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The exodus has left consumers across the country who don’t get their insurance through an employer with fewer health-care choices, and in cases such as the Briggses’, without access to the care they had come to rely on for chronic conditions. In 2014, the first year the ACA marketplaces were open, there was an average of five insurers to choose from in each state, according to Kaiser Family Foundation data. In 2018, it will be three and a half. Karen Pollitz, a senior fellow at Kaiser, called it a “sleeper issue.” “I’m not shocked to hear it,” she said of the Virginia family’s predicament. “From the beginning, the first year Obamacare opened, there was a healthy mix [of plans], and that started to constrict quickly. I always worried that this was happening.” The ACA included a guarantee to consumers of “network adequacy standards”ugg boots uggs outlet store intended to ensure every marketplace had a sufficient “number and types of providers.” But those standards have never been defined or enforced, Pollitz said. There are no specific measures — such as how long or how far it takes to get to providers or what percentage of in-network doctors a carrier has to have. “What we’re left with is just words” about adequacy, Pollitz said. [Trump officials slash advertising, grants to help Americans get ACA insurance] Ken Schrad, spokesman for the Virginia State Corporation Commission’s insurance bureau, said the state “has been fortunate to have sufficient number of carriers on the federal exchange.” But he said it has been clear the entire year that the uncertainty out of Washington would have negative effects on the marketplace individuals use to shop for coverage. [Insurers restricting choice of doctors and hospitals to keep costs down] It is not uncommon for insurers to cut larger research-based hospitals from its plans on the exchanges as a way to cut costs. By narrowing their networks,uggs australia carriers avoid paying the higher rates that academic medical centers charge. But some consumers received welcome news this week when Cigna announced on Wednesday that it had reached an agreement with Virginia Commonwealth University Medical Center to bring the Richmond-based hospital system in-network. For Cindy Jones, the announcement ended months of stress. When Anthem did not reenter the market in Henrico County, just outsideof Richmond, where Jones lives, she found herself in the same predicament as the Briggs family.,ugg boots outlet, @uggs for cheap 828 @uggs are ugly 837 @ugg boot reviews 717 @uggs in snow 259 @uggs macys 572