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Studies Track Record Progress for Marketplace Choice, Competition, and Affordability


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Published May 9, 2023 • by AHIP

More than 16 million Americans choose high-quality, affordable coverage through the Affordable Care Act’s health insurance Marketplace. They deserve the robust competition evident in the Marketplace — which results in more choices, better quality, and lower costs for hardworking American families.

So it’s good news for Americans that both McKinsey & Company and the Robert Wood Johnson Foundation recently found that increased participation in the Marketplace for the 2023 enrollment season bolstered competition and improved health care affordability for Americans.

Year after year, Americans have experienced more choices at lower prices. According to McKinsey, 87% of those shopping through the Marketplace could choose plans from three or more health insurance providers in 2023 — a dramatic increase from 49% in 2018. On average, shoppers had a choice of six or more health insurance providers to choose from during the 2023 Open Enrollment season.

Marketplace competition is working for consumers by combatting rising health care prices. The more health insurance providers in a market, the lower the benchmark premiums. The Robert Wood Johnson Foundation found that consumers paid $128 less in average premiums in markets with five or more plans than markets with just one plan.

Health insurance providers know that America’s rural communities face more challenges and are creating real solutions to improve access. Rural regions and smaller cities tend to have fewer plan choices than larger metropolitan areas. Because of the limited provider options in rural markets, health insurance providers there often face greater difficulties in negotiating lower prices with providers, which results in higher premiums for consumers. Despite these challenges, overall health insurance provider participation in rural — and all — markets continues to increase, as just 4% of counties had access to only a single insurance provider in 2023 - down significantly from 52% in 2018.

Health insurance providers are committed to ensuring that all Americans have affordable access to high-value coverage. AHIP will continue to support policies that improve affordability and access through a competitive Marketplace.

Healthier People Through Healthier Markets

Every American deserves access to affordable, comprehensive, high-quality coverage and care. But health care prices continue to escalate year after year, making coverage and care less accessible for everyone. Health insurance providers have developed detailed policy prescriptions to improve health care competition, and we are committed to working with state and federal officials as well as other health care leaders to take decisive action.

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