Limited Choice of Obamacare Insurers in Some Parts of the Southwest

The New York Times is reporting that all of Arizona, much of Nevada, and portions of Utah and Colorado will have only one insurer available under the Affordable Care Act (ACA, Obamacare) marketplace (Figure 1) (1).

Figure 1. New York Times compilation of insurance company announcements for providing coverage under the ACA or Obamacare.

About 35,000 people buying insurance in Affordable Care Act marketplaces in 45 counties could have no choice in carriers in Ohio and Missouri (Figure 1), This would be the first time that has happened since the marketplaces were opened in 2014.

Some insurance companies are still deciding what they will do in 2018, and others may reverse course, so these numbers could go up or down.

Most Americans get health insurance from a job or government program, but about 22 million people buy individual policies under Obamacare. More than half of them use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from an insurer or broker, outside the Obamacare marketplaces. A recent New York Times analysis showed that many insurers are now choosing to sell exclusively outside the marketplaces, where their customers are not eligible for federal subsidies. Because customers cannot use subsidies for these plans, many may not be able to afford coverage.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

1. Park H, Carlsen A. For the first time, 45 counties could have no insurer in the Obamacare marketplaces. New York Times. June 9, 2017. Available at: https://www.nytimes.com/interactive/2017/06/09/us/counties-with-one-or-no-obamacare-insurer.html (accessed 6/12/17).

Cite as: Robbins RA. Limited choice of healthcare insurers in some parts of the southwest. Southwest J Pulm Crit Care. 2017;14(6):295. doi: https://doi.org/10.13175/swjpcc074-17 PDF 

Smoking Rates Low in Southwest

The Gallup survey confirms that smoking rates in the US are declining and that smoking rates are lower in the Southwest than the US as a whole (1). Nationally, the smoking rate fell to 19.7% in 2013 from 21.1% in 2008. Among the Southwest states California ranked second (15.0%), Colorado ninth (17.4%), and Arizona tenth (17.5%). Only New Mexico was above the Nation's average at 20.0%. Utah remains the state with the lowest percentage of smokers, 12.2 percent, and Kentucky the highest, 30.2 percent.

Nine of the 10 states with the lowest smoking rates have outright bans on smoking in private worksites, restaurants, and bars, with California allowing for ventilated rooms. Bans are significantly less common in the 10 states with the highest smoking rates. Kentucky, West Virginia, and Mississippi -- the states with the three highest smoking rates -- do not have statewide smoking bans. In addition, these three states have some of the lowest average cost of a pack of cigarettes (2).

The Campaign for Tobacco-Free Kids has identified access to tobacco as a major factor in youth smoking (3). However, tobacco products still remain readily accessible. Recently, CVS, the National chain of pharmacies, announced that it will no longer sell cigarettes (4). A recent New York Times op-ed called for Walgreen’s to do the same (5).

Richard A. Robbins, MD

Editor

References

1. McCarthy J. In U.S., Smoking Rate Lowest in Utah, Highest in Kentucky. Available at: http://www.gallup.com/poll/167771/smoking-rate-lowest-utah-highest-kentucky.aspx?utm_source=rss&utm_medium=rss&utm_campaign=in-u-s-smoking-rate-lowest-in-utah-highest-in-kentucky-smoking-rate-in-alaska-has-dropped-the-most-since-2008 (accessed 4/12/14).
2. Boonn A. Campaign for tobacco-free kids. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0202.pdf (accessed 4/12/14).
3. Campaign for tobacco-free kids. Enforcing laws prohibiting cigarette sales to kids reduces youth smoking. Available at: http://www.tobaccofreekids.org/research/factsheets/pdf/0049.pdf (accessed 4/12/14).
4. CVS quits for good. Available at: http://info.cvscaremark.com/cvs-insights/cvs-quits (accessed 4/12/14).
5. Bach PS. The tobacco ties that bind. New York Times. 4/10/14. Available at: http://www.nytimes.com/2014/04/11/opinion/the-tobacco-ties-that-bind.html?_r=0 (accessed 4/12/14).

Reference as: Robbins RA. Smoking rates low in southwest. Southwest J Pulm Crit Care. 2014;8(4):233. doi: http://dx.doi.org/10.13175/swjpcc051-14 PDF