NPR confirms what I suspected in September: "Competition" not necessarily as big a factor as expected
2019 OPEN ENROLLMENT ENDS (most states)
Time: D H M S
Remember, the ACA's Medical Loss Ratio rule (80% of all premiums have to go towards actual healthcare, leaving only a 20% maximum margin for administrative/operational costs) already does a pretty good job of keeping carriers from outright gouging enrollees...although that only comes into play when the carriers would otherwise be spending less than 80% on healthcare claims. In cases where they're already spending more than 80%, it's kind of moot...and for the past couple of years, many carriers are at 100% or higher, which is the main reason some of them are pulling out of the market next year in the first place.
In other words, unlike other "retail" markets where more competition is generally considered to automatically help keep prices down, there's only so much that more players can do in the individual health insurance market. If everyone is already losing money, adding one more to the mix isn't gonna make anyone else drop their rates further.
...Taking this logic to the extreme, both the Hertel Report publisher and the CEO of one of the most successful ACA exchanges are both essentially arguing that LESS competition would be HELPFUL to keeping premium rates down, while also helping maintain continuity of care...because you'll be slicing an already-small risk pool into fewer slices, thus making it larger and more diverse.
...I'm not sure that this argument holds true in every case...after all, California and some other states have over a dozen carriers apiece and seems to be doing just fine, and giving a single carrier a complete monopoly across an entire state would certainly NOT be a good idea, even with the 80/20 MLR rule in place..but the general point is food for thought.
For Many, Fewer Obamacare Choices Doesn't Mean Higher Prices
People in Columbia, S.C., had their pick of four health insurers last year when they shopped for policies during the Affordable Care Act's open enrollment.
This time they have just one: Blue Cross Blue Shield of South Carolina, which had the most Obamacare enrollees in Richland County in 2016 due to its low prices.
It's a change that's been repeated around the country after big health insurers such as Aetna, Humana and United Healthcare pulled out of dozens of Obamacare marketplaces that they judged unprofitable.
Almost a third of all counties in the United States have just one insurer in the marketplace for people buying individual coverage for 2017. In 2015, just 7 percent had one insurer, according to a Kaiser Family Foundation analysis. Twenty percent of Obamacare consumers will choose 2017 plans in counties served by a single insurer, according to the government.
But there's a surprising bottom line: Although prices are going up in almost all areas, they're not significantly higher than they are for people living in areas served by multiple insurers, according to data reviewed by consulting firm Avalere Health.
The NPR article focuses more on the impact of the APTC subsidies than the changes to the full-price, unsubsidized premiums, but the point still stands: When it comes to the health insurance market, the MLR rule is already carrying most of the "no price gouging" weight on its shoulders...and again, a competitor will generally only force you to keep your prices lower if you're making some amount of profit in that market in the first place.