Congress Isn’t the Only Way We Could Lose Access to the ACA

Photo credit: TBIT, CC0 Public Domain.

So I don’t know where we’ll be, in terms of the House of Representatives voting on the American Health Care Act, when you read this. As I write it, I’ve got a livestream of the House debate going in another tab, and a pro-AHCA representative is literally speaking about how health insurance companies are exiting the ACA because it isn’t working for them—which is the very topic I wanted to write about.

Iowa Obamacare program on verge of collapse as congressional uncertainty takes its toll

Iowa’s last major Affordable Care Act insurer threatened on Wednesday to pull out from the state’s marketplace next year, the latest step in a sudden collapse of the state’s insurance marketplace that holds ominous signs for health care customers in states across the county.

If Minnesota-based Medica follows through on its threat not to sell plans in 2018, Iowa could be the first state to lack any insurers on its exchanges in all but a handful of counties.


Aetna announced Wednesday that it would pull out of Virginia’s individual marketplace next year, as it was on track to lose more than $200 million this year on insurance sales to individuals.

Even if the House votes no on the AHCA, or even if they vote yes and the bill goes to the Senate and they vote no, people can still lose access to Affordable Care Act insurance.

Is there anything we as individuals can do about this? Do we need start calling Aetna and saying… um… we won’t buy their insurance if they don’t remain in the ACA exchange? (How would we even do that? Most of us only have the opportunity to choose our insurers if we’re already in the ACA exchange; otherwise, our employer chooses. Maybe we could tell these companies that we won’t buy supplemental insurance through them, but if there’s no one else offering the supplemental insurance we need, then… see, this gets complicated really quickly.)

This isn’t a rhetorical question, by the way. It’s a real question. Even if the AHCA bill doesn’t pass (and the next AHCA bill doesn’t pass, and so on) insurers can still refuse to offer ACA marketplace plans, leaving plenty of people with no real access to health insurance.

Maybe all of these paths do in fact lead to ACA reform—in which case, I hope it is a reform that focuses on providing affordable care to everyone, and not one that focuses on profits.

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