Early Observations on Health Insurance Exchanges: Market Trends and Enrollment Data
Observations from 2014 and 2015 indicate increased competition and enrollment in health insurance exchanges post-ACA implementation. Market concentration pre-ACA was high, hindering competition. Insights include buyer demographics, state-specific enrollment rates, and insurer participation growth.
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Early Observations Regarding Health Insurance Exchanges Marketplace Competition, Enrollment, and Pricing in 2014 and 2015 Cynthia Cox, Kaiser Family Foundation February 24, 2015
Before the ACA, most states individual insurance markets were highly concentrated Median market concentration (Herfindahl index, HHI) Median number of issuers with at least 5% market share 5,000 5 4,500 4,000 4 3,500 3,000 3 2,500 2,000 2 1,500 1,000 1 500 0 0 2010 2011 2012 2013 2010 2011 2012 2013 Kaiser Family Foundation analysis of Mark Farrah AssociatesTMdata
Background on health insurance exchanges Pre-ACA individual market Highly concentrated Medical underwriting hampered competition Exchanges were created to: Expand access Encourage insurers to participate Promote competition
Who is buying on the 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 Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
2015 Marketplace signups in states using HealthCare.gov Percentage of potential market signed up varies by state Florida 64% Maine 60% Pennsylvania 52% Delaware 52% Alaska 24% North Dakota 23% South Dakota 21% Iowa 20% Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
Insurer participation has increased in most state Marketplaces 2014 2015 New York New York 16 16 Wisconsin Ohio 13 16 California Wisconsin 11 15 Ohio Texas 11 14 Oregon Michigan 11 13 U.S. Average U.S. Average 5 6 Rhode Island Delaware 2 2 Vermont Hawaii 2 2 Wyoming Vermont 2 2 New Hampshire Wyoming 1 2 West Virginia West Virginia 1 1 0 5 10 15 20 0 5 10 15 20 Kaiser Family Foundation State Health Facts http://kff.org/state-category/health-reform/
Market Share of Insurers in Californias Individual Market (2012) and Exchange (as of Feb. 28, 2014) 47% Wellpoint (incl. Anthem) 30% 20% Kaiser Permanente 18% 19% Blue Shield of California Group Pre-ACA Individual 29% Exchange 3% Health Net 18% 10% Other Insurers 5% 0% 10% 20% 30% 40% 50% Source: Kaiser Family Foundation, Sizing Up Exchange Market Competition March 1, 2014
Market Share of Insurers in New Yorks Individual Market (2012) and Exchange (as of Dec. 30, 2013) 28% Wellpoint (incl. Empire BCBS) 18% 20% UnitedHealth 2% 15% Lifetime (incl. Excellus BCBS) 6% 11% Freelancers Insurance Company 10% EmblemHealth 12% Pre-ACA Individual 2% MVP Health Care 10% Exchange 0% Health Republic 16% 0% Fidelis Care 14% 0% MetroPlus Health Plan 11% 14% Other Insurers 11% 0% 5% 10% 15% 20% 25% 30% Source: Kaiser Family Foundation, Sizing Up Exchange Market Competition March 1, 2014
Market Share of Insurers in Minnesotas Individual Market (2012) and Exchange (as of Feb. 19, 2014) 59% Blue Cross Blue Shield 24% 17% Medica 4% 11% HealthPartners 12% Pre-ACA Individual 7% Exchange Assurant 3% PreferredOne 58% 3% Other Insurers 2% 0% 10% 20% 30% 40% 50% 60% 70% Source: Kaiser Family Foundation, Sizing Up Exchange Market Competition March 1, 2014
Market Share of Insurers in Connecticuts Individual Market (2012) and Exchange (as of Feb. 18, 2014) 45% Wellpoint (incl. Anthem) 60% 22% Aetna 19% UnitedHealth Pre-ACA Individual 8% Exchange EmblemHealth (incl. ConnectiCare) 37% 0% HealthyCT 3% 5% Other Insurers 0% 10% 20% 30% 40% 50% 60% 70% Source: Kaiser Family Foundation, Sizing Up Exchange Market Competition March 1, 2014
What Americans paid for the second-lowest cost silver plan in 2014, before tax credits Monthly Premium > $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/.
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/
Trends & Lessons from first 2 years 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
