Politics, enrollment system glitches and plan administration glitches aside, where did public health insurance exchange system users have the best choice of health plans?

The U.S. Government Accountability Office (GAO) tried to answer that question for members of Congress and found that different approaches to analyzing competition data produced different results.

The analysts looked at both state-based Patient Protection and Affordable Care Act (PPACA) exchanges and exchanges run by the U.S. Department of Health and Human Services (HHS). The average individual exchange had six participating qualified health plan (QHP) issuers, including three issuers who were new to the state’s individual market. Those QHP issuers had an average total share of 57 percent of the state’s individual health insurance market in 2012.

In the small-group market, the average exchange had four QHP issuers and one new issuer. The QHP issuers had a 56 percent share of the state’s 2012 small-group market.

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But the analysts found that the number and size of QHP issuers varied widely by state, and that the number of QHPs available did not necessarily have much to do with the number of issuers.

In the individual market, the number of individual issuers ranged from just one in New Hampshire to 17 in New York state. The QHP issuers’ share of a state’s 2012 market ranged from 0 percent in New Hampshire to 92 percent.

But all residents of New Hampshire had a choice of at least 11 individual QHPs, and some residents of Alabama had as few as seven QHP choices.

In New York state, the number of individual QHP choices in each market ranged from 91 to 174, even though the participating issuers accounted for just 36 percent of the state’s 2012 individual market.

  Number of individual QHP issuers QHP issuers’ share of state’s individual 2012 market
Alabama 2 92
Alaska 2 65
Arizona 10 60
Arkansas 3 85
California 12 30
Colorado 10 12
Connecticut 3 45
Delaware 3 57
District of Columbia 4 90
Florida 11 52
Georgia 5 34
Hawaii 2 98
Idaho 4 62
Illinois 8 83
Indiana 4 63
Iowa 4 3
Kansas 4 78
Kentucky 3 96
Louisiana 5 83
Maine 2 49
Maryland 6 69
Massachusetts 11 95
Michigan 12 59
Minnesota 5 63
Mississippi 2 10
Missouri 4 61
Montana 3 67
Nebraska 4 70
Nevada 4 7
New Hampshire 1 0
New Jersey 4 70
New Mexico 4 49
New York 17 36
North Carolina 2 89
North Dakota 3 76
Ohio 12 41
Oklahoma 6 70
Oregon 11 58
Pennsylvania 14 74
Rhode Island 94 94
South Carolina 4 59
South Dakota 3 17
Tennessee 4 45
Texas 12 76
Utah 6 47
Vermont 2 90
Virginia 8 13
Washington 8 48
West Virginia 1 61
Wisconsin 13 36
Wyoming 2 40
Source: GAO