Last week was a blur. I had a whirlwind tour of the health policy universe. I received a job offer that I have declined. I then met with a team that is charged to produce awesome work in health policy and I am looking forward to see where things could go from here. I was on the phone explaining Silver Gap and Silver Spam pricing strategies to a lot of very smart people. All of this had my wife chuckling at me.
I also had a chance to talk to a very smart and wonky friend of the blog who asked a very good question — what are the odds that there are no carriers in a state in 2018 on Exchange?
I do not think this is likely. I think it is highly likely that there are a number of states where there is a single carrier and even more states which may have multiple carriers but with a clear division so that most counties in those states only have a single carrier. However I am having a hard time seeing the mechanics of carriers completely dropping out and abandoning states en masse. Could it happen in a single state? Yes, I think it is unlikely but possible. Would it happen in four or five states? No.
The basis of my response is that the federal subsidy structure makes it very hard for a carrier to continually lose money in a state if it is the only carrier. Let’s look at a few scenarios below the fold.