Latest Issue of Health Plan Week Examines Local, Regional Insurer Participation in New Exchange Marketplaces

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Local and regional insurers are considering the same factors as the major carriers when it comes to selling on or withdrawing from exchanges, reports Atlantic Information Services’s Health Plan Week in its Sept. 24 issue.

Local and regional insurers are considering the same factors as the major carriers when it comes to selling on or withdrawing from exchanges, reports Atlantic Information Services, Inc.’s (AIS) Health Plan Week in its Sept. 23 issue. While large carriers have made it clear that economic and regulatory factors are playing into their decisions on whether to be in an exchange, local and regional insurers have done the same thing, with some leaping in and others retreating.

For example, HPW cites Physicians Health Plan (PHP) of Mid-Michigan, a subsidiary of Sparrow Health System, which pulled out of Michigan’s exchange because of what the company said were “too many uncertainties.” The insurer also cited fears of adverse selection and the federal government’s slow pace in informing the public about the new marketplaces. Other plans, like the brand-new Oscar Health Insurance which will operate on New York state’s public exchange, are eager to participate.

Purva Rawal, a senior manager at consulting firm Avalere Health LLC, tells HPW, “regional and local plans are making a pretty big vie for market share in 2014. Our analysis shows that about a third of the plans that are expected to participate [in exchanges] in 2014 are local and regional plans. In general the trend is you’ve got a lot of regional plans, Blues players and locals participating,” Rawal says.

In some states, these regional and local players will be butting heads with national carriers for market share, but in others competition will be sparse. For instance, Aetna Inc.’s Coventry Health unit and Blue Cross and Blue Shield of North Carolina are now the only two insurers left in North Carolina’s exchange, with the Blues plan the only one offering coverage in all of the state’s counties. Coventry also pulled out of the West Virginia public exchange, leaving only Highmark Inc.’s Blue Cross Blue Shield licensee as the sole carrier in that state’s individual exchange. But in other states, like California, there are mostly smaller insurers like Chinese Community Health Plan and Contra Costa Health Services vying for market share against Health Net, Inc. and regional brands, with UnitedHealth Group’s UnitedHealthcare and Aetna Inc. sitting it out in the state.

Roy Ramthun, president of Maryland-based HSA Consulting Services and a former senior health policy advisor to President George W. Bush, tells HPW that beyond fears of adverse selection, tough competition for provider contracts may make insurers think twice about being in exchanges. “Another factor is that some of the Blues plans have pretty sizable market share in some states. And given that many of the Blues plans still have most favored nation pricing power, where they can demand the lowest reimbursement rates with their contracts, other carriers may say, ‘we just can’t compete in that environment and we are unwilling to put in the resources that are necessary,’” he says.

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About Health Plan Week
Published since 1991, the 8-page weekly newsletter Health Plan Week provides timely, objective business, financial and regulatory news of the health insurance industry. Coverage includes new benefit designs and underwriting practices, new products and marketing strategies, mergers and alliances, financial performance and results, Medicare and Medicaid opportunities, disease management, and the flood of reform-driven regulatory initiatives including medical loss ratios, exchanges, ACOs and myriad benefit design changes that are mandated. Visit for more information.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
Atlantic Information Services
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