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.

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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.

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