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CLEVELAND — An insurer has stepped up to sell individual health insurance policies to the last county in the United States without coverage in 2018, signaling the resilience of an Obamacare market that had been forecast to fail.

The Ohio-based insurer CareSource has struck an agreement to sell policies in Paulding County, in the northwestern corner of the state, ending months of efforts by insurance commissioners nationwide to maintain coverage despite decisions by major insurers to bolt from the individual market.

The deal was a win for Obamacare, which survived a Republican repeal effort and uncertainty created by the Trump administration’s refusal to guarantee that it would continue to pay cost-sharing subsidies that support the individual exchange market.


“Working through this challenge has been a priority for the department and our staff in recent weeks and I’m proud of the collaborative approach insurers have been willing to take so that we could come together and solve this problem,” Ohio insurance commissioner Jillian Froment said. “There is a lot of uncertainty facing consumers when it comes to health insurance and these announcements will provide important relief.”



In a statement CareSource President Pamela Morris said, “The Marketplace provides vital health care coverage to more than 10.3 million Americans and we want to be a resource for consumers left without options. Our decision to offer coverage in the bare counties speaks to our mission and commitment to the Marketplace and serving those who are in need of health care coverage.”

Earlier this year, more than 40 mostly rural counties across the country faced the prospect of having no options for their exchanges. Insurers who withdrew cited steep losses and a lack of clarity over the future of President Obama’s Affordable Care Act. Many counties still have only one insurer, and premiums in many regions will increase significantly next year due to the financial pressures facing insurers.

Republican governors keep market intact

On Wednesday, the Centers for Medicare and Medicaid Services issued a press release noting that Paulding County was the only area left without an insurer. The release added: “It’s also projected that 1,478 counties — over 45 percent of counties nationwide — could have only one issuer in 2018. This could represent more than 2.6 million Exchange participants with only one health insurance option, which means they will not have any choices.”

However, Thursday’s announcement means there will be no gaps in coverage. And ironically, it was primarily the work of Republican governors that prevented the market from crumbling.

In Ohio, Republican John Kasich, an opponent of Trump’s in the presidential election and supporter of Obamacare’s Medicaid expansion, worked with insurers to fill the gaps. Earlier this year, Anthem Blue Cross and Blue Shield pulled out of the state, as did Dayton-based Premier Health Plan, leaving 20 counties without coverage for 2018.

In the end, Kasich’s administration struck arrangements with five different health plans to provide coverage, including CareSource, Medical Mutual of Ohio, Buckeye Health Plan, Molina Healthcare of Ohio, and Paramount Health Plan.

Prior to Thursday, several other states also struck deals with insurers to fill gaps left in their markets. Anthem pulled out of Nevada earlier this month, but Republican Gov. Brian Sandoval’s administration reached an agreement with Centene Corp. to provide coverage.

Still, the longer-term viability of Obamacare remains under debate in Congress. “Making sure coverage is available has been our goal through this process, but this is a temporary solution and one that only applies to 2018,” Froment said. “Beyond that, insurers are still looking for predictability in the health insurance market. Now is the time for Congress to work on reforms that will strengthen our health insurance markets in ways that improve access and affordability.”