A customer walks out of a Miami-based insurance agency helping people enroll in health insurance plans under the Affordable Care Act.
Meanwhile, a handful of health insurance plans across the country are going in the opposite direction, dropping out of government marketplaces. Nine insurers from federal exchanges and four from states won't be offering their services through the marketplaces anymore. California faces a net loss of two insurers and Minnesota's exchange will lose its largest and least-expensive insurer.
'They may not have gotten a high enrollment and therefore may not want to continue the expense of offering their services,' says Gary Claxton, a vice president at the Kaiser Family Foundation.
PreferredOne in Minnesota, the state's largest provider that also offered the lowest-priced options, is withdrawing this year because it found participation unsustainable in both cost and administrative work.
Contra Costa Health Plan in California is withdrawing because of new requirements by the Centers for Medicare and Medicaid Services issued in May this year, which says companies must offer the same rates both inside and outside the exchange.
Patricia Tanquary, the health plan CEO, says this mandate would lead to potential rate increases and administrative and financial burdens for CCHP. These burdens would detract from its mission to provide coverage for low-income and vulnerable populations during a time of rapidly expanding enrollment for Medi-Cal, the state's health insurance program for the poor, she says.
The online marketplaces are built for people who are not getting health insurance through their employer, or through the government-run Medicare or Medicaid. The Affordable Care Act requires Americans to buy health insurance regardless of the means, and though they can do so through a broker or directly through an insurer's website, they won't receive the same tax breaks the exchanges offer, which can save them thousands of dollars. Therefore, if people were to automatically re-enroll in a plan that has dropped from the marketplaces they may pay significantly more for health care next year.
A report released earlier this month from the Kaiser Family Foundation also shows plans that offered lower rates last year may not offer the same rates this year, and that some plans may be less expensive, depending on where people live.
Claxton points out that an insurance company's participation in the exchanges can be expensive. They have to select plans they will offer, get them approved, and once consumers are enrolled, they have to serve them. Health insurance companies that withdraw also may be looking at what other companies are charging and realize they can't offer competitive prices, he says.
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Pollack says even though some health insurance companies have dropped from the exchanges, they are outweighed by new companies joining, and therefore continue to give consumers more options.
Last year 191 insurers offered plans in some of the 36 states that use Healthcare.gov and have not created their own marketplaces. This year there early reports show that 248 insurers will participate. In the eight states that create their own exchanges, 67 insurers will offer plans, up from 61 last year.
The number of insurers in Indiana is rising to nine and the number in Missouri is doubling to eight. New Hampshire's options will increase to five this year, from only one last year, and West Virginia will gain a second insurer. Alabama, Maine, Mississippi and North Carolina will gain a third insurer; and Arkansas and Montana will gain a fourth on the federal exchanges.
Though an insurer might be listed within a particular state, that doesn't mean it serves every county. The health agency did not have information that broke down individual counties.
'Because the issuer data for 2015 we used were still preliminary, we did not conduct any analysis of issuer participation at the local level,' says an HHS official.
Rural areas, in particular, have gaps in the number of providers available simply because areas are so spread out and the number of doctors and hospitals is extremely low.
Some health insurance companies were hesitant to sign up for exchanges in the first place, taking a 'wait-and-see' approach to how they would perform and who would sign up. Several state exchanges and Healthcare.gov had a rocky rollout last year, making it difficult or near impossible for some consumers to sign up through their websites.
Wellmark Blue Cross Blue Shield is holding off another year on potentially joining exchanges in Iowa and South Dakota because of concerns about data discrepancies that could affect consumers' eligibility and whether they receive subsidies, says Traci McBee, a company spokeswoman.
'In addition, how data is transferred between the system, government entities and ultimately, health insurers, continues to be problematic,' she says, adding the company had already seen incremental improvements on the technical end.
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Pollack says companies were being cautious because they were concerned the marketplaces might not be profitable. The fact that more companies are looking to sign up shows a vote of confidence in the system.
'Companies believe the marketplaces are stable and good places to provide their product, and that there are good opportunities to make a profit,' Pollack says.
Consumer groups and some news reports have said the one-year waiting period could have problematic implications. They say it could be that insurance companies wanted the sickest, and therefore most-expensive, patients already registered for other plans so they can collect the healthier and younger patients in subsequent enrollments.
'It's possible, but we're not in the board room,' Claxton says. He admits, however, that it would have made sense to see sicker people enroll earlier because prior to Obamacare people were turned away for a pre-existing condition.
Pollack says the cost of covering additional sick and disabled people would have been very expensive. But enrollees turned out to be a balanced pool, he says.
'They were healthy as well as sick, and young as well as old,' he says.
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