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The ACA's 'bare county' problem disappears

Speaker Paul Ryan said this week there are "dozens of counties around America that have zero insurers left." As it turns out, he was off by dozens.
Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on Feb. 5, 2015 in Miami, Fla. (Joe Raedle/Getty)
Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on Feb. 5, 2015 in Miami, Fla. 
By Steve Benen, Steve Benen

At a town-hall forum this week, House Speaker Paul Ryan (R-Wis.) pointed to a specific concern when making the case that "Obamacare is not working." As Congress' top Republican argued, "We've got dozens of counties around America that have zero insurers left. So doing nothing really isn't an option."

It's generally known as the "bare counties" -- or "bald spot" -- problem. Under the Affordable Care Act, consumers purchase coverage from private insurers, but if someone lives in an area in which no insurance company is participating in an exchange marketplace, there's an obvious problem.

But as is too often the case, Ryan flubbed the details. Last week, in a nation of 3,000 counties, there were just two with no participating insurers. By the time the Speaker of the House was making his criticism, there was just one "bare" county. And as of this morning, as the Associated Press reported, we're down to literally zero.

The lone county currently at risk of going uncovered on the federal health law's insurance exchanges has landed an insurer.CareSource will step up to provide health insurance coverage in Paulding County, Ohio, in 2018, The Associated Press has learned. The company and state Department of Insurance planned to announce the arrangement Thursday.

So, as things currently stand, the Kaiser Family Foundation map of areas with no insurers in the marketplace is itself bare. Paul Ryan said on Monday there are "dozens of counties around America that have zero insurers left," and while that may have seemed likely at one point in the recent past, as of now, he was off by dozens.

This is not to say the Affordable Care Act is suddenly on easy street. It's not. Donald Trump is still threatening to sabotage the law; Republican antics have spooked insurers and caused premium increases; and many GOP policymakers are still exploring every possible repeal option they can think of.

But for seven years, the right has tried to identify critical, existential threats to "Obamacare." For seven years, each of these threats has come and gone, and the ACA is still standing.