A rise in insurer participation in the Affordable Care Act individual marketplace indicates that payers are anticipating a fruitful year ahead. The installation of a new president and ongoing Covid-19 pandemic appear to be driving this trend.
Over the past year, insurer participation in the ACA individual marketplace has grown and benchmark premiums have declined, according to a new analysis by the Robert Wood Johnson Foundation. The total number of insurance offerings sold on the marketplace is now 9,144, which is about 75% of the 2015 record high.
This suggests that insurers are anticipating increased enrollment as a result of federal policy changes and the impact of the Covid-19 pandemic, said Katherine Hempstead, senior policy adviser at RWJF and author of the analysis, in an email.
“The Biden administration has been emphatic about its commitment to the ACA marketplace,” she said. In particular, the administration has committed to preserving and expanding health coverage to help Americans during the pandemic.
In his American Rescue Plan, President Joe Biden called on Congress to subsidize continuation health coverage through the end of September and to expand and increase the value of the Premium Tax Credit. The latter move will help lower or eliminate health insurance premiums and ensure enrollees will not pay more than 8.5% of their income for coverage.
Further, Biden recently reopened the HealthCare.gov insurance markets for three months to enable Americans to sign up for coverage amid the ongoing pandemic.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Though these policy changes are temporary, there is a commitment on the part of the administration to try to make them permanent, Hempstead said.
Drilling down into participation among major insurers, Hempstead found that Anthem, UnitedHealth and Cigna currently comprise about two-thirds of the national commercial offerings on the individual marketplace. Centene, which dominates the Medicaid managed care organizations category, made its largest single-year increase, nearly doubling its marketplace offerings from 2020 to 2021.
In addition, participation by newcomers like Oscar and Bright Health has grown steadily. Bright Health is now in 10 states, and Oscar is in 19.
Another key analysis finding is that states that have yet to expand Medicaid saw increases in insurer participation. Increased participation in the ACA individual marketplace was particularly focused in Florida, Georgia, North Carolina and Texas, where the number of offerings increased by almost 50% in the last year.
“This is where the greatest number of uninsured people live, so it is the biggest opportunity for membership growth,” Hempstead said.
Looking ahead, it is clear that insurers are hopeful that a significant expansion in healthcare coverage is due, and they see the ACA marketplace as an increasingly important part of the coverage landscape, according to the analysis.
Photo: BrianAJackson, Getty Images
