More Americans live in an area where three or more health insurers sold coverage on the Affordable Care Act exchanges in 2019 compared with the year before, according to an Urban Institute analysis published Thursday.
That's important because premiums are generally lower in places where multiple health insurers compete to sell insurance plans. But while competition on the exchanges is improving, it still isn't on par with 2017 levels, according to the analysis.
"It's encouraging to see signs of stabilization in the individual market," Anne Weiss, managing director at the Robert Wood Johnson Foundation, said in a statement. "However, geographic location still plays too great a role in consumers' coverage options and how much they cost."
The analysis adds to other research showing the ACA exchanges are bouncing back to being more competitive after a wave of health insurers initially exited the exchanges in 2017 and 2018 because they were losing money. Health insurers that remained are now turning profits.
The Urban Institute analysis, which was funded by the Robert Wood Johnson Foundation, found that 37.5% of the population lives in a "premium rating region" where one or two health insurers offer ACA exchange coverage in 2019. The rest—62.8%— have a choice between three or more.
That's an improvement over 2018, when 45.1% of the population lived in a region with one or two insurers, while 53.5% had a choice between three or more insurers. In 2017, 33.8% of people lived in a region with just one or two insurers while the rest had access to three or more.
Southerners were more likely to live in areas with little competition between exchange insurers, while people in the Northeast were more likely to live in regions with five or more insurers.
The analysis also found that premiums are much higher in places with one insurer compared to areas with five or more. Median benchmark premiums for a 40-year-old nonsmoker were $376 per month in rating regions with five or more insurers in 2019. In regions with just one insurer, the median benchmark premium was $592 per month.
The Urban Institute's analysis isn't the only research showing competition increased in the ACA marketplace in 2019. In November last year, the Robert Wood Johnson Foundation's Katherine Hempstead found that the percentage of U.S. counties with only one insurer declined to 35% this year from about half last year.
