Republicans call for repealing the Affordable Care Act because it fosters weak competition and limited choice in insurance marketplaces. But their replacement bill, according to the New York Times, could actually make the problem worse in the rural counties that are struggling the most.
This assessment is based on interviews with healthcare industry experts, including Jon Kingsdale, a faculty member in the Brown Executive Master in Healthcare Leadership.
“These areas are not going to be solved by a market, unless there is some magic internet substitute for providers that pops up some day,” said Kingsdale. His expertise is based on having run the Massachusetts Health Connector, the state’s exchange before Obamacare, where he experienced firsthand the challenges of attracting insurers to less populous regions of a state.
According to the Times, Kingsdale pointed out that insurers in New England tend to pay higher prices to small, rural hospitals than they do to big, urban academic teaching hospitals with all the latest treatments.
Quoting the Congressional Budget Office (CBO) in its evaluation of the Republican bill, the New York Times predicts that the lack of rural coverage will get worse if the Senate bill becomes law. “Some sparsely populated areas might have no nongroup insurance offered because the reductions in subsidies would lead fewer people to decide to purchase insurance — and markets with few purchasers are less profitable for insurers.” This assessment differed from its evaluation of the situation under current law, where the CBO said the markets would be essentially stable.
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