The decision by Aetna and other health care insurance providers to scale back participation in Arizona's Affordable Care Act Marketplace exchange will hit one county harder than any other, a state Department of Insurance spokesman said.

"(In) one county, Pinal County, with Aetna's withdrawal, there will no longer be in the exchange any individual health care insurance providers," Arizona Department of Insurance Public Information Officer Stephen Briggs told Arizona Business Daily.

  

That's going to make things legally tough for Pinal County residents who get their health care insurance coverage from the state's health insurance marketplace, commonly referred to as the exchange. The Affordable Care Act, also known as Obamacare, mandates that most U.S. citizens acquire and maintain health insurance coverage and imposes fines if they don't. The act also provides subsidies to assist lower-income people pay for their health insurance plans.

  

To get those subsidies, health care insurance consumers are required to purchase plans through the ACA Marketplace or exchanges.

That won't be a possibility in Pinal County, near Phoenix, starting next year, Briggs said. "We've had a couple of other companies file to offer insurance in Pinal County but they're off the exchange," Briggs said.

Briggs said the state currently has no insurers that have filed to offer exchange plans in Pinal County.

Blue Cross Blue Shield of Arizona announced in June it planned to withdraw from Pinal and Maricopa counties because of heavy losses. The nonprofit, in the same statement, said it would continue to offer plans through the state's exchange in the rest of the Arizona, particularly in low population, rural areas.

"As a local company, we couldn't overlook that several counties would have no options or very limited access if we didn't find a way to stay in the market," Blue Cross Blue Shield President and CEO Rich Boals said. "Yet, we had to strike a balance between how we serve the market and the losses these plans incurred. We lost $185 million on individual ACA plans in just two years. After months of working through scenarios, we believe we have found a mix of plan types and benefits changes that will make these ACA plans sustainable for at least another year."

  

For a time, it looked like Aetna might step in to fill that gap, at least in Pinal County where that health insurance provider had planned to expand its exchange presence, Briggs said. "Aetna wasn't in Pinal County," Briggs said. "Currently, they're not offering in Pinal County, they were looking to expand their market into Pinel County."

Now that won't happen. Aetna recently said that in 2017 it will stop offering individual health care coverage in 11 of the 15 states where the company currently participates in the Affordable Care Act. The insurance giant faces hundreds of millions of dollars in losses because of its involvement in Obamacare, which lead to the business decision to pull out, Aetna's Chairman CEO Mark Bertolini said in a press release announcing the decision.

"Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward," Bertolini said. "More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states. As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision."

It sounds likedecision tied to losses, but a July 5 letter from Bertolini to the Justice Department, obtained by Huffington Post reporters, also ties Aetna's decision to proposed insurance company mergers, which the Department of Justice may not approve.

Whatever all the reasons, Aetna is expected to pull out of 11 states, including Arizona, North Carolina, Pennsylvania and Florida, but will continue to sell plans on state exchanges in Iowa, Delaware, Nebraska and Virginia.

"It's the state of the Unaffordable Care Act," Rep. Robert Pittenger told Patient Daily last week. "Let's be real. There's nothing affordable about it. Premiums have gone up, deductions have gone up and health care is less accessible. Other than that, it's a great success."

All Savers, a health insurance provider currently on the exchange for Pinal County, also has announced plans to withdraw from Arizona, Briggs said.

The culmination of all these announced withdrawals of health care coverage providers from the exchange in Arizona is especially bad news for consumers in Pinal County, Briggs said. "That's why Pinal County now has no providers offering individual health plan coverage," Briggs said.