The District of Columbia Health Benefit Exchange Authority announced that four insurers have agreed to sell health insurance through its Patient Protection and Affordable Care Act (PPACA) exchange system.

The four insurers -- Aetna Inc. (NYSE:AET), CareFirst BlueCross BlueShield, Kaiser Permanente, and a unit of UnitedHealth Group Inc. (NYSE:UNH) -- have applied to sell a total of 34 policies through the district's individual exchange and 259 plans through its Small Business Health Options Program small-group exchange, exchange officials said.

The insurers are supposed to file their exchange plan rates with the exchange by May 31.

PPACA requires the U.S. Department of Health and Human Services and state regulators to set up exchanges, or health insurance marketplaces, in all 50 states and the District of Columbia by Oct. 1.

States can decide whether to let HHS provide exchange services or set up their own.

The District of Columbia decided to set up its own exchange program, even though with about 632,000 residents, it's one of the lowest-population jurisdictions eligible to set up an exchange program.

Vermont, which has 626,000 residents, is the only eligible jurisdiction that is setting up its own exchange system. Vermont recently said two carriers will be selling "qualified health plans" through its exchange system.

Illinois, a state with about 24 times as many residents as the District of Columbia, has attracted six carriers to its exchange.

Even some employers and benefits advisors who say they like PPACA have expressed concerns about the D.C. exchange managers' effort to have all small-group health insurance sales go through the exchange.

D.C. exchange officials, including its director, Mila Kofman, have argued that it needs to get all of its small-group business onto the exchange, because the district is such a small market that maintaining separate exchange and non-exchange small-group markets would not be viable.

Kofman said in a statement that the results of the D.C. exchange QHP solicitation show that district insurers are committed to offering good options for the district's residents and businesses.

"We will have a strong, competitive market where individuals and small businesses will have a wide variety of options," Kofman said.

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