Apr. 24—Individual market insurance competition deteriorated in two states, improved in two others, and remained unchanged in three states after the launch of government-run marketplaces, a recent seven-state analysis found.

Among the seven states studied by the Kaiser Family Foundation, the worst-performing individual insurance markets after the fall 2013 launch of the Affordable Care Act’s (ACA’s) marketplaces were in Connecticut and Washington, compared with the preceding year. The seven states, all of which were operating their own marketplaces, were the first to release marketplace enrollment numbers by insurer.

In Washington, the number of insurers with more than 5 percent of the market share remained unchanged at three; those insurers controlled 92 percent of the exchange market. The market share of the largest insurer increased from 40 percent in 2012 to 62 percent after the ACA marketplace launched.

Connecticut’s market competition also contracted, with two insurers, Wellpoint (Anthem) and EmblemHealth (ConnectiCare) increasing their market share from 54 percent of the individual market in 2012 to 97 percent of the ACA exchange market.

Competition is unlikely to improve soon in Connecticut because the state barred any insurer that did not participate in 2014 from entering the marketplace for two more years.

The analysis indicated that some marketplaces have failed to increase individual insurance market competition, which was a major goal of the ACA. Competition was unchanged or “mixed” in Minnesota, Nevada, and Rhode Island, the analysis found.

As in many states, the dominant post-ACA insurer in Minnesota, PreferredOne, was able to grab market share by offering the exchange’s lowest-cost plans, which included a popular narrow-provider network plan.

Meanwhile, competition improved in two of the largest insurance markets: California and New York.

For instance, New York’s individual market was moderately concentrated before the ACA, but its government-run exchange is considered unconcentrated, according to the analysis’ authors.

“New York’s exchange acts as an active purchaser, meaning the state selectively contracts with plans, rather than allowing any qualified insurer to participate,” wrote the analysis. “Even so, the state has 16 parent companies offering plans in the exchange in various parts of the state, 7 of which hold market shares greater than five percent.”

The extent to which competition will increase in the 2015 plans, which insurers will begin submitting to regulators next month, remains unclear.

Aetna told investors Thursday that it is unlikely to move into more than the 17 ACA marketplaces in which it sells plans, according to media reports. But a UnitedHealth Group executive indicated last week that the insurer may increase the number of marketplaces where it offers plans beyond the five in which it participates.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.

Publication Date: Thursday, April 24, 2014