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President Barack Obama (foreground, with back to camera) visited Milwaukee in March 2016 to mark the city's progress in enrolling residents on the Obamacare marketplace for health insurance. (Rick Wood/Milwaukee Journal Sentinel) President Barack Obama (foreground, with back to camera) visited Milwaukee in March 2016 to mark the city's progress in enrolling residents on the Obamacare marketplace for health insurance. (Rick Wood/Milwaukee Journal Sentinel)

President Barack Obama (foreground, with back to camera) visited Milwaukee in March 2016 to mark the city's progress in enrolling residents on the Obamacare marketplace for health insurance. (Rick Wood/Milwaukee Journal Sentinel)

Tom Kertscher
By Tom Kertscher August 4, 2017

Nearly half of counties have no providers or one for health insurance on the Obamacare exchanges?

Two Republican talking points in attacking Obamacare are particularly prominent.

One is that the health care law has failed, as House Speaker Paul Ryan declared in a January 2017 claim that, in one form or another, continues to be repeated. We rated it Mostly False.

The Affordable Care Act did not meet all its promises, including a big one -- that you could keep your insurance plan if you liked it. But health care costs have risen more slowly since the law took effect and the law has met its major goal of getting more people insured, an estimated 20 million.

Another Obamacare attack, often stated in the same breath, is that in much of the country health insurance providers are drying up.

One of Ryan’s fellow Wisconsin Republicans, U.S. Rep. Sean Duffy, made that claim July 20, 2017, in a television interview on EWTN, a Catholic network.

"We let Democrats off the hook," Duffy said. "They gave us a failing health care package. You have almost half the counties in America that have one provider or no provider for insurance. This law is crumbling."

Markets with fewer insurers have been linked to fewer affordable choices for health insurance and higher prices.

As we’ll see, Duffy might be right -- but he’s a bit ahead of it’s time.

Trump’s similar claim

To be clear, Duffy is referring to the relatively few Americans who buy their own health insurance on the Obamacare exchanges, not the vast majority who are covered by an employer or a government program such as Medicare.

In March 2017, when President Donald Trump claimed that one-third of the nation’s counties "only have one insurer left" on the exchanges, PolitiFact National’s rating was True. There was only one insurance provider to choose from in 32 percent of the nation’s counties, based on figures from the nonprofit Kaiser Family Foundation, a respected authority on health care.

But that was four months before Duffy’s claim. And Duffy’s claim goes further than those made by many Republicans.  

Duffy’s evidence

To back Duffy’s statement, his office cited a June 2017 analysis by the New York Times. It estimated that 1,433 counties -- or about 45 percent of all counties -- are expected to have one insurer or no insurers in the Obamacare marketplaces, unless another carrier steps in. The marketplaces are where 12 million people buy their own coverage.

The Times said it used Kaiser data showing which companies currently offer plans in each county, and combined that with announcements from insurance companies saying which counties they plan to exit or enter in 2018.

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So, the 45 percent is an estimate for 2018, not a current count.

Currently, according to the article and Kaiser data, 1,036 counties have one provider.

That’s 33 percent of all counties.

There aren’t any counties right now that have no insurers on the exchanges.

Other views

The Robert Wood Johnson Foundation, a nonprofit research group, also confirmed that 33 percent of counties in 2017 have only one health insurer on the exchanges. And, like the Times, it estimates that in 2018, 45 percent of counties will have one insurer or none.

Two health care experts, however, told us it’s too soon to say whether the 45 percent figure will be accurate.

Cynthia Cox, the associate director of Kaiser’s program for the Study of Health Reform and Private Insurance, said most states haven’t disclosed enough information publicly to make such an estimate.

And Urban Institute health policy fellow John Holahan said that while 45 percent might be a fair estimate currently, the percentage likely will turn out to be lower because more insurers will probably enter the exchanges for 2018.

(By the way, Wisconsin tends to fare well on these measures. In 2017, according to Kaiser, the number of insurers on the exchanges ranged from 1 -- in Alabama, Alaska, Oklahoma, South Carolina and Wyoming -- to 15 in Wisconsin. The average was four.)

One note before we close:

Counties with one provider or no provider are concentrated in rural areas. So, even though one-third of counties currently have only one insurer, only about one in every five people who buy that insurance is affected.

Our rating

Duffy said: "You have almost half the counties in America that have one provider or no provider for insurance" on the Obamacare exchanges.

Currently, 33 percent of counties have only one company selling health insurance policies to individuals on the Obamacare exchanges. There are no counties that have no providers.

The element of truth in Duffy’s claim is that the New York Times estimates that in 2018, 45 percent of counties will have one provider or no providers. But that’s a projection and the article notes that the current figure is 33 percent.

We rate Duffy’s statement Mostly False.

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Mostly False
"You have almost half the counties in America that have one provider or no provider for insurance" on the Obamacare exchanges.
In an interview
Thursday, July 20, 2017

Our Sources

EWTN, Sean Duffy interview (4:50), July 20, 2017

Email, Sean Duffy spokesman Mark Bednar, July 24, 2017

New York Times, "For the First Time, 45 Counties Could Have No Insurer in the Obamacare Marketplaces," June 9, 2017

PolitiFact National, "Donald Trump: One-third of counties have only one insurer on Affordable Care Act exchanges," March 13, 2017

Kaiser Family Foundation, associate sirector for the Program for the Study of Health Reform and Private Insurance Cynthia Cox, July 24, 2017

Kaiser Family Foundation, "Counties at Risk of Having No Insurer on the Marketplace (Exchange) in 2018," July 12, 2017

Kaiser Family Foundation, "Insurer Participation in the 2017 Individual Marketplace," accessed July 24, 2017

Kaiser Family Foundation, "Insurer Participation on ACA Marketplaces, 2014-2017," June 1, 2017

Robert Wood Johnson Foundation, "Marketplace Pulse: Bare County Jamboree," July 19, 2017

Heritage Foundation, "Insurer ACA Exchange Participation Declines in 2016," March 14, 2016

Urban Institute, "Cross-Cutting Issues: Insurer Participation and Competition in Health Insurance Exchanges: Early Indications from Selected States," July 2013

Email, Mark Pocan spokesman Ron Boehmer, July 24, 2017

Interview, Urban Institute health policy fellow John Holahan, July 24, 2017

Email, Robert Wood Johnson Foundation senior adviser to the executive vice president Katherine Hempstead, July 25, 2017

Los Angeles Times, "Obamacare is only 'exploding' in red states," July 13, 2017

 

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