(Bloomberg) – The Patient Protection and Affordable Care Act (PPACA) public exchange program may not be doing much to increase competition in health insurance markets, according to the Kaiser Family Foundation.

In California, for example, four big insurers have largely carved up the state’s “qualified health plan” (QHP) market. The divide is now “moderately concentrated,” instead of “highly concentrated,” Kaiser researchers reported in an analysis of QHP enrollment trends in seven states.

“There are some examples of smaller or newer plans being able to get a sizable piece of the market in the exchanges, but, by and large, a lot of the players in the exchanges that are the biggest were the biggest before as well,” Cynthia Cox, a senior analyst at Kaiser, said in a phone interview.

About 5 million Americans had signed up for QHPs through the public exchanges as of Monday, according to the U.S. government.

PPACA drafters created the exchanges in an effort to ease access and improve transparency for people who shop for insurance on their own, or about 5 percent of the U.S. population. The drafters also hoped to shake up the monopolies and duopolies that dominate some states’ health insurance markets.

In recent years, one insurance company has enrolled at least half of the individual market insureds in 30 states, according to the analysts.

In California, WellPoint Inc.’s Anthem brand covered about 47 percent of the individual market customers before PPACA came along. The company will be covering about 30 percent of the 869,000 people who selected coverage through that state’s public exchange, Covered California, by March 1.

In New York, the company had a 28 percent share in the pre-PPACA individual market and now has 18 percent of the QHP market.

In Nevada, the company had a 34 percent share in the pre-PPACA individual market share and now has a 12 percent share of the QHP market.

In Connecticut, the company had a 45 percent share in the pre-PPACA individual market and now has a 60 percent share of the QHP market.

Market concentration may be higher in some QHP markets than it was in the pre-PPACA individual market.

In Minnesota, for example, PreferredOne, a closely held company based in Golden Valley, Minnesota, has signed about 59 percent of the QHP customers using the state’s MNsure exchange. In the pre-PPACA market, Minnesota’s Blue Cross Blue Shield plan had a 59 percent share, while PreferredOne had a 3 percent share. Blue Cross Blue Shield now has 24 percent share in the QHP market.

Enrollment figures for most states’ off-exchange individual commercial health insurance markets are not yet available.

Kristin Binns, a WellPoint spokeswoman, warned against drawing conclusions from the Kaiser data, because of the lack of data on people who signed up for individual coverage without using the public exchange system.

The U.S. Department of Health and Human Services (HHS) notes that about 95 percent of Americans now have access to a public exchange that offers a choice between at least two different insurance carriers.

“All consumers shopping in the marketplaces also have greater transparency where they can compare comprehensive, affordable plans side by side to find the one that best meets their needs,” Joanne Peters, an HHS representative, said in an e-mail.

See also:

 

 

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.