The Trump administration published a map Tuesday of projected health insurer participation in the Affordable Care Act marketplaces. It gets a lot wrong.
This map is meant to be a snapshot of who is currently signed up to sell coverage on the Affordable Care Act markets when they begin open enrollment in November 2017
For starters, it doesn’t even get the data right. But more to the point, the Trump administration is instead using data from mid-June to project what insurer participation will be in the late fall — and to make the argument that the markets are falling apart.
“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all,” Medicare administrator Seema Verma said in a statement.
Except this data doesn’t really show that at all. Let’s dig into some of the problems with this map. The biggest problem with this map is that the situation with Obamacare is very, very fluid. It is true that some health insurers have quit the marketplaces, leaving 47 counties at risk of having no plans signed up in 2018. But it’s also true that other health insurance plans are eying those empty marketplaces as business opportunities.
Case in point: Hours after the Trump administration released this map, health insurer Centene announced plans to expand into Missouri — one of the states that currently has 25 counties with no plans signed up for 2018.
"Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive healthcare services to our members," said the plan’s chief executive Michael Neidorff said in a statement.
It certainly makes sense to talk about the counties that are at risk of having no Obamacare health plans in 2018, and what that means for the enrollees who live in those areas. But it doesn’t make much sense at all to take a snapshot in mid-June — before we’ve even reached the deadline for insurance plans to sign up to sell on the marketplaces — and describe it as “projected” 2018 participation.
The data on eight states is completely wrong
One odd data choice the Trump administration made with this map was, in eight states that run their own marketplaces, to “roll the carrier count up to the state level rather than county.”
Essentially, Health and Human Services officials took the number of insurance plans selling anywhere in the state and treated them as if they were selling everywhere in the state. This means that a plan selling in just one county is counted as selling in every county.
This is a weird decision because county-level data is readily available in every state. And it means that the map is not accurate at all in the eight states where they used this method.
Take Colorado, for example. In the Trump administration map you see that every county is dark green, indicating three health insurance plans selling everywhere.
But when you look at the county-level data — which the Robert Wood Johnson Foundation makes available for free, and which we here at Vox used to make an ACA map-making tool — it’s a totally different picture. Some counties have three competitors while others have just one.
It’s unclear why the Trump administration made this particular decision with its Obamacare map. Ironically, it actually makes the Affordable Care Act look more competitive than it actually is.
This map is about politics, not policy
You can tell by looking at the map of Washington state. This is one of those eight states where the map says it is counting data at the state-level, not the county-level.
But the Trump administration doesn’t follow its rule entirely here. Nearly the state is dark green in the map of Washington State because they’ve decided to roll data up to the state level. But there are two counties are bright red, to indicate they have zero health plans. HHS broke its mapping rule to make a political point about the Affordable Care Act.
If you want to know what the Washington map actually looks like, I’ve included a more accurate version here, with county-level data. You can see that some counties, like those surrounding the Seattle area, have strong competition. Others in more rural areas along the Pacific coast and the Oregon border, are struggling to attract competitors.
It’s possible that some insurers may come into those counties. Washington state has generally been quite supportive of the health care law, and seems to want it to succeed. Or they might not, leaving about 3,000 Washington state residents with no Obamacare options. But right now, it’s far too early to tell — and this map doesn’t give a good picture of what choices will be available in 2018.