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 working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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