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ACA competition dwindles under Trump

The Trump administration has been touting the fact that Affordable Care Act coverage is on track for relatively modest premium increases next year in much of the country. But a new paper published in Health Affairs offers a reminder that Trump has not been a friend to the ACA’s exchanges.

Data: Kaiser Family Foundation; Map: Lazaro Gamio / Axios

By the numbers: In 2016, 93% of the country lived in a county where they'd have at least three insurers to choose from, if they wanted to buy coverage through the exchanges. This year, that's down to 60% of the population.

Unsurprisingly, the places where insurers backed out tended to be rural, impoverished and unhealthy.

"It is unclear" whether this trend "represented a long-run equilibrium or more transient factors such as the fluid policy environment and insurer 'panic' over early losses," the paper says.

The bottom line: Premiums also skyrocketed in this period — the average premium for a middle-of-the-road policy rose by about 37% from 2017 to 2018. And insurers have said plainly that policy changes from the administration and congressional Republicans made them skittish.