Gabel Jon R, Whitmore Heidi, Green Matthew, Stromber Sam
Health Care Evaluation Department, NORC, University of Chicago, Chicago, IL.
Health Care Department, NORC, University of Chicago, Chicago, IL.
Issue Brief (Commonw Fund). 2018 Mar 1;2018:1-9.
In 2017, five states--Alabama, Alaska, Oklahoma, South Carolina, and Wyoming--had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers.
Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans.
Robert Wood Johnson Foundation's HIX Compare, which provides national data on the marketplaces from 2014 to 2017.
In 2010, the individual insurance market was already concentrated in the five study states, with Blue Cross and Blue Shield (BCBS) plans covering the majority of enrollees. By 2015, with the marketplaces in full swing, more issuers were competing in the five states. But by 2016, co-ops were facing bankruptcy and left the marketplaces in these states; and in 2017, citing large financial losses, national issuers UnitedHealthcare, Aetna, and Humana also exited, leaving only a single BCBS plan in each state. Three of the five states experienced substantially higher annual premium increases than the national average. Policy options with bipartisan support, such as resuming cost-sharing reduction payments and reestablishing reinsurance and risk corridors, could help attract new or returning issuers to marketplaces in these states.
2017年，阿拉巴马州、阿拉斯加州、俄克拉荷马州、南卡罗来纳州和怀俄明州这五个州只有一家保险公司参与其医保市场，限制了消费者的选择以及保险公司之间的竞争。
研究2010年（《平价医疗法案》颁布之前）至2017年个人市场的参与历史，并分析市场计划中的保费变化。
罗伯特·伍德·约翰逊基金会的医保市场比较项目，该项目提供了2014年至2017年市场的全国数据。
2010年，这五个研究州的个人保险市场已经高度集中，蓝十字蓝盾（BCBS）计划覆盖了大多数参保者。到2015年，随着医保市场全面展开，更多的保险公司在这五个州展开竞争。但到2016年，合作社面临破产并退出了这些州的市场；2017年，全国性保险公司联合健康保险、安泰保险和哈门那公司也因巨额财务亏损而退出，导致每个州只剩下一个蓝十字蓝盾计划。这五个州中有三个州的年保费涨幅大幅高于全国平均水平。两党都支持的政策选择，比如恢复成本分摊削减支付以及重新建立再保险和风险走廊，可能有助于吸引新的或回归的保险公司进入这些州的市场。
