In areas with only one or two health insurers offering plans on government marketplaces—predominantly rural areas—people paid higher premiums, says a study by the Robert Wood Johnson Foundation and the Urban Institute. The study found that all of Alaska, Alabama, North Carolina, Oklahoma, most of Arizona, and rural areas in several states, only had one insurer to choose from.
The study found that 146 of the 498 rating regions, representing 12.6 percent of the population, "had only one insurer selling non-group coverage through its state marketplace in 2017; 125 had just two insurers." While 34 percent of the population—mostly rural— lives in regions with one or two marketplace insurers, 32 percent—mostly urban—lives in areas with five or more insurers. Researchers found that "lack of competition is strongly associated with higher premiums." (Study graphic: Medium monthly premiums paid based on how many insurer options were available in region)
"In regions with just one insurer, monthly premiums were $451 or higher in half of the silver 'benchmark' plans on which premium subsidies are based," Michelle Andrews reports for Kaiser Health News. "In contrast, in areas where six or more insurers offered plans, monthly premiums were much lower for comparable coverage: Half were $270 or less. Premium growth from 2016 to 2017 also varied substantially based on how many insurers participated in a region: Median premium growth was 30 percent in areas with one insurer versus 5 percent in regions with six or more carriers."
"As insurers finalize plans for participating in the 2018 exchanges, policy experts have speculated that the uncertainty surrounding the Affordable Care Act will lead insurers to continue to pull back from some online marketplaces or exit them altogether, leaving a growing number of people with fewer, pricier options. Insurers in most states have until mid-June to decide, but news has slowly trickled out," Andrews writes. "Aetna announced earlier this week that next year the company will not participate in the individual market in Delaware and Nebraska, the last two states in which it currently sells exchange plans."
The study found that 146 of the 498 rating regions, representing 12.6 percent of the population, "had only one insurer selling non-group coverage through its state marketplace in 2017; 125 had just two insurers." While 34 percent of the population—mostly rural— lives in regions with one or two marketplace insurers, 32 percent—mostly urban—lives in areas with five or more insurers. Researchers found that "lack of competition is strongly associated with higher premiums." (Study graphic: Medium monthly premiums paid based on how many insurer options were available in region)
"As insurers finalize plans for participating in the 2018 exchanges, policy experts have speculated that the uncertainty surrounding the Affordable Care Act will lead insurers to continue to pull back from some online marketplaces or exit them altogether, leaving a growing number of people with fewer, pricier options. Insurers in most states have until mid-June to decide, but news has slowly trickled out," Andrews writes. "Aetna announced earlier this week that next year the company will not participate in the individual market in Delaware and Nebraska, the last two states in which it currently sells exchange plans."
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