So much for choice. In many parts of the country, Obamacare customers will be down to one insurer when they go to sign up for coverage next year on the public exchanges.
A central tenet of the federal health law was to offer a range of affordable health plans through competition among private insurers. But a wave of insurer failures and the recent decision by several of the largest companies, including Aetna, to exit markets are leaving large portions of the country with functional monopolies for next year.
According to an analysis done for The Upshot by the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose next year. The analysis shows that there are five entire states currently set to have one insurer, although our map also includes two more states because the plans for more carriers are not final. By comparison, only 2 percent of eligible customers last year had only one choice.
A similar analysis by Avalere Health, another consulting firm, also highlighted the increase in areas with only one insurance carrier.
The market is still in some flux. Final contracts between insurers and the federal government won’t be signed until late September. That means it is still possible that additional insurers will choose to enter new markets between now and then, and the competitive picture could improve. It is also possible that some carriers will decide to exit. It was just this week that Aetna surprised regulators and others with the news that it was leaving most of the markets where it offered policies on the exchange, leaving it in just four states.
The Obama administration says it is too early to evaluate competition in the Obamacare markets for 2017. Marjorie Connolly, a spokeswoman for the Department of Health and Human Services, said: “A number of steps remain before the full picture of marketplace competition and prices are known. Regardless, we remain confident that the majority of marketplace consumers will have multiple choices and will be able to select a plan for less than $75 per month when Open Enrollment begins Nov. 1.”
Many places in the country still have robust choice and competition, including many large population centers like Denver, Los Angeles, New York and Miami. But large areas have limited choice, like the five states that now have only one issuer: Alabama, Alaska, Oklahoma, South Carolina and Wyoming. (Our map also shows Kansas and North Carolina with only one, but the picture may change for parts of those states, because additional insurers have said they plan to enter.)
Large sections of other states may also be down to one carrier, including Florida, Utah and Missouri. It also appears that there is one county in Arizona, Pinal County, between Phoenix and Tucson, where no carriers are set to offer health plans in the marketplace.
While the dwindling competition may not be fatal, “it isn’t ideal,” conceded Larry Levitt, a senior executive at the Kaiser Family Foundation. People shopping for plans in the exchanges will be left with fewer insurer choices but also, probably, fewer choices of doctors and hospitals because the companies that remain will most likely offer sharply narrow networks.
More info from our President