Having a Democrat House Majority means peace of mind overall for those who have individual health insurance policies. Unfortunately, for the last two years, between Trump and the GOP House & Senate, all perspective on health insurance was lost and the last two years have been filled with anxiety caused by repeated attempts to repeal the ACA and constant efforts to weaken it.
While all of this was going on, the A.C.A. Marketplace has continued on and by some measures is doing better. Insurance company margins have continued to improve during 2018, and a number of insurers entered the market or expanded their service area for 2019. The average number of companies per state in 2019 is 4.0, ranging from one company in five states (Alaska, Delaware, Mississippi, Nebraska, and Wyoming) to more than 10 companies in three states (California, New York and Wisconsin). In 2019, 58% of enrollees (living in about 23% of counties) have a choice of three or more insurers, up from 48% of enrollees in 2018. Although there are an average of 4.0 insurance companies per state, many insurers do not participate statewide. Insurer participation varies greatly within states, and rural areas tend to have fewer insurers. On average, metro-area counties have 2.3 insurers participating in 2019, compared to 1.8 insurers in non-metro counties. In 2018, 87% of enrollees lived in metro counties.
The main repercussions of Trump’s Executive Orders, Trump Administration actions and the GOP legislature is that the U.S. is turning into two countries for the sake of health care and as they say in real estate, it’s location, location, location. It’s important to note that two of the three states that have more than 10 companies have their own health insurance exchange (California and New York). New guidance from the Trump Administration would give states wider latitude to expand or narrow the income range eligible for subsidies, target them toward younger people or allow them to be used for less costly but skimpier types of insurance. This could result in the pre-ACA health insurance market where your health insurance choices are completely dependent upon the State you live in. Because the real question is: Is Trump Pushing Health Insurance Innovation Or An ACA Rollback? In a future post, I’ll take a look at the states that are having success with their State Health Insurance Exchanges.