Obamacare is adding insurers where they’re most needed

Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, except for next week. Health Reform Watch will be on vacation the week of June 9th and will return June 16th. Read previous columns here.

You can almost think of two types of "problem" Obamacare exchanges. First, there are the ones still having massive technical problems, and then there are the ones that had trouble attracting insurers.

It's looking like the second problem is much easier to fix.

State health insurance marketplaces that offered consumers very few health plan choices in 2014 are starting to add more insurers — slowly, in most cases. But this is a sign that insurers are feeling confident about the second year of the Affordable Care Act's coverage expansion.

The development is important for a few reasons. For one, recent research suggests that more competition in the exchanges could help temper premium increases. Other new analysis shows that exchange plans, on average, are cheaper than individual plans offered outside the insurance marketplaces. And given the narrow networks in exchange plans, more insurers could mean better access to providers.

In New Hampshire, the exchange's only insurer last year had excluded 10 of 26 hospitals in the state from its network, meaning the exchange's customers were limited in their choice of care providers. In 2015, though, New Hampshire will have five insurers selling individual and family health plans on the exchange, state officials announced this week. That also includes the expansion of two non-profit, co-op plans that received start-up funding from the Affordable Care Act.

Then there's West Virginia, a poorer state and one of the least healthy in the country — not exactly an attractive market for insurers. Just one insurer sold 2014 exchange plans, but a second insurer from Kentucky, another co-op, will join in 2015. Kentucky Health Cooperative, which signed up 75 percent of the approximately 82,000 people who selected private plans in Kentucky's exchange, will sell plans statewide in West Virginia next year.

The two insurers selling individual plans on Maine's exchange will be joined by a third in 2015, the state announced this week. The two insurers selling in 2014 have proposed average rate increases of .1 percent and 3.1 percent, well below what's been offered in other states so far.

Although Washington state had one of the more successful individual exchanges this year, it never fully launched an insurance marketplace for small businesses — just one insurer sold health plans in a couple of counties in 2014. At least one insurer, Moda Health, has applied to sell statewide on the small business exchange in 2015, according to Washington state's insurance department.

The plan offerings could obviously be more robust in these marketplaces, and they may continue to grow in the coming years. For now, though, this seems to be a positive sign for the health-care law.

Top health policy reads from around the Web:

The race to get HealthCare.gov 2.0 ready on time. "The Obama administration is revamping HealthCare.gov and scrapping significant parts of the federal health-insurance marketplace in an effort to avoid the problems that plagued the site's launch last fall, according to presentations to health insurers and interviews with government officials and contractors. But the makeover—and the tight timeline to accomplish it—are raising concerns that consumers could face another rocky rollout this fall when they return to the site to choose health plans. Some key back-end functions, including a system to automate payments to insurers, are running behind schedule, according to a presentation federal officials made to health insurers." Spencer E. Ante, Anna Wilde Mathews and Louise Radnofsky in the Wall Street Journal.

One woman's way of opting out of Obamacare. "Tucker is part of a small but growing group of Americans whose opposition to the Affordable Care Act is spurring them to seek out alternatives, choosing once-fringe methods to pay for their medical care in an effort to skirt the many requirements the law imposes on the private health insurance market. The result is a burgeoning business among brokers, clinics and insurers that are advertising themselves as a way to avoid the sweeping federal program. The options range from Christian co-ops such as Tucker’s to membership-based primary-care clinics to insurance policies that cover specific diseases, such as cancer." Sandhya Somashekhar in the Washington Post.

The price of unlocking the brain's mysteries. "The National Institutes of Health set an ambitious $4.5 billion price tag on its part of President Obama’s Brain Initiative on Thursday, stamping it as an effort on the scale of the Human Genome Project. The goals of the Brain Initiative were clearly grand when Mr. Obama announced it a year ago — nothing less than developing and applying new technology to crack the toughest unsolved puzzles of how the brains of humans and animals function. The hope is to lay a foundation for future advances in the medical treatment of brain disorders." James Gorman in the New York Times.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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