Roughly 41 percent of counties in the United States could have only one insurer participating on the Affordable Care Act exchanges next year, according to a new analysis from Avalere Health.

This percentage is up from the lack of participation in 2017, when roughly one-third of counties, or 33 percent, had only one insurer participating on the exchanges.

According to their count, there will be 47 counties that will have no insurer participating on the exchange leaving about 34,000 consumers with no choice.

Only 27 percent of counties will likely have more than three health insurers participating. In 2016, 64 percent of counties had three or more insurers participating.

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