Competition Thwarts ACA Exchange Rate Hikes, but Rural Areas Struggle With It

While “benchmark” Affordable Care Act premiums rose in 2023 after declining for multiple years, greater insurer competition in heavily populated regions is still helping to keep rates in check, according to a new analysis from the Urban Institute. Yet some rural areas and smaller cities often don’t attract enough insurers to create meaningful competition — a market dynamic that remains challenging to overcome, one of the report’s authors says.

To produce the analysis, researchers examined premium and insurer participation data from HealthCare.gov for 33 states and from 18 state-based marketplace websites. They zeroed in on “benchmark” premiums — or the rates for the second-lowest-cost silver plans available — because those determine the level of premium tax credits consumers receive.

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Leslie Small

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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