The recent departure from the marketplace of insurers Aetna and UnitedHealthcare has created a split in Obamacare that only promises to widen.

Coastal and northern areas in the U.S. usually have many insurance options for Obamacare customers.  But southern and rural areas are seeing an exodus of insurers to the point that some rural counties may not have any insurance options at all.

The Hill:

"There's really two kind of stories that are playing out,” said Cynthia Cox, who studies insurer competition at the Kaiser Family Foundation (KFF).

The trend is likely to be accelerated by the departure of Aetna and UnitedHealthcare from ObamaCare marketplaces in 2017. The loss of those insurers won’t affect all parts of the country equally, experts say. 

“The combined effect of these exits is mostly concentrated in southern states and particularly rural counties within those states,” Cox said. 

According to an analysis from the consulting firm Avalere, as of now, there will be just one insurer offering ObamaCare coverage next year in seven states: Alabama, Oklahoma, South Carolina, Wyoming, Alaska, North Carolina and Kansas. It is possible that more insurers could enter these markets before next year.

In one county in Arizona, there might not be an ObamaCare plan available at all.

Aetna had been the only insurer offering a plan in Pinal County. Unless federal and state officials can find another insurer to fill the void in 2017, the county’s 400,000 residents will not be able to buy coverage on an ObamaCare exchange.

The dearth of options in rural, sparsely populated areas is a far cry from what Democrats promised when selling the Affordable Care Act. 

Obama talked at the time about how the law would create a “one-stop shop” for insurance, comparing it to websites where people can look for airline tickets. 

“Just visit healthcare.gov, and there you can compare insurance plans, side by side, the same way you’d shop for a plane ticket on Kayak or a TV on Amazon,” Obama said in 2013. “You enter some basic information, you’ll be presented with a list of quality, affordable plans that are available in your area, with clear descriptions of what each plan covers, and what it will cost.  You’ll find more choices, more competition, and in many cases, lower prices.” 

In states like Oklahoma, the reality is different, with just one insurer to choose from in the online marketplace. 

“We certainly see this as an issue,” said Mike Rhoads, Oklahoma’s deputy insurance commissioner. “With only a single carrier out there, there is no competition.” 

“I think competition drives price sensitivity by these carriers,” Rhoads said. 

We still don't know the complete extent of increases in premiums when the next enrollment period opens later in the fall.  For some of those states with few insurance options, the increase is likely to be huge.  Other states with more options are likely to see single-digit hikes.

But this is beside the point.  Obamacare was oversold and is not delivering anything close to what it was supposed to.  The expansion of Medicaid – celebrated as proof that the law works – is only piling millions of more people on a dysfunctional system.  Doctors and hospitals are dropping Medicaid patients, others aren't accepting any new ones, and the entire rickety system is "unsustainable" according to the Centers for Medicare and Medicaid Services.

Obama's signature law might not survive his second term.