Fears about public exchanges threatening established insurers may have been exaggerated, at least in the country's largest ACA marketplace.
In California's exchange, the two Blues plans sold more than half of all individual policies.
WellPoint's Anthem Blue Cross of California sold 30 percent of individual policies in Covered California's first open enrollment period, while the nonprofit Blue Shield of California sold 27 percent of them.
That's a bit of a slip for Anthem's pre-exchange market share of 47 percent, in 2012, but it's an increase for Blue Shield of California, which had a 19 percent pre-exchange market share, according to the Kaiser Family Foundation's analysis of market data.
Health Net, one of three publicly-traded insurers on the exchange, also garnered a pretty huge increase in membership through the exchange. The Los Angeles-based company had only a three percent share of the pre-exchange individual market, but sold 18 percent of all individual policies in Covered California.
Kaiser Permanente, the second largest pre-exchange individual insurer, has seen its previous 20 percent market share fall slightly in Covered California, to 17 percent.
The other seven insurers in Covered California sold between 1,800 and 38,124 individual policies: L.A. Care Health Plan, a nonprofit HMO, sold 38,124 plans (a 2.7 percent market share); Chinese Community Health Plan, a Bay Area nonprofit HMO sold 14,306 (a 1 percent market share); and Molina Healthcare, the other publicly-traded insurer, sold 11,731 (a 0.84 percent market share).
Changing market share
Comparing the market shares of insurers before the advent of public exchanges to those sold in Covered California may not be entirely "apples to apples," but it's pretty close.
In 2012, about 1.58 million Californians were covered through individual policies, and 1.39 million just enrolled in plans through the state state exchange between October and April 15 (although the 205,000 plans purchased in the last 15 days of open enrollment haven't yet been included in the market share calculations).
So while there may be several hundred individuals plans that were sold in California, unsubsidized, outside the exchange, it's still a reasonable comparison, since all of California's major pre-ACA players are participating in the exchange, said Larry Levitt, a senior vice president at the Kaiser Family Foundation and a co-author of a study probing the pre- and post-exchange market shares of individual insurers in seven states.
Blue Shield and Health Net both saw the largest increases in membership, probably because they offered some of the lowest premiums in several of California's 19 rating areas.
Blue Shield had the lowest premiums in at least a few areas and Health Net had the lowest premiums in most of Southern California, where much of its new membership is based, according to Levitt and his colleagues' analysis.
Whether or not those premium pricing trends -- silver tiered plans for a 40-year-old ranging from $220 to $375 before subsidies -- continue next year remains to be seen, however.
Covered California has tried to use the model of "active purchasing," negotiating rates with insurers and rejecting 20 of the original 33 that applied to sell exchange plans (two that were approved, Aetna and UnitedHealth Group, ended up withdrawing).
To offer consumers more information about plan premiums as well as access, networks and customer service, California's exchange is also going ahead with a quality rating system, similar to Medicare Advantage, this and next year, before the Affordable Care Act's timeline of 2016.