The Patient Protection and Affordable Care Act (PPACA) has been putting health insurance industry employment numbers on a spine-twisting rollercoaster in recent years.
Major medical insurers, in particular, need fewer individual health insurance underwriters, but more tech people who understand how to connect with HealthCare.gov without connecting with hackers from Bulgaria.
The PPACA individual and employer coverage mandates have offered medical insurers the possibility of getting more revenue, but the PPACA minimum medical loss ratio (MLR) standards, the PPACA rate review program and a barrage of PPACA-related penalties, fees, taxes and legislative affairs costs pose the threat of converting profit margins into loss margins.
Meanwhile, the Census Bureau has interesting state-by-state County Business Patterns survey figures for every year from 1998 through 2013, the year before PPACA changed everything.
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One interesting way to look at the numbers is to compare the data for 2003 with the data for 2013.
In 2003, the health maintenance organization (HMO) movement was sputtering out, the failure of the Medicare+Choice private Medicare plan market was fresh in insurance executives’ memories, and the personal health account concept was starting to spread.
In 2013, Medicare Advantage was hot, health savings accounts were becoming a core product, and the PPACA commercial health insurance programs were starting to take shape.
See also: PPACA spawned dozens of startups
Health insurers did better at creating jobs over that period than the financial services industry as a whole.
Financial services employment fell 6.2 percent, to 6.1 million.
Insurance carrier employment fell 4.4 percent, to 1.4 million.
Health insurance and medical insurance employment rose 11 percent, to 503,818.
The picture the numbers paint is not crystal clear. The North American Industry Classification System (NAICS) code for health carriers, 524114, lumps dental insurers together with major medical insurers and may also include issuers of some other health-related products. A table showing state-level summary data leaves out totals for some states for some years for a wide variety of reasons.
We tried comparing the state-level totals that we could get for 2003 and 2014, anyway, to get a rough sense of how health insurance ups and downs might have affected the number of people employed by health insurers in each state.
See also: 10 best cities for jobs: 2015
At the state-level, changes ranged from job count increases over 100 percent down to decreases of almost 50 percent.
This week, we’ll present a list of the states with the worst decreases, which shows how health insurer consolidation has hit the job count in some markets. Next week, we’ll present the states with the biggest increases.
For a look at the states with what would appear to be the coldest health insurance carrier employment markets, and an all-state health insurer employment table, read on.
10. South Dakota
2003 health carrier employment: 1,251
2013 health carrier employment: 1,194
Change, from 2003 to 2013, in percent: -5%
2003 health carrier employment: 1,719
2013 health carrier employment: 1,552
Change, from 2003 to 2013, in percent: -10%
See also: Low-cost CO-OPs win share
8. Rhode Island
2003 health carrier employment: 2,186
2013 health carrier employment: 1,863
Change, from 2003 to 2013, in percent: -15%
Image: Newport, Rhode Island (Getty Images/Albert Pego)
2003 health carrier employment: 4,154
2013 health carrier employment: 3,403
Change, from 2003 to 2013, in percent: -18%