Early Observations Regarding Health Insurance Exchanges Marketplace Competition, Enrollment, and...
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Transcript of Early Observations Regarding Health Insurance Exchanges Marketplace Competition, Enrollment, and...
Early Observations Regarding Health Insurance ExchangesMarketplace Competition, Enrollment, and Pricing in 2014 and 2015
Cynthia Cox, Kaiser Family Foundation
February 24, 2015
2010 2011 2012 20130
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
Median market concentration (Herfindahl index, HHI)
Kaiser Family Foundation analysis of Mark Farrah AssociatesTM data
Before the ACA, most states’ individual insurance markets were highly concentrated
2010 2011 2012 20130
1
2
3
4
5
Median number of issuers with at least 5% market share
• Pre-ACA individual market– Highly concentrated– Medical underwriting hampered competition
• Exchanges were created to:– Expand access– Encourage insurers to participate– Promote competition
Background on health insurance exchanges
• 2014– About 8 million signed up by end of open enrollment– 28% of potential market– Most received financial assistance (85%)– Most picked silver (65%) and bronze (20%)
• 2015– 6.7 million still enrolled at beginning of open enrollment– Approx. 11.4 million signed up by end of open enrollment– Vast majority receive financial assistance
Who is buying on the exchanges?
Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
Iowa
South Dakota
North Dakota
Alaska
Delaware
Pennsylvania
Maine
Florida
20%
21%
23%
24%
52%
52%
60%
64%
2015 Marketplace signups in states using HealthCare.gov
Percentage of potential market signed up varies by state
Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
West Virginia
New Hampshire
Wyoming
Vermont
Rhode Island
U.S. Average
Oregon
Ohio
California
Wisconsin
New York
0 2 4 6 8 10 12 14 16 18
1
1
2
2
2
5
11
11
11
13
16
2014
Insurer participation has increased in most state Marketplaces
West Virginia
Wyoming
Vermont
Hawaii
Delaware
U.S. Average
Michigan
Texas
Wisconsin
Ohio
New York
0 2 4 6 8 10 12 14 16 18
1
2
2
2
2
6
13
14
15
16
16
2015
Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
Other Insurers
Health Net
Blue Shield of California Group
Kaiser Permanente
Wellpoint (incl. Anthem)
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
5%
18%
29%
18%
30%
10%
3%
19%
20%
47%
Pre-ACA IndividualExchange
Source: Kaiser Family Foundation, “Sizing Up Exchange Market Competition” March 1, 2014
Market Share of Insurers in California’s Individual Market (2012) and Exchange (as of Feb. 28, 2014)
Other Insurers
MetroPlus Health Plan
Fidelis Care
Health Republic
MVP Health Care
EmblemHealth
Freelancers Insurance Company
Lifetime (incl. Excellus BCBS)
UnitedHealth
Wellpoint (incl. Empire BCBS)
0% 5% 10% 15% 20% 25% 30%11%
11%
14%
16%
10%
12%
6%
2%
18%
14%
0%
0%
0%
2%
10%
11%
15%
20%
28%
Pre-ACA IndividualExchange
Market Share of Insurers in New York’s Individual Market (2012) and Exchange (as of Dec. 30, 2013)
Source: Kaiser Family Foundation, “Sizing Up Exchange Market Competition” March 1, 2014
Other Insurers
PreferredOne
Assurant
HealthPartners
Medica
Blue Cross Blue Shield
0% 10% 20% 30% 40% 50% 60% 70%
2%
58%
12%
4%
24%
3%
3%
7%
11%
17%
59%
Pre-ACA IndividualExchange
Market Share of Insurers in Minnesota’s Individual Market (2012) and Exchange (as of Feb. 19, 2014)
Source: Kaiser Family Foundation, “Sizing Up Exchange Market Competition” March 1, 2014
Other Insurers
HealthyCT
EmblemHealth (incl. ConnectiCare)
UnitedHealth
Aetna
Wellpoint (incl. Anthem)
0% 10% 20% 30% 40% 50% 60% 70%
3%
37%
60%
5%
0%
8%
19%
22%
45%
Pre-ACA IndividualExchange
Market Share of Insurers in Connecticut’s Individual Market (2012) and Exchange (as of Feb. 18, 2014)
Source: Kaiser Family Foundation, “Sizing Up Exchange Market Competition” March 1, 2014
> $375> $325 - $375> $275 - $325> $225 - $275≤ $225
Notes: Premiums indicate the amount a 40-year-old would need to spend on the second-lowest cost silver plan in a given county or region.Source: Premiums for state-based exchanges were obtained through a Kaiser Family Foundation review of insurer rate filings to state regulators. Premiums for federally-facilitated and partnership exchanges were obtained from data published by HealthCare.gov, as of January 22, 2014, available at https://www.healthcare.gov/health-plan-information/.
Monthly Premium
What Americans paid for the second-lowest cost silver plan in 2014, before tax credits
The difference in premiums Americans pay for the second-lowest cost silver plan from 2014 to 2015, before tax credits
Notes: The premium changes shown are for the second-lowest cost silver (“benchmark”) plan available to a 40-year-old in a given county or region.Source: Kaiser Family Foundation analysis of insurer rate filings to state regulators and premium data published by HealthCare.gov, available at https://www.healthcare.gov/health-plan-information-2015/
• Individual market highly concentrated 2010 - 2013• Marketplace insurer participation increased 2014 - 2015• Some marketplaces are more competitive than pre-ACA,
but no guarantee of early success • Trends in the future:
– Narrow networks– Migration to self-insurance among small employers– Private exchanges
Trends & Lessons from first 2 years