CHARLOTTESVILLE, Va. -- Repeatedly rated one of the healthiest and happiest places to live in the United States, this medium-sized college town with spectacular views of the Blue Ridge Mountains tends to attract entrepreneurs, freelancers and creative types who can live anywhere they want because they're not tied to a corporate job.
But this year, many of those untethered workers may be wishing they lived anywhere but here. Residents of Charlottesville and three surrounding counties who buy health insurance without employer support or government subsidies have been hit with the highest health insurance premiums in the country -- more than three times the price they paid last year.
Premiums are also substantially higher than average, although not as high as in Charlottesville, in southwestern rural Georgia, certain Colorado ski resort towns, the Connecticut suburbs of New York City, and large parts of Wisconsin and Wyoming, among other places.
Charlottesville's premium spike may be an anomaly. But insurance experts say it could be an indication of what might happen in other parts of the country next fall, when insurers post their final rates for 2019.
Nationwide, premiums for average-priced policies -- according to a Kaiser Family Foundation analysis -- offered on and off the health insurance exchanges created under the Affordable Care Act rose by more than a third compared with 2017. The biggest statewide hikes were in Iowa (88 percent), Utah (78 percent), New Hampshire (78 percent), Wyoming (72 percent) and Virginia (66 percent).
The underlying cause of the rate hikes is clear: efforts last year by the Trump administration and its allies in Congress to dismantle the Affordable Care Act -- and promises of further attempts in the year ahead.
"It all added up to chaos and uncertainty in the insurance market," said Sabrina Corlette, a Georgetown University research professor and insurance expert. "And uncertainty always leads to higher premiums."
This year, a handful of Democratic-led states are gearing up to curb further rate hikes by enacting laws and adopting insurance regulations designed to shore up the traditional insurance industry and restore parts of the ACA, known as Obamacare.
At the same time, at least one Republican-leaning state has moved to further unravel the federal health law by encouraging insurance companies to offer cheap policies with fewer benefits. Others are expected to follow.
Both red and blue states are reacting to a series of federal actions.