new york republican efforts dismantle obamacare disarray hundreds u.s. counties risk lose access private health coverage 2018 insurers consider pull market come months republican senators fail week repeal replace obamacare former president barack obama signature healthcare reform law create new uncertainty program provide health benefit 20 million americans fund manage 2018. response republican president donald trump friday suggest administration would let obamacare program implode weaken enforcement law requirement individuals buy insurance threaten cut fund seek change plan benefit regulations anthem inc cigna corp health care service corp molina healthcare four big health insurers sell obamacare plan say weigh whether pull market 2018 rather face financial losses sept. 27 finalize plan far 40 u.s. counties expect insurer offer individual coverage next year number could rise hundreds accord u.s. government data kaiser family foundation analysis insurer disclosures 1,300 counties primarily 15 state currently one insurer participate 2018. anthem hcsc last man stand one-third counties state put areas particular risk right number counties immediate risk insurers 2018 small could easily grow significantly couple major insurers decide exit larry levitt health economist kaiser family foundation say many insurers wait answer trump lawmakers whether continue fund billion annual government subsidies without assurances many insurers plan raise rat additional 20 percent aug. 16 deadline premium price others say many unknowns make business risky last-minute drama leave millions americans question whether medical coverage next year julie grady 59-year-old small business owner carson city nevada currently cover blue cross blue shield nevada part anthem already decide leave exchange county state carson city insurer exchange next year grady pay reduce premium 70 per month deductible 1,000 plan part affordable care act commonly call obamacare grady look uninsured law would go without health insurance say would stay healthy hike eat well trouble something catastrophic happen would lose everything anthem second-largest u.s. health insurer sell blue cross blue shield plan 14 state already decide pull individual market nevada ohio indiana wisconsin 2018. early week chief executive officer joe swedish say still weigh 2018 participation state state like colorado georgia kentucky missouri virginia anthem sell plan 250 counties insurer could leave bare next year accord government data health care service corp blue cross blue shield licensee five state obamacare individual insurer 90 texas counties 75 oklahoma counties half dozen illinois counties confirm friday submit products five state still weigh next year work regulatory file process hope fully participate ... 2018 however final decisions make hcsc spokeswoman kristen cunningham say molina million members obamacare plan cigna 250,000 participants say need certainty government decide 2018 participation would weigh decisions late september deadline state insurance regulators work hard recent months replace insurers leave nevada instance centene corp aetna inc enter counties anthem leave insurance commissioner say would favor insurers medicaid contract bid unlikely find replacements new dropouts final weeks particularly trump administration signal fund billion subsidies out-of-pocket medical cost almost chance would step participate say kurt wrobel fellow society actuaries chief financial officer geisinger health plan pennsylvania insurers say likely raise rat hope work blue cross blue shield michigan file two set rat state department insurance one 32 percent high fate subsidies remain unclear plan pull say rick notter director individual business bcbs michigan would certainly help certainty around market hold hundreds counties risk obamacare insurer 2018