Dive Brief:
- The number of rural counties on Healthcare.gov that have only one insurer will nearly quadruple, going from 7.8% in 2016 to 30.7% in 2017, according to a new Vox analysis.
- The 2017 ACA marketplaces are poised to see reduced competition across the board following announcements of pull-outs by several major insurers, but it's the rural areas that will be taking the brunt of the hit.
- In comparison, while urban counties will also be seeing their lowest levels of marketplace competition since 2014 - just 19.6% of urban counties on Healthcare.gov will be served by one insurer, the analysis shows.
Dive Insight:
Vox's findings of reduced competition being most felt in rural states agree with recent, related studies by the Kaiser Family Foundation and Avalere. The analysis adds to the discussion on why rural areas are having a harder time attracting insurers and what strategies could potentially help.
The problem is nothing new to rural regions Vox said, noting that lower populations and concentrations of physicians and hospitals make it harder for insurers to do business and that it has only gotten more difficult in recent years, due to factors in the healthcare landscape including too many rural hospital closures and the decision of many states to decline Medicaid expansion.
“It’s tough in these rural markets, because it’s not like these rural markets were really competitive to begin with before ACA,” New York University economist Michael Dickstein told Vox.
That's not to say that the ACA hasn't so far had a positive impact on the rural uninsured rate, however. That number dropped from 11.5% in 2014 to 9.1% in 2015, according to the CDC's National Center for Health Statistics.
One possible solution may be found in how states define their rating areas, Dickstein suggested to Vox, noting that states that combine less populated counties with neighboring urban ones improve the offerings for the rural counties by an average of 0.6 to 0.8 more insurers, and bring lower premiums. On the flip side, when rural counties are isolated in their own coverage regions, competition tends to be reduced.