Although it may be premature to perform last rites on insurance exchanges created under the Affordable Care Act (ACA), it's fair to say that they are on life support in many states.
"We continue to see a decline in issuer participation in the health insurance exchanges, leaving consumers with fewer and fewer insurance options," Seema Verma, administrator of the federal Centers for Medicare & Medicaid Services, said in a report issued in late July. "I am deeply concerned about the crisis situation facing the individual market in many states across the nation."
The agency projects that residents of 49 counties will have no options to choose from when they try to enroll in a plan through an exchange for 2018. Another 2.4 million exchange participants in 1,300 counties may have only one carrier option next year, according to the report (see chart below).
The Heritage Foundation, a conservative think-tank in Washington, D.C., says the reduction in the number of carriers continues a pattern that started with the inception of the ACA:
"One of the stated aims of the ACA was to increase competition among health insurance companies. That goal has not been realized, and by several different measures, the ACA's exchanges offer less competition and choice in 2017 than ever before. Now in the fourth year of operation, the exchanges continue to be far less competitive than the individual health insurance market was before the ACA's implementation. Moreover, insurer participation in the law's government-run exchanges has declined over the past two years and is now at the lowest level yet. This lack of insurer participation leaves exchange customers in 70 percent of U.S. counties with no insurer choice, or a choice between merely two insurers."