Last updated on: 5/27/2015 | Author:

Has Obamacare Increased Health Insurance Competition? – DEBATED

General Reference (not clearly pro or con)

The Henry J. Kaiser Family Foundation stated the following in its Mar. 17, 2014 issue brief written by Cynthia Cox, MPH, Rosa Ma, Gary Claxton, and Larry Levitt, MPP, “Sizing Up Exchange Market Competition,” available at

“The individual health insurance market historically has been highly concentrated, with only modest competition in most states. At the time the Affordable Care Act (ACA) was signed into law in 2010, a single insurer had at least half of the individual market in 30 states and the District of Columbia…

Health insurance exchanges (also called marketplaces) are intended to promote price competition in the individual and small group insurance markets through greater transparency…

Preliminary exchange enrollment data released by seven states provides an opportunity to look at how competition may be changing in the individual market. To do this, we compared early enrollment across insurers in these exchanges to market share statistics from each state’s 2012 individual market prior to full ACA implementation…

Analysis of the early results suggests a diversity of results across states. On one hand, two large states, California and New York, appear to be noticeably more competitive than their 2012 individual markets as a whole. On the other hand, exchanges in Connecticut (where two major insurers decided not to participate in the exchange) and Washington appear to be less competitive than their individual markets were in 2012…

The long-term success of the exchanges and other ACA provisions governing market rules will be measured in part by how well they facilitate market competition, providing consumers with a diversity of choices and hopefully lower prices for insurance than would have otherwise been the case.”

PRO (yes)


The US Department of Health and Human Services stated the following in its Jan. 8, 2015 report “Health Plan Choice and Premiums in the 2015 Health Insurance Marketplace,” available at

“Our research indicates that the Affordable Care Act is working to enhance competition, expand choice and promote affordability among Marketplace health insurance plans in 2015…

There are over 25 percent more issuers participating in the Marketplace in 2015. About 91 percent of consumers will be able to choose from 3 or more issuers—up from 74 percent in 2014. Consumers can choose from an average of 40 health plans for 2015 coverage—up from 30 in 2014—based on analysis at the county level…

The Affordable Care Act is working to create a dynamic, competitive Marketplace, with more choice and affordable premiums in 2015. This offers new opportunities for consumers to comparison shop to select the plan that best meets their needs and budget. More choice also means more competition between plans that in turn results in downward pressure on premiums. Consumers who bought a 2014 plan and decide to shop actively for a comparable 2015 plan will often be able to find lower premiums.”


Administration Officials in President Barack Obama’s White House stated the following in a May 30, 2013 memorandum “Early Results: Competition, Choice, and Affordable Coverage in the Health Insurance Marketplace in 2014,” available at the White House website:

“Many individuals currently have little choice among health insurers, and the Affordable Care Act is working to create a market that will attract new entrants and increase competition and choice…

The Marketplace is attracting new insurance choices and increasing competition for consumers, especially in States where it is really needed…

About 90% of target enrollees will have five or more difference insurance company choices – based on data from the 19 States with a HHS-run Marketplace and from other State-run Marketplaces that have publicly released information about their submissions.

Together, these States represent an estimated 80% of the 7 million people CBO estimates will enroll in the Marketplace in 2014.”


The Bipartisan Policy Center (BPC) stated in its Aug. 24, 2012 report “Primer: Understanding the Effect of the Supreme Court Ruling on the Patient Protection and Affordable Care Act,” available at the BPC website:

“To address the unaffordability of insurance premiums in the individual and small-group markets, the ACA established health insurance exchanges that are designed to provide one-stop-shopping platforms in which consumers can compare and purchase insurance online. Offering consumers transparency in insurance pricing and product information should help promote competition and affordability…

As a result of the Supreme Court decision, approximately three million additional individuals—primarily those between 100 and 138 percent of FPL—are now expected to enroll in the insurance exchanges. This influx of people may have a positive impact on the functioning of those exchanges. More consumers create more competition, and a competitive marketplace that makes insurance more affordable is one of the key principles underlying the insurance exchange concept.”


