Between September 2008 and September 2009 the nation's top eight health insurance plans saw membership decline by 1.7 million.
Those losses are continuing in both the fully-insured and administrative services only (ASO) segments, according to Mark Farrah Associates, a Kennebunk, Maine-based provider of market data and intelligence solutions.
Health plan membership decreased by 1.3 percent, from 133.2 million in 2008 to 131.5 million for 2009. ASO enrollment decreased 1.1 percent and risk enrollment declined 1.6 percent for these plans.
"There are many reasons (that insurance enrollment has gone down), not the least being the economy," said Lynn A. Dunbrack, program director at Health Industry Insights, an IDC company. "We are also finding that people are opting to go without insurance and paying wholly out of pocket."
The eight leading companies reported a combined loss of 860,000 members between the second and third quarters of 2009, with ASO enrollment declining 0.4 percent and risk enrollment declining 0.9 percent for the period.
"With unemployment at 10 percent in the U.S. as of January 2010, obviously many previously employed and therefore insured individuals are not on the rolls anymore," said Janice Young, program director of Payer IT Strategies at Health Industry Insights.
According to the Department of Labor's Bureau of Statistics, in December 2009 the number of unemployed persons stood at 15.3 million, and the unemployment rate was 10.0 percent. At the start of the recession in December 2007, the number of unemployed persons was 7.7 million, and the unemployment rate 5 percent.
"Since we tie healthcare insurance to employment in this country, these data more than corroborate and likely suggest the main cause for decrease in enrollment among the big health plans," said Young. "One might even wonder why it isn't higher, but that may be explained by individuals let go that opted for COBRA continuing coverage."
Young said options for an individual market or state mandates (such as in Massachusetts) could change the health plan enrollment numbers, but insurance rates are still exceedingly high and individuals without work may not elect very expensive coverage unless mandated, due to the very high cost.
"If unemployment rates continue to rise in 2010, without intervention at the federal or state level, I'd project that some health plan losses in membership would continue," said Young. "If the national healthcare reform doesn't pass, I feel quite certain that the states will pick up some of the momentum, as has Massachusetts, Oregon and Washington, among others."
The Health Care Services Corporation, which includes Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas, and Humana were the only organizations among the top eight plans to see enrollment gains in the third quarter.
The top eight U.S. health insurers are Aetna, CIGNA, HCSC, Health Net, Humana, Kaiser Permanente, UnitedHealth Group and WellPoint. They cover nearly 60 percent of the total insured population in the nation.