In Philadelphia, a 40-year-oldwho makes $36,420 a year (350 percent of the federal poverty limit)will now have to pay $254 a month next year, up from $101 a monthin 2018.

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A new analysis shows strong signs of improvementin the Affordable Care Act marketplace but warns thatthings may have actually gotten worse for customers in the greatest need.

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The analysis by the Robert Wood Johnson Foundation finds thatthe number of counties with only one ACA insurer will decline from 50percent to 35 percent in 2019, based on plans submitted by insurersearlier this month.

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The increased competition should push down prices, writes Katherine Hempstead, asenior policy adviser at RWJF. However, the lower sticker price maynot help the many ACA customers who qualify for premium subsidies.In fact, it may lead to them paying more.

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Related: How ACA 'dine and dashers' affect themarket

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Here's how it works:

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The federal government determines the size of a customer'ssubsidy based on the person's income and the price of the“benchmark” silver plan in their county. The person's incomedetermines the maximum they will pay for a premium. The governmentthen provides the gap between that figure and the price of thebenchmark plan. So if a person's out-of-pocket maximum is capped at$50 a month but the benchmark plan costs $300 a month, that personreceives a $250 subsidy.

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However, the individual does not have to use that subsidy to buythe benchmark plan. They can use it to purchase an even cheaper“bronze” plan, which may leave them paying no premium at all. Thisis the route that many low-income ACA customers have opted for inrecent years, and it helps explain why premium hikes has not hurtenrollment among subsidized customers.

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Somewhat perversely, the decrease in the price of the benchmarkplan in some markets ends up hurting subsidized customers. Theamount they are provided in subsidy goes down, often leaving thempaying more for their bronze plans.

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“Overall, in about 70 percent of (federally facilitatedmarketplace) counties with a new carrier, subsidized enrollees willlose purchasing power, while in about 66 percent of these counties,unsubsidized customers will see premium reductions,” explainsHempstead.

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In Philadelphia, for instance, customers who don't qualify forsubsidies should be celebrating. The price of the benchmark planfell by a whopping $200, from $635 to $435. The cost of thecheapest bronze plan also fell from $400 to $370.

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However, for subsidized customers in Philadelphia who wereenrolled in the bronze plan, they will be paying much more thanthey were before. A 40-year-old who makes $36,420 a year (350percent of the federal poverty limit) will now have to pay $254 amonth next year, up from $101 a month in 2018.

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Hempstead concludes: “In the longer run, the competition thatcomes from increased carrier entry is almost certainly beneficial,and increased choices for consumers have a value that cannot bemeasured. Nevertheless, while in many markets unsubsidizedconsumers will see premium reductions, many subsidized consumerswill lose purchasing power, and it remains to be seen how thesechanges will be reflected in overall enrollment.”

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