The Federal Registrar stated in its Mar. 27, 2012 rule announcement “Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers,” available at the Federal Registrar website:

“This final rule will implement the new Affordable Insurance Exchanges (‘Exchanges’), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.”

CON (no)


Robert Moffit, PhD, Senior Fellow in the Center for Health Policy Studies at The Heritage Foundation, stated the following in his Apr. 22, 2015 article “Five Years Later: Obamacare’s Dim Prospects,” available at the MedPage Today website:

“Competition: In 2009, President Obama correctly criticized America’s health insurance markets as being noncompetitive, with 75% of the insurance markets controlled by five or fewer carriers in 34 states.

Did the ACA broaden insurance competition? No. A comparison of the number of insurers selling coverage in the public exchanges in 2015 with the number of insurers that sold individual coverage in 2013 shows the exchanges are 21.5% less competitive. At the county level, many Americans are finding their range of insurer choice is even more constrained. For example, 58% of the nation’s counties have only three or fewer insurers offering coverage in their exchange.”


Jeffrey Young, health care reporter for the Huffington Post, stated the following in his Jan. 27, 2014 article “These Health Insurance Companies Are Winning at Obamacare,” available at the Huffington Post website:

“Months after the launch of the Affordable Care Act’s health insurance exchanges, large insurance companies such as WellPoint still dominate many local markets — although smaller insurers are challenging some of the biggest players in some markets, according to data from nine states analyzed by The Huffington Post

While more than 120 insurance companies are offering coverage through the exchanges, the problem of poor competition isn’t solved yet… And HuffPost’s analysis comparing insurer market share between 2014 to date and 2011 shows the status quo is mostly holding in several states — including Rhode Island, California and Connecticut — where companies with the biggest market shares in 2011 are leading enrollments via the state’s exchanges.”


Alyene Senger, Research Associate at the Heritage Foundation, stated the following in her Nov. 8, 2013 article “Lack of Competition in Obamacare’s Exchanges: Over Half of US Has Two or Fewer Carriers,” available at

“Analyzing insurer participation in both federal and state-run exchanges shows that the President’s health care law has almost completely failed to increase insurance market competition…

In the vast majority of states, the number of insurers competing in the state’s exchange is actually less than the number of carriers that previously sold individual market policies in the state.

At the local level, in over half of the 3,135 counties in the U.S., consumers will face an exchange market that is either a duopoly or monopoly. In 78 percent of U.S. counties, exchange enrollees will have a choice of coverage from three or fewer carriers.

The exchange market in over 94 percent of U.S. counties will feature competition among five or fewer companies. In Alabama, about 96 percent of that state’s counties will have only one insurer offering coverage in the exchange…

By the standards of the President’s own ‘guiding principle,’ his law largely fails. Obamacare’s overregulation of insurance is to blame for the lack of competition in the exchanges. The flawed policies contained in Obamacare neither foster competition nor increase consumer choice, and they will continue to negatively impact American consumers and increase costs.”


Barak D. Richman, JD, Professor of Law and Business Administration at Duke University, wrote in his June 15, 2012 report “Beyond Repeal and Replace Ideas for Real Health Reform,” available at

“The Patient Protection and Affordable Care Act of 2010 (PPACA) does little to address the monopoly problem and may even worsen it. The highly regulated and heavily subsidized regime ahead under the PPACA already has triggered a feverish scramble among health industry firms (insurers, pharmaceutical manufacturers, physician practice groups, and device makers, as well as hospitals) to get bigger market share and also become better connected politically to ensure that they will be among the politically dependent survivor incumbents in the years ahead…

Unless a more effective competition policy can be implemented in the health sector, many millions of additional Americans will soon carry exactly the kind of health coverage that currently serves provider and supplier monopolists so well.”