First, we now have four states at least in which there is likely to be only one Exchange health insurer in 2017: Alaska, Alabama, Oklahoma and Wyoming. And, in Alaska, that insurer is receiving extra state support from taxpayers there to keep it involved this year. Even in states where there is more than one insurer overall, there are hundreds of counties in which there is going to be just one insurer. Moreover, it’s no longer a situation in many areas where you can pick a plan that lets you choose your doctors: more and more, it’s an HMO or nothing.
Second, even in states where some degree of competition remains, gross premiums are going up immensely. As Charles Gaba of the pro-Obamacare but generally careful website acasignups.net has calculated, if people renew their current policies where possible in 2017, their gross premiums will increase an average of 23% (assuming insurers receive their desired increases). In five states, Illinois, Montana, Oklahoma, Arizona and Tennessee, Gaba shows that these increases average more than 40%.