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Affordable Care Act Remnants Flunk Market Concentration Test

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Congress has repealed or defunded many Affordable Care Act (ACA) provisions that were originally supposed to help the ACA increase the level of competition in the individual and family major medical insurance market.

Analysts at Mark Farrah Associates have data suggesting that the shrunken version of the ACA in operation in the real world has not done much to increase individual health insurance market competition.


The top five insurers accounted for about 44% of individual market sales in 2019, according to Mark Farrah Associates data.

That’s up from 32% in 2015, when insurer interest in the ACA public exchanged program peaked, and it’s also up from 41%, before most major ACA individual health insurance rules and programs had started to come to life.

The dominant player in the U.S. individual market today is Centene Corp., with a 14% share.

Two single-state carriers also make the list: GuideWell, the parent of Florida Blue, has a 9.2% share, and Blue Shield of California has a 5.9% share.

Kaiser Permanente ranks third, with an 8.3% share.

Anthem ranks fifth, with a 5.5% share.

UnitedHealth ranked among the top individual health plans in 2015, with 1.1 enrollees. The company then backed away from the ACA exchange program because of concerns about how the program was being it administered. It had only about 261,000 individual health enrollees in 2019, according to Mark Farrah Associates.

— Read AXA Plays in U.S. Individual Health Market: Life and Health Deal Updateon ThinkAdvisor.

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