Some face fewer choices, or none, under Affordable Care Act

File/Medical records
File/Medical records

NORFOLK, Va. (AP) — Virginians will face fewer choices— or none at all — when buying health insurance through the Affordable Care Act.

Starting next year, only one insurer will sell the coverage in 28 of Virginia’s independent cities or counties, many of them rural, The Associated Press has found. Currently, at least two insurers, if not more, offer plans throughout the state.

That lack of competition could lead to more expensive premiums, experts say. And some people may find doctors suddenly out of their network.

“Any pullout is going to be significant,” said Peter Cunningham, a health behavior and policy professor at Virginia Commonwealth University. “But especially if they’re pulling out of rural counties. They’re going to be the most vulnerable in terms of having less choice.”

The situation in Virginia reflects a nationwide trend as insurance companies face increasing costs. And Americans who use the health insurance markets created by the health care law championed by President Barack Obama face less choice than at any time since the program started.

The analysis by AP and the consulting firm Avalere Health found that about one-third of U.S. counties will have only one health marketplace insurer next year. That’s more than 1,000 counties in 26 states — roughly double the number of counties in 2014, the first year of coverage through the program.

In Virginia, Sentara Healthcare will stop selling ACA plans in more than 70 counties and cities, although such plans remain available in some areas. United Healthcare and Aetna are pulling plans in a few locations.

John DeGruttola, a senior vice president for Sentara, said in a statement that continuing to sell ACA plans in some places would have increased premiums for all customers. He said ACA insurance has “attracted a large number of members with significantly high healthcare costs, which have greatly escalated our medical expenses.”

Virginians also have been facing higher ACA premiums. For instance, a 50-year-old non-smoker will pay about $519 a month next year if he lives in one of four counties and lacks a subsidy. In 2015, the price would have been $270.

Granted, about 85 percent of Americans on an ACA plan get some level of subsidy, depending on income. But even with the assistance, many people have not signed up.

In Virginia, enrollment has climbed to about 422,000 this year, a nearly 10 percent increase from last year, according to the AP’s analysis. But 12.5 percent of Virginians under age 65, or about 874,000 people, still lack medical insurance, according to a May report from the Virginia Healthcare Foundation.

Cunningham, the VCU professor, said many people are probably weighing whether to pay the premiums or the fine for lacking insurance. The fine is often less, he said, even with the insurance subsidy.

.