WASHINGTON -- The Senate Republican plan to use tax legislation to repeal the federal requirement that Americans have health coverage threatens to derail insurance markets in conservative, rural swaths of the country, according to a Los Angeles Times data analysis.
That could leave consumers in these regions -- including most or all of Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, as well as parts of many other states -- with either no options for coverage or health plans that are prohibitively expensive.
"It's very, very concerning to us," said Denise Burke, health care analyst at the Department of Insurance in Wyoming, where the cheapest plan for a 40-year-old consumer in most of the state will cost $586 a month next year.
The precise nationwide impact of the Senate GOP tax plan, which would eliminate the Affordable Care Act's unpopular mandate penalty, is unclear, as many forces affect how much insurance costs and where insurers sell plans.
But the legislation is widely expected to cause insurers to raise prices or exit markets out of fear that fewer healthy people will buy plans if there is no longer a penalty for going without coverage.
The risk is greatest in places where health insurance is already very expensive and where there are few insurers.
For example, there are 454 counties where there will be only one insurer selling marketplace plans in 2018 and where the cheapest plan for a 40-year-old consumer will cost more than $500 a month, according to the Times analysis, which is based on data from the nonprofit Kaiser Family Foundation.
"Repealing the individual mandate will affect insurance markets everywhere," said Larry Levitt, a health insurance expert at the foundation. "But markets where there is already little choice and high premiums are especially vulnerable. ... Rural areas could be especially hard hit."
Eighty-six percent of these 454 at-risk counties have fewer than 50,000 residents, census data show. Health care costs are often higher in rural areas, as there are fewer medical providers and populations tend to be older and sicker.
These counties also overwhelmingly supported Donald Trump last year, with 9 out of 10 backing the Republican presidential ticket, according to election data.