Only one health insurer in Oklahoma is left selling coverage through the federal marketplace, and the hospital in this city of 36,000 is not in the network. Premiums are among the highest in the country, and while most marketplace customers qualify for the Affordable Care Act’s income-based subsidies that lower the cost, many of Ms. Roll’s middle-class clients do not.
“A lot of them are friends,” she said, “and I’m having to tell them: ‘My God, your premium just doubled. I’m so sorry.’”
In neighboring New Mexico, also under Republican leadership, the Affordable Care Act marketplace is in far better shape. Marketplace customers can still choose among four insurers, and the state has one of the lowest average premium costs.
Nearly four years after they opened, the Affordable Care Act’s insurance marketplaces, also known as exchanges, are not uniformly failing, as Mr. Trump claims. Instead, they have risen or fallen in no small part because of political and policy decisions by each state. New Mexico embraced the law, and its marketplace has been healthy, while Oklahoma resisted at every step, and its marketplace is foundered.
