One-third of the counties — think of it, one-third — only have one insurer left on the Affordable Care Act exchanges.
Insurance providers are "fleeing" Affordable Care Act insurance exchanges, President Donald Trump said at a March 13 "listening session" on health care. "One-third of the counties — think of it, one-third — only have one insurer left," Trump said, adding that the Republican replacement for the 2010 health care law known as Obamacare will have "far more choices, at a lower cost." Trump has the right statistic about insurance provider participation. In 32 percent of counties, individuals looking to buy health insurance through the Affordable Care Act online marketplace have just one choice for their insurance provider, according to an analysis by the nonpartisan Kaiser Family Foundation, last updated in November 2016. In several states, including Alabama, Alaska, Oklahoma, South Carolina and Wyoming, there’s only one insurance provider total participating in each state’s online marketplace in 2017. That’s a significant change from 2016, when just 7 percent of counties — and one state, Wyoming — were limited to one insurance provider on the online exchanges. On the other end of the spectrum, Wisconsin has 15 insurance providers participating in the exchanges in 2017, and Ohio has 11. It’s important to note that Trump’s claim doesn’t mean one-third of people have only one provider to choose from for health insurance. Because rural and sparsely populated areas tend to have lower competition, about 21 percent, or one-fifth, of exchange enrollees live in these counties where there’s only one insurance provider to choose from, according to Kaiser. So of the approximately 9.2 million people enrolled in the Affordable Care Act exchanges in 2017, about 1.9 million could only purchase insurance from one company. These individuals could still buy insurance outside the marketplace and from another provider. But if they did so, they wouldn’t be able to get a federal subsidy to defray the cost. Insurance companies that have dropped from the exchanges — including UnitedHealthGroup, Humana and Aetna — have said they were losing money by participating. Among plans offered on the exchanges, costs have gone way up. Looking at a standard measurement used by the Department of Health and Human Services — what a family of four with a household income of $60,000 would pay for premiums on the second-lowest-cost silver plan — average premiums for this type of plan rose by 38 percent between 2014 and 2017. "Of course, everyone would like to see more competition in the marketplaces — that's important for keeping costs down," said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service. "But there has always been a recognition that there would be more competition in some places than others." Glied added that individual insurance markets in many states were highly concentrated before the Affordable Care Act, too. Our ruling Trump said, "One-third of the counties — think of it, one-third — only have one insurer left." As long as you know that Trump is specifically talking about Affordable Care Act exchanges, Trump’s figure checks out. People trying to purchase insurance on a government exchange only have one provider to choose from in 32 percent of the nation’s counties, according to late 2016 data from Kaiser. That means 21 percent of Affordable Care Act enrollees, or about 1.9 million people in 2017, can only pick from one health insurance provider. We rate Trump’s claim True. See Figure 1 on PolitiFact.com
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