The Perfect Companion Piece to my Response to Avik Roy

I've got to give a big shout-out to Uri Manor, who has written an excellent follow-up to my Response to Avik Roy regarding the "How many were previously insured?" issue.

It's very late, I'm very tired and I haven't had a chance to review all of his math, so I can't comment specifically on his conclusions, but if nothing else he adds one more crucial factor to the subject: NOT EVERY INSURANCE COMPANY PARTICIPATES IN THE EXCHANGES AT ALL.

Just as a quick example:

( – Major health insurance companies--Blue Cross, Aetna, United, Humana--have decided not to participate in various states in the Obamacare health-insurance exchanges that will be the only place Americans will be able to buy a health insurance plan using the federal subsidies authorized under the Obamacare law.

...Aetna, a fortune 100 company with $34.2 billion in revenue, has pulled out of the government-run exchanges in three states, including the state of Connecticut, where it is based.

Founded in Hartford, Conn., in 1850, Aetna withdrew its application to participate in that state on Monday, the Hartford Courant reported. The company said it was withdrawing from there and in Georgia and Maryland because limitations the state governments would impose on their rates would not allow them to make money.

Aetna. Friggin' AETNA. This isn't some tiny little upstart, this is one of the largest insurance corporations in the world...and anyone who enrolls in a health insurance policy through them in CT, GA or MD is an off-exchange QHP by definition.

But wait, there's more!

Anthem Blue Cross has withdrawn its bid to participate in the California's government-run Obamacare exchange marketing insurance to small businesses.

United Health Group, the largest health insurer in the United States, has taken a pass on California's individual health insurance exchange.

...Similarly, only five insurers are participating in the exchange in Georgia, after Aetna and Coventry Health Insurance dropped out last week.

...Two of the three largest health insurers in Wisconsin will also not participate in the state’s Obamacare exchange.


People have been asking me for the past week or so why I'm so certain that there's 4 million or more Off-Exchange QHPs out there, when I've "only" been able to document about 560,000 so far.

Until now, I just pointed out that those 560K are only from 2 states (WA and WI), plus a dozen companies scattered across the rest of the country.

The thing is, whenever I give that response, I've only been thinking about how many policies the 100+ companies which operate both on and off of the exchanges were selling.

I never even thought about how many companies--in many cases, large companies--sell private, fully ACA-compliