Insurer participation in rural health insurance marketplaces: are some markets intrinsically more competitive than others?
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Rural policy brief
- Author(s):
- Barker, Abigail R., author McBride, Timothy D., author Mueller, Keith J., author
- Contributor(s):
- RUPRI Center for Rural Health Policy Analysis, issuing body. Rural Health Research & Policy Centers, issuing body. Rural Policy Research Institute (U.S.), issuing body.
- Publication:
- Iowa City, IA : Rural Policy Research Institute, June 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Economic Competition Health Insurance Exchanges Insurance Carriers Rural Population United States
- Genre(s):
- Technical Report
- Abstract:
- Purpose. Recent policies aiming to improve existing individual insurance markets have relied on market competition. However, the success of such an approach depends on the presence of at least a handful of insurers in each local market. This brief reports on analyses of insurer participation data in three market-based health insurance programs (the Federal Employees Health Benefits Program [FEHBP], Medicare Advantage [MA], and Health Insurance Marketplaces [HIMs]) to assess the extent to which participation in HIMs may be associated with prior levels of local market competition, holding constant other relevant factors such as population measures. Key Findings. (1) HIM market concentration in 2014 was generally lower as population density increased, i.e., rural markets were more concentrated. In 2017, the pattern continued to hold, with those counties that still attracted several insurers averaging the lowest prior-year FEHBP Herfindahl Index. (2) In 2014-17, the number of HIM insurers was correlated with the level of FEHBP market concentration as measured by the Herfindahl Index (where 100 equals complete concentration). For example, among counties with fewer than 10 persons per square mile, the 2013 FEHBP Herfindahl Index averaged 45.5 for the counties that had only one firm participating in HIMs in 2014 but only 34.0 for the counties that had seven or more HIM insurers in 2014. (3) Prior FEHBP market concentration is a significant predictor of low insurer participation in HIMs, holding other factors constant, with the magnitude of the effect increasing from 2014 to 2017. A county with a one-point greater FEHBP Herfindahl Index in 2016 was 3.4 percent more likely to have low participation in the 2017 HIMs, up from 1.8 percent in the 2014 HIMs. This finding suggests that an underlying level of competition, based upon historic and/or institutional factors, plays a role in HIMs' success or lack thereof in rural places.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (4 pages)).
- NLM Unique ID:
- 101771062 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101771062