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Indeed some of the very same counties lack Medicare Advantage plans, and for some of the same reasons. These areas have too few people for real competition among insurers or among providers. These gaps are not a huge problem in Medicare. Why is that? Because Medicare has a powerful alternative to Medicare Advantage. It’s called traditional Medicare, but it might as well be labeled the public option. Its pricing power keeps prices reasonable. Seniors are essentially insulated from the pricing challenges of rural care. So here’s the irony: Trump Country really needs a way to bypass the ACA marketplaces entirely. So Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and for the President. What about the politics?
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