Dive Brief:

• The two states with the lowest number of enrollees in the state insurance exchanges, Iowa and South Dakota, have something in common: Their private insurance markets have one dominant player, Wellmark Blue Cross and Blue Shield, which refused to sell on state exchanges last year. It also plans to stay out of the exchanges in 2015.
• Prior to last year's enrollment, Wellmark held 87% of the private individual market in Iowa and 73% in South Dakota. Only 11% of eligible residents in both states signed up for subsidized plans in 2014. Some believe exchange enrollment was low because a big insurer like Wellmark didn't market plans.
• The insurance company told MedPage Today in an email that they were avoiding Healthcare.gov because of technical problems and data discrepancies on the site. The spokesperson said the company needs its information to be "timely, secure and accurate."

Dive Insight:

Cliff Gold, chief operating officer of CoOportunity Health, one of Wellmark's competitors in Iowa that did provide plans on the exchange, said not joining would create a better pool of people to insure. "If one wanted to cleanse their risk pool, there is no better way to do it than to stay off the exchange where presumably lower-income, less healthy people would come on," he said.

CoOportunity also said it plans to increase premiums by 14.3% in 2015, in part because Wellmark is not on the exchange. Coventry Health Care of Iowa, another exchange participant, said the company has proposed an 8.7% premium increase for 2015.