As three major insurance companies reduce their presence in the Affordable Care Act individual marketplace, a lack of choice for customers is becoming a major concern.

A new analysis of the individual marketplace by the Kaiser Family Foundation found that in 31 percent of U.S. counties, only one carrier will be operating next year. In another 31 percent of counties, only two will be offering plans.

The irony is that the lack of competition within the ACA marketplace appears to be driven at least in part by a legal battle the Obama administration is waging to prevent two major insurance mergers that it contends would harm competition.

Aetna, which had previously indicated a desire to expand their offerings in the marketplace, announced days after the lawsuit was filed that it would be exiting the marketplace in most states.

Anthem, the other insurance giant whose acquisition the U.S. Department of Justice is trying to thwart, has not similarly announced an immediate plan to exit state marketplaces, but it hinted that that may soon be the plan when it announced that, upon further scrutiny of its financials, it determined it had lost money on its Obamacare business last year.

Separate from that legal battle, UnitedHealthcare, the largest insurer in the country, has reduced its ACA business to five states after reporting hundreds of millions of dollars in losses on its marketplace plans.

The lack of competition is particularly pronounced in the South. No county in Alabama or South Carolina has more than one carrier in operation, and Florida, Mississippi, Georgia and North Carolina are mostly made up of such counties.

Arkansas is an interesting anomaly in the South. Every county in the state has at least three carriers offering marketplace plans.

Another study released on Monday by the University of Miami School of Business served up some good news about the ACA.

The research was based on a meta-analysis of over 100 other studies of the ACA, and concluded that the landmark law had led to over 20 million Americans gaining coverage. Roughly 11.7 million gained coverage through the marketplace, 10.8 million were added to the Medicaid rolls and 3 million young people were allowed to stay on their parents’ insurance.

However, the same research highlighted one of the nagging concerns about the ACA: Not enough providers will accept ACA plans. The study found that 40 percent of Americans still report at least one issue in getting access to health care, a problem that disproportionately affects those on the lower rungs of the economy and people of color.

Instant Insights /

Nearly a third of U.S. counties will have only one ACA carrier next year

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