There are now 45 counties in the U.S. with no Obamacare insurer

The number of counties in the U.S. with no Obamacare insurer doubled during the past week. The New York Times reports there are now 35,000 current enrollees who, unless something changes, will have no coverage option next year:

Next year, about 35,000 people buying insurance in Affordable Care Act marketplaces in 45 counties could have no carriers to choose from. This would be the first time that has happened since the marketplaces were opened in 2014.

The estimate is based on a New York Times analysis that also found that about 3 million people in 1,388 counties could have just one insurer available to them.

About 45 percent of counties are expected to have one or no insurer in the marketplaces — where about 12 million people buy their own coverage — unless another carrier steps in…

Typically, markets with fewer insurers have also seen larger increases in prices, according to research by the Robert Wood Johnson Foundation and the Urban Institute.

There’s an important caveat here, which is that many insurers are still deciding whether or not to stay in the marketplaces or get out. And depending on what they decide, the number of counties with no insurers could go up or down significantly. Still, there’s no denying that there is a pattern of decreased competition in the marketplaces since Obamacare launched. The NY Times created this graphic (which I have rearranged slightly to fit on the page):

Clearly, this is not a thriving marketplace. When you add to that the fact that overall enrollment was down this year, and well below the modest gains predicted by the CBO, you have a picture of a health scheme that is not working as planned.

That does not mean Obamacare will completely collapse on its own. At some point, double-digit rate increases will make staying in the market profitable for insurers. And as I’ve written before, the subsidies which most on-exchange buyers are getting mean that they are insulated from the price hikes (which get absorbed by taxpayers). So some zombie version of Obamacare, more like an entitlement to private insurance for people just above the Medicaid threshold, will probably never die unless the bill is repealed. But that outcome is a long way from what President Obama and Democrats promised when the law was passed in 2010.