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Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018.

Abigail R Barker, Lindsey Nienstedt, Leah M Kemper

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    This summary is machine-generated.

    Average health insurance premiums in marketplaces increased from 2014 to 2018, with higher costs in rural areas. Many counties now have only one insurance issuer available.

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    Area of Science:

    • Health policy analysis
    • Health economics
    • Insurance market dynamics

    Background:

    • The Patient Protection and Affordable Care Act (PPACA) established Health Insurance Marketplaces (HIMs) in 2014.
    • Marketplace insurance premiums have shown considerable variation since implementation.
    • Understanding premium changes and market variations is crucial for ongoing policy debates.

    Purpose of the Study:

    • To assess changes in average HIM plan premiums from 2014 to 2018, prior to subsidies.
    • To emphasize the increasing premium disparities between rural and urban areas.
    • To inform Congressional discussions regarding the future of the PPACA program.

    Main Methods:

    • Analysis of average Health Insurance Marketplace plan premiums from 2014 to 2018.
    • Examination of premium variations across rural and urban locations.
    • Comparison of premium trends in states that expanded Medicaid versus those that did not.

    Main Results:

    • Insurance issuer participation decreased in both rural and urban areas.
    • Average premiums increased across all categories, with a widening gap between Medicaid expansion and non-expansion states.
    • Rural counties experienced higher average premiums than urban counties ($43/month vs. $27/month).
    • The trend of lower premium changes in densely populated areas was no longer observed.
    • In 2018, 52% of counties had only one insurance issuer, with 55% of rural counties affected.

    Conclusions:

    • Health Insurance Marketplace premiums have risen, particularly in rural areas.
    • Reduced issuer competition, with many counties having only one option, likely contributes to premium increases.
    • The widening premium gap between states that expanded Medicaid and those that did not warrants further investigation.