It is official that Affordable Care Act plans will be sold in every part of the U.S. next year. About 20 Ohio counties could have been left without ACA coverage in 2018, according to the state, causing about 11,000 people to lose their coverage. The state’s insurance regulators have now found insurers to cover every one.

A small Ohio county that would be the last one not covered has received notice that CareSource, a nonprofit health insurer, will sell coverage in the county. Paulding County, in the northwest corner of the state, had been left without ACA coverage for 2018 after Anthem Inc. pulled out. CareSource Chief Executive Officer Pamela Morris said in a statement, “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.”

About 10 million people are currently served through HealthCare.gov and its state counterparts created under the Affordable Care Act. There had been predictions that some Americans wouldn’t have access to coverage under the law in 2018. People in places without Obamacare plans can still buy health insurance, but wouldn’t have access to the subsidized coverage available under the law.

Many of the large, publicly traded companies have pulled back from the law due to uncertainties in the market. Insurers were hit with heavy losses after struggling to attract enough young, healthy customers to offset the claims from those with health issues. It is still possible that insurers will decide to pull out of some markets before the late September deadline to sign contracts with the federal government to offer coverage on the exchanges.

At various points this year, more than 90 counties across the United States risked not having any insurers offering marketplace coverage for 2018. Small, rural counties have had the most trouble securing insurers due to their smaller, older customer base. These counties usually have a care provider, like a hospital system, that has a dominant market position making it difficult to negotiate payment rates.

The Trump administration has backed efforts to repeal the Affordable Care Act, saying law has “failed to deliver.” President Trump has threatened to cut off important subsidies to insurance companies, known as cost-sharing reduction payments. Last week, the federal government announced that it will make these payments for this month, but their future is unclear.

Consumers still face few or no choices in some places because of the pullbacks. About 2.5 million people, or 23 percent of ACA customers, live in counties where only one insurer will offer coverage next year. Another 26 percent live in counties that will have two options.

Matt Lloyd, a spokesman for the Department of Health and Human Services, said, “On [the ACA] exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country, and choices continue to vanish.” Republican Gov. John Kasich of Ohio has been part of a bipartisan governors’ group calling for a compromise on the health care law to stabilize the insurance markets.

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