A Single Insurer Holds Obamacare's Fate In 2 States

NPR reports:

Here's a health law pop quiz: Which two states have the least successful Obamacare exchanges?

You might guess a state in the Deep South where political opposition to the health law has been fierce. Or maybe you'd say Missouri. It passed a state law saying consumer advisers funded by the Affordable Care Act aren't allowed to give advice about plans to consumers.

But those answers would be wrong.

Iowa and South Dakota are the two states where the ACA insurance marketplaces have struggled the most. In both states, just 11.1 percent of residents eligible for subsidized insurance signed up for it — the lowest rates in all 50 states and the District of Columbia, according to data from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

What happened in Iowa and South Dakota? The answer lies in commerce, not politics.

The individual insurance market in both states is dominated by one insurer, Wellmark Blue Cross and Blue Shield. Wellmark BCBS chose not to sell on the ACA exchanges in the first year, locking out its consumers from buying subsidized plans from the company. And it has decided to stay out of the Iowa and South Dakota exchanges for Year 2.

Before last year's enrollment, Wellmark had 87 percent of the individual market in Iowa and 73 percent of South Dakota's market.

ObamaCare means the cartelization of health care. It was all about limiting choices.