Knoxville, Tenn., could be the first city in the U.S. where Obamacare completely collapses, leaving tens of thousands of people without the option to buy a subsidized insurance policy.

Humana, the city’s only remaining insurance provider on its Obamacare exchange, announced it is exiting the market in 2018. If that happens, Knoxville citizens will be in a rough spot. Unless another insurance provider fills Humana’s place, some 40,000 people in the Knoxville area will likely be left without the option to purchase an Obamacare-subsidized insurance policy, CNN reports.

Knoxville is illustrative of one of the main problems with Obamacare: It doesn’t promote market-based competition. Insurers pull out of marketplaces where it is not cost-efficient for them to provide services, and, as a result, consumers are left with fewer options at higher prices. (RELATED: White House: Obamacare Premiums Will Rise By Double Digits Next Year)

Tennessee is one of the largest casualties of the current health care system. Three insurers have pulled out of the state entirely, the state’s co-op failed and premiums continue to skyrocket annually by double-digits. Tennessee’s health commissioner has all but given up, describing the state’s health care system as “very near collapse.”

As it stands, insurance providers have until July 1 to let state authorities know what plans they will provide, if any, on the exchanges in 2018. State officials expect a formal announcement from providers within two months.

Knoxville citizens would still have the option of purchasing insurance on the private marketplace. Without the Obamacare subsidy to purchase insurance, it is unclear how many consumers would choose to participate in the private insurance market.

To help struggling consumers in their state, Sens. Lamar Alexander and Bob Corker of Tennessee put forth legislation that would allow consumers to use Obamacare subsidies to purchase any state-approved insurance plan on the private marketplace. If the bill passes, it would remain in effect through 2019.

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