Early Payer Market Share Leaders in the Public Health Exchanges

The strategies of insurers like UnitedHealth Group and WellPoint are under the microscope as data from four of the five largest U.S. states is collected by SNL Financial Group.

Among four of the most populated states, New York currently has the most variety among its leading health exchange insurers. The state is the only one with three insurers holding double-digit market share through the newly opened state exchanges, according to a new set of data released from SNL Financial.

WellPoint holds the biggest share of New York’s state exchange market, covering 31.15 percent of the market accounted for in the data, closely followed by UnitedHealth Group (30.23 percent). In the other three states covered, one insurer has more market share than all other insurers participating in the respective exchanges.

UnitedHealth only plans to take part in about 12 exchanges in 2014, based on remarks made Sept. 10 by Gail Boudreaux, EVP of UnitedHealth Group and CEO of its health benefits business. Employing a "fairly conservative" approach, UnitedHealth will monitor the dynamics and then decide how it wants to proceed, Boudreaux said.

UnitedHealth was not present, for instance, in the lists disclosed by insurance departments of participating insurers for California, Florida and Illinois, the three other states SNL examined for this analysis. Texas, the other top-five U.S. state in terms of population, plans to have the federal government run its exchange, and SNL's attempt to obtain a list of the participants in that state ahead of the Oct. 1 launch date was declined.

In California, Kaiser Foundation Health Plan has brought in 44.68 percent of the total revenue yielded from the exchange thus far. WellPoint is the only other insurers holding double-digit market share (10.53 percent), followed by Health Net (8.56 percent), Blue Shield of California (7.32 percent) and Local Initiative Health (1.80 percent).

“On the one hand, companies like UnitedHealth might be missing out on a potential first-mover advantage, with the ability to quickly gain market share in a given state,” as Dr. Jaime Estupiñán, a partner with Booz & Co., pointed out in an interview with SNL. “But on the other, a wait-and-see approach will allow companies to get a better handle on the risk, such as whether previously uninsured people will have pent-up demand for medical care. In the end, insurers can always decide to participate next year,” he said.

The leading insurer in Florida’s state exchange is Blue Cross and Blue Shield of Florida (43.54 percent), followed by Aetna (9.37 percent), Molina Healthcare (9.14 percent), Cigna (7.42 percent) and Humana (7.01 percent).

Illinois’ state exchange is the most lopsided of the four, however, with Health Care Service Corp. covering 69.31 percent of the market. Humana (6.24 percent), Aetna (4.54 percent) and Carle Holding (4.34 percent) round out the picture presented by SNL, which means nearly 16 percent of the market is unaccounted for in missing data.

While this analysis is limited to the individual market, the exchanges also have small group options with policies for small businesses with 50 employees or fewer. The online implementation of this small group program has already been delayed and much uncertainty remains. But in both the small group and individual markets, insurers have created contingency plans, such as having service representatives in case online functionality is not available, according to SNL, adding that it’ll probably take a while for the effects of the new business on insurers will be seen.

Justin Stephani is a reporter at Insurance Networking News, a SourceMedia publication.