There are 47 counties in the United States that are projected to have no insurer participating in the Affordable Care Act exchanges in 2018, according to a report from the Centers for Medicare and Medicaid Services.

Insurers such as Anthem and Aetna have announced this year that they are planning exits from the marketplace, which will leave some areas with no options.

The agency looked at health insurer announcements through June 9 and created a map to show which counties will have no Obamacare insurer in 2018. This map will change based on future announcements if more insurers exit.

“As many as 1,200 counties—nearly 40 percent of counties nationwide—could have only one issuer in 2018,” the agency explains. “Currently, for 2018 at least 35,000 active Exchange participants live in the counties projected to be without coverage in 2018, and roughly 2.4 million Exchange participants are projected to have one issuer. It’s expected that the number of consumers with no coverage choices will rise.”

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