Adrian Burns

USA Today Network - Ohio

Shelly Kutschbach-Horch has health insurance she can afford and a doctor she likes. But all that could change in 2017.

Kutschbach-Horch is among thousands of Ohioans who get insurance through the Affordable Care Act, known as Obamacare, who could experience higher prices and fewer plan and doctor options next year as health care providers pull out of the state. While all 88 Ohio counties currently have four or more insurance companies offering plans through Obamacare, in 2017 19 counties are expected to have just one insurer, and 28 counties will drop to two insurers amid a rash of insurer exits, the Ohio Department of Insurance said.

Kutschbach-Horch’s insurance provider, United HealthCare Services Inc., recently told her it will no longer offer insurance through Obamacare next year. And that leaves Kutschbach-Horch, who is self-employed in Chillicothe, wondering what her health insurance options will be.

“They fine you if you don’t have insurance, and then they take your options away,” Kutschbach-Horsch said.

Many Ohioans are in the same boat. The 19 counties dropping to one insurance provider include Muskingum County — Ohio’s 31st largest by population — along with Coshocton, Crawford, Knox, Morgan and Perry counties.

The 28 counties dropping to two insurance providers include Richland County, the state’s 23rd largest by population. Insurers have largely cited poor Obamacare plan financial results as their reason for leaving some areas.

The loss of insurance options, particularly in rural areas, is typically not a good thing for patients, said Dan Atkinson, CEO of the Muskingum Valley Health Center, which provides health care to the poor and others in Muskingum, Morgan, Guernsey and Coshocton counties.

Each insurer typically has its own network of doctors available to customers. Fewer insurance choices can result in a smaller pool of doctors that would be covered.

“I think that this change could potentially limit where individuals in the Affordable Care Act can access care to some degree,” he said. “There is definitely a shortage of primary care access in all four counties we provide services to.”

Kutschbach-Horch, who drives to Columbus to see a doctor that she knows and likes, said one major concern is finding a local doctor that her next insurance plan will cover.

“In Ross County it’s really hard to find a primary care doctor that is taking new patients,” she said. Kutschbach-Horch said she won’t know until later this year what new insurance plan she might choose, and if it will cover her preferred doctor in Columbus.

Ohio is not alone in its plight. About 2 million people nationally will likely have to change plans for 2017 due to insurers leaving Affordable Care Act marketplaces, going out of business or dropping certain plan choices, according to data from expert Charles Gaba of ACASignups.net, which tracks Obamacare enrollment and insurer data.

There were 243,714 total Obamacare enrollees in Ohio at the start of 2016, and there are 13,229 enrollees in the 19 counties expected to drop to one insurance provider, according to data from the U.S. Department of Health & Human Services.

The one Obamacare insurer left in nearly a fourth of Ohio’s counties will be Anthem Inc., the Ohio Department of Insurance said. The Indianapolis-based insurer did not return calls and emails requesting comment.

And it’s unlikely there will new entrants to the Ohio’s Obamacare health insurance marketplace in 2017, as the process for adding or removing companies from Ohio’s offerings has concluded, said Lt. Gov. Mary Taylor, who also serves as director of the Ohio Department of Insurance.

“I’m especially concerned with the new numbers,” said Taylor, a Republican who opposes Obamacare. “If you think back to Ohio prior to the implementation of Obamacare, we had a vibrant health insurance market with many carriers across the state.”

There are 17 health insurers offering coverage through Obamacare in Ohio in 2016, with six expected to drop out for 2017, according to the Ohio Department of Insurance. They are United Healthcare of Ohio Inc., All Savers Health Plans, Healthspan Inc., Healthspan Integrated Care, Aetna Inc. and Inhealth, the department said.

“You’re seeing choices reduced and prices going up,” Taylor said. Health insurance premiums for Obamacare are expected to rise by an average of 12.6 percent in 2017 from 2016 levels, she said. Average Obamacare premiums in Ohio in 2017 are expected to be 91 percent above levels seen in 2013, Taylor said.

In a study released Aug. 24, the US Department of Health and Human services touted the ability to shop for plans as a way to mitigate rising costs from some insurers.

“Last year, more than 40 percent of returning HealthCare.gov consumers switched plans. They saved an average of $42 per month, or about $500 annually,” the study said.

But many Ohioans, particularly those in the 19 counties that will have one insurer option, won’t have many options for shopping around, Taylor said.

“Consumers in those markets are going to be severely restricted,” she said.

While some areas are expected to see only one insurer option, Obamacare requires participating insurance companies to offer multiple plans at different price levels and with different levels of coverage.

Still, despite some insurers pulling out in Ohio, subsidized coverage will remain available to those who may have had no health insurance options prior to Obamacare, said Chris Keck, deputy Ohio director for Enroll America, a nonprofit coalition that helps individuals sign up for Obamacare.

“It’s important to keep in mind that most folks will get financial assistance to pay for a plan, and that all plans in the marketplace cover essential health insurance benefits,” he said.

For its part, Enroll America will continue to work to connect Ohioans with the right Obamacare insurance plan, despite cutbacks, Keck said.

“Everyone wants to find a coverage that is best for them,” he said. “Our role is to make sure folks out there know what options are available.”

But the fine details of what plans and coverage will be available to Ohioans won’t be known for sure until Obamacare open enrollment starts Nov. 1, Keck said. That is when Ohioans can sign up for Obamacare or choose a new plan, he said.