Dive Brief:
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The Affordable Care Act exchanges will see more competition in 2019, according to a new Kaiser Family Foundation report, in a rebound from prior years.
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An average of four payers per state will participate in the ACA marketplace in 2019, an increase from 3.5 in 2018. Less than one-fifth of enrollees will have one payer option, which is the lowest level since 2016. Despite those increases, the ACA exchanges’ market remains smaller than in the early days of the marketplace.
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Meanwhile, CMS announced on Wednesday that 804,556 people signed up for a plan through Healthcare.gov in the second week of open enrollment. Nearly 1.2 million Americans have signed up for health insurance so far. Enrollment is trending below the 2018 numbers.
Dive Insight:
Recent years have seen major payers drop out of the exchanges. However, more insurance companies are entering the marketplace and expanding their footprints for next year.
That's despite Congress spiking the individual mandate penalty in 2019 and the Trump administration expanding low-cost offerings beyond the exchanges. The market stability is evident in the modest premium increases planned in most states in 2019. For the first time, ACA federal exchange premiums for the second-lowest cost silver plans are expected to decrease an average of 1.5%.
In its new report, Kaiser Family Foundation said the state average was five payers in the ACA marketplace in 2014, including only one in New Hampshire and West Virginia and 16 in New York. That average increased to six per state in 2015 before falling to 5.6 in 2016 and then 4.3 in 2017, as multiple payers left the marketplace because of losses and market instability. That average dropped even further to 3.5 in 2018. Slightly more than half of enrollees were limited to fewer than three payer options this year.
Despite concerns of more problems in 2018, ACA payers have actually found their footing — and are even enjoying profits now. Payers, such as Centene, Cigna, Oscar Health, Anthem and Wellmark are moving back into the market or expanding to more counties in 2019.
Only a handful of counties are losing an insurer in 2019.
— Cynthia Cox (@cynthiaccox) November 14, 2018
608 counties are gaining at least one insurer. pic.twitter.com/hSgSP8cnz2
More than half of enrollees will once again have a choice of at least three payers in the exchanges in 2019.
There are still wide discrepancies though. Three states will have more than 10 payers and five will only have one option. Rural areas will again see fewer payers, KFF said.
For 2019, most payers will still practice silver loading. This practice lets insurance companies move costs associated with losing cost-sharing reduction (CSR) payments onto silver plans. Subsidies are tied to the cost of silver plans, which increases financial assistance to members. Silver loading means lower member costs.
Though consumers have more payer options in 2019, so far there has been little interest in open enrollment. Critics worry that 2019 will see even fewer people in the exchanges as Americans are no longer required to have health insurance.
CMS reported last week that only 371,676 people selected plans on Healthcare.gov during the first days of open enrollment. The second week saw enrollment numbers of more than 800,000 people. Of the roughly 1.2 million that have signed up so far, more than 270,000 are new enrollees.