I’ve touched on this topic before. Above, courtesy of the McKinsey Center for Healthcare Reform, is a side-by-side depiction on a by county basis of the number of insurance carriers that served each county at the start of the third Affordable Care Act open enrollment (OE3) compared with the number of insurance carriers that will serve each county at the start of the fourth open enrollment (OE4).
As you can see, there is a marked decline in the number of carriers. Whether you think that poses a problem or not depends on whether you think that insurance monopolies will inevitably increase prices or be able to wield monopoly power in other ways.
Even that notorious right wing rag The Washington Post is citing 1 in 4 counties as having only one provider.
Since insurers are pulling out it would only be common sense to infer monopoly status, and ability to raise premiums, is the goal. The only way it could not is for the population to somehow morph into an actuarially sound one under a single provider. Don’t count on that, or unicorns. The healthy can still bet only $600 that they will be fine. The other way, of course, is to hope for government subsidy, which is just a way of saying that political avoidance of full death spiral will induce the government to force your neighbor to pay your stealth premium increase.
Should also add a map showing how many counties had just one or two insurers before the ACA. I suspect the before and after maps will look pretty much the same. Probably barrier to entry.
Steve
There was an increase in carriers from OE1 to OE2, a decrease from OE2 to OE3, and what looks to be a big decrease from OE3 to OE4. If you’re expecting competition to lower costs, the number of carriers is trending the wrong way.
I was hoping, not really expecting, that conservatives were right and competition would hold down costs. Not looking good, however, I believe this is for the individual market and that makes up just about 6% of the market.
Steve