Whether or not Obamacare will explode in the near future is a matter of debate.
But if it does, it likely wouldn’t be a massive death spiral across all 50 states. It would die in specific regions because all the insurers there pull out.
Knoxville, Tennessee, may be the first place where Obamacare fails. Humana, the only insurer on the exchange there, is exiting the market in 2018. Unless another carrier steps in, roughly 40,000 people in the 16 counties in and around Knoxville could be left without the option to buy a subsidized insurance policy.
The lack of competition on many of the exchanges is one of Obamacare’s biggest problems. One in five consumers have only one choice this year, up from 2% in 2016, according to the Kaiser Family Foundation.
Pinal County in Arizona almost became the first Obamacare casualty last year after Aetna scaled back its participation. But the Obama administration and state regulators worked to bring Blue Cross Blue Shield of Arizona back to that area, said Cynthia Cox, associate director at the Kaiser Family Foundation. It had pulled out earlier.
Knoxville residents, however, may not be as fortunate. Insurers in Tennessee and nationwide are even more skittish about playing on the exchanges with all the uncertainty surrounding President Trump and Congress’ plans to repeal and replace the Affordable Care Act. More large players, including Anthema, Aetna, and Molina Healthcare, have said they are evaluating their involvement next year. Insurers have to start submitting their 2018 plans and premiums in coming weeks.
Tennessee already lost three other insurers in recent years. UnitedHealth and Assurant Health both pulled out, while Community Health Alliance, the state’s co-op insurer failed in 2015. Premiums jumped between 44% and 62% this year.