Obamacare customers in nearly two thirds of U.S. counties had three or fewer insurers to choose from in 2016, a GOP senator said Monday in an office report that argues President Obama oversold his signature law as a catalyst for competition.
The analysis by Sen. Ben Sasse, Nebraska Republican, said web-based exchanges under the Affordable Care Act had nearly 6 percent fewer insurers competing on them in 2016 than in 2015, and that it is best to look at county data to see how people are fairing under Obamacare, which requires Americans to hold insurance.
“Facts don’t spin. Families are forced to choose between fewer insurers on the ACA’s exchanges,” said Mr. Sasse, who worked as a health policy counselor during the Bush administration. “Competition is good for consumers — this new data should be a wakeup call that healthcare in this country is headed in the wrong direction.”
The Health and Human Services Department says nine in 10 returning consumers were able to choose from three or more issuers in 2016, and that looking at counties instead of where people actually live is misleading.
People with pre-existing medical conditions were often locked out the market before Obamacare, it frequently notes, so they had no choices at the time.
Mr. Sasse’s report, which counted parent insurers and not subsidiaries, said customers in over a third of the nation’s counties (36 percent) had only one or two insurers to choose from on the exchange for 2016 coverage.
Another 27 percent of counties could choose from three insurers or fewer, meaning 63 percent of counties topped out at three.
As envisioned, the exchanges were set up as state-based online markets where insurers would vie for millions of new consumers, now that government subsidies were available to people who could not afford coverage in the past. The competition would force insurers to keep their prices in check.
But Mr. Sasse’s state-level data said 289 insurers sold coverage on the exchanges overall for 2016, down from 307 in 2015, despite a 21-percent increase in participating insurers from 2014 to 2015.
The senator also looked at county-level data because insurance consumers can only pick from plans available there, and not any plan offered in their state. For instance, Texas had 16 insurers operating on the exchange for 2016, or “a number far higher than in most states.”
“However, for those living in Texas, no one can choose from 16 insurers,” the report said. “Rather, two-thirds of the state’s counties have only one or two insurers offering coverage — a monopoly or duopoly.”
Mr. Sasse’s report says the “most extreme” example is Wyoming, where only one insurer is offering coverage on the exchange, “creating a monopoly at both the state and county levels.”
Mr. Sasse’s report also said fewer insurers are offering coverage on the 2016 exchanges than in the pre-Obamacare market of 2013, though HHS argued there was no justification for excluding insurers who still offer plans off the exchanges.
The administration recently reported that 12.7 million people signed up for 2016 coverage on the exchanges, including 4.9 million brand-new customers. It also said 8.8 million customers had effectuated coverage at the end of 2015, meaning it did not meet its goal of 9.1 million because of marketplace attrition.
Mr. Sasse said Obamacare is coming up short on the fiscal end, too, concluding that lackluster competition has translated into rake hikes in some parts of the country.
HHS’s recent enrollment report said the average exchange customer in the 38 states using HealthCare.gov is paying $106 per month after subsidy for 2016 coverage, up from $101 per month in 2015.
The GOP has pledged to repeal Obamacare if they seize the White House and retain majorities in both chambers in 2017.
Though they haven’t posted a bill in the six years since Obamacare passed, GOP lawmakers say they are working on “market-oriented” reforms that would bolster competition by allowing insurers to sell their products across state lines, among other things, with the hope of driving down costs.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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