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Blues plans dominate ACA market, but there may be new competition

Urban Institute analysis shows there may be an expansion of health insurance options in 2021, as national insurers are reportedly reentering market.

Susan Morse, Managing Editor

New research from the Urban Institute paints a portrait of what is beginning to happen in states' ACA marketplaces.

In 2018, Blues plans dominated the marketplace, but with increasing COVID-related unemployment, more insurers may choose to join the marketplace to fill consumer needs for health insurance.

Urban Institute researchers point out that there may be an expansion of health insurance options in the marketplaces in 2021, as national insurers are reportedly reentering.


Health plans issued by Blue Cross Blue Shield companies accounted for nearly half of marketplace enrollment in 2018, but Medicaid health plans are emerging as competition, new analysis from the Urban Institute shows.

With funding from the Robert Wood Johnson Foundation, the researchers analyzed new information from the Centers for Medicare and Medicaid Services.

The research shows that national insurers are likely to reenter the marketplace due to an increase, resulting from wide-scale unemployment, the loss of employer-sponsored insurance because of to COVID-19 and the economic fallout.

The analysis also shows that cost isn't always the main factor driving consumers' health plan selection.


The analysis shows that Blue Cross Blue Shield-affiliated insurers hold all, or close to all, of the enrollment in 11 states' marketplaces. In another nine states Blues plans have the majority of the enrollment, though they face increasing competition from other insurer types, typically Medicaid insurers.

Medicaid plans are the dominant insurers in another eight states.

Researchers say the data is a baseline for marketplace enrollment prior to entering the period shaped by the COVID-19 pandemic.


"The ACA marketplace has become more competitive over the past several years, with widespread entry from Medicaid managed care organizations and others," said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. "We expect competition to accelerate as millions lose their jobs and turn to the marketplace for coverage."

Twitter: @SusanJMorse
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