"Residents of wealthier, more populated counties in the U.S. receive lower-priced choices than those living in counties with a single insurer," Martin and Weaver report. In counties with one insurer, the average price for a 50-year-old to purchase a silver plan, the one most commonly sold, through the marketplace was $406. In contrast, citizens in counties with four insurers could purchase a silver plan for an average of $329. This phenomena represents the tactics of insurers who avoid areas with unemployment problems and high numbers of unhealthy residents, the reporters write.
For example, Aetna Inc. and UnitedHealth Group Inc. offer services "in more counties outside of the marketplaces, where plans are sold directly to consumers and federal subsidies aren't available," they write. Rebecca Stephens found out that she only had one health insurer option in Hardee County, Florida, and the plan she wanted to purchase would cost her approximately $200 more per month than a comparable plan in Tampa. "That is costs me more for health insurance than someone in Tampa doesn't seem equal to me," she told the Journal.
Coverage prices were higher in rural places even before health reform. Jon Urbanek, a senior vice president at Florida Blue, cited shortage of hospitals and doctors as a key reason for the higher premiums. "Our costs are higher," he said. "The premiums we charge reflect the cost of the providers." People in smaller cities and suburbs, too, are often limited to fewer choices and subject to higher prices. "From a consumer's standpoint, it's unfair," said Dylan Roby, a program director at UCLA's health policy research center.
Glenn Melnick, a health-care economist at RAND Corp., thinks areas with low populations will not easily attract additional insurers. "I don't think the health law can overcome those economics," he said. The Congressional Budget Office reported that approximately 20 million Americans can get income-based tax credits to reduce health insurance costs; some brokers and insurers think these subsidies will negate the price disparities for some people. Russell Childers, an insurance broker from Americus, Ga., told the Journal, "Most people are receiving a high enough subsidy for coverage that they don't care." (Read more)