craft a solution that doesn’t violate requirements set up under the Affordable Care Act.
Stephen Briggs, a spokesman for the Arizona Insurance Department, said there’s little his agency can do about the situation, since the federal government operates the state marketplace and is in charge of certifying its plans. But he said state regulators are in touch with CMS and are prepared to give as much “flexibility” to Pinal residents as they’re able to.
“We’ll do our best here to work it for Arizona, but it’s not a problem we created,” Briggs said.
Rep. Raul Grijalva, a Democrat whose district overlaps with the southwestern portion of Pinal County, has used the situation to call for a government-run, “public-option” plan, an idea liberals often espouse but which lacked enough political support to include in the 2010 Affordable Care Act.
The situation in Pinal “highlights the systemic problems of relying on only for-profit insurers to supply our nation’s healthcare and re-opens the debate surrounding a public option for healthcare,” Grijalva wrote in an Aug. 25 Time Magazine op-ed.
