RICHMOND, Va. — Virginians who buy health insurance on their own and not through an employer may have nowhere to buy it from next year in several counties and cities across the state.

Four health insurers have pulled out or reduced their participation in the federal health law’s insurance marketplace in Virginia, driven in large part over the fate of billions of dollars in payments from the federal government to cover cost-sharing reductions for customers with modest incomes. The estimated $7 billion a year “cost-sharing reductions” have been challenged by Republicans in court, and President Donald Trump isn’t offering any long-term guarantees the payments will continue.

“This falls in Washington’s lap,” said Secretary of Health and Human Resources Dr. Bill Hazel. “They’ve managed to manufacture a crisis that they saw coming.”

The so-called “bare” counties and cities that currently have no individual health insurance plans available for next year are largely in rural areas around the state, including Roanoke and most parts of southwest Virginia. Last week, Optima Health said it would no longer offer individual plans in certain parts of the state. The company slightly modified its plans Tuesday, leaving 44 counties and 14 cities still bare, according to State Corporation Commission spokesman Ken Schrad.

There are also five counties where part of the county will have coverage available, he said.

About 60,000 Virginians who currently have insurance through the marketplace won’t be able to buy insurance next year unless new insurers are found, Hazel said.

In some of the bare areas, Anthem will offer “off-exchange” where customers won’t be able to use tax credits or subsidies to buy a plan. But Doug Gray, executive director of the Virginia Association of Health Plans, said those areas area currently limited to the city of Bristol and Scott County and Washington County.

The Kaiser Family Foundation identified Virginia as the only state in country with counties and cities that are currently without options next year on the individual marketplace, The Roanoke Times reported Tuesday . Earlier this year, well over 40 mostly rural counties around the country faced the prospect of having no options for their exchanges next year, but insurers have gradually come forward to fill the gaps.

Insurers have been pulling back from the exchanges for a few years now, after getting stung by heavy losses and struggling to attract enough young, healthy customers to balance all the claims they get from people who use their coverage.

Coverage choices have grown particularly thin in rural areas. Those markets are uninviting for insurers because they usually have a smaller, older customer base and a care provider like a hospital system with a dominant market position. That can make it difficult to negotiate payment rates.

But Gray said uncertainty over the future of former President Barack Obama’s health care law, and the cost sharing reduction payments in particular, that the main reason why so many Virginians are at risk of not being able to buy insurance next year.

“None of this is a mystery,” he said. “It’s the uncertainty that something that is required to be funded will be funded.”

Schrad said the state is “aggressively working” to attract new insurers to cover the bare areas and Hazel said Anthem has told him it is rethinking parts of its planned withdrawal. Insurers have a Sept. 27 deadline to sign up if they want to participate in the exchange next year.

Hazel said the state can only do so much to persuade new insurers to come to Virginia and said he thinks it will take an act of Congress to solve the problem.

“And I cannot handicap them these days,” he said.


Information from: The Roanoke Times, http://www.roanoke.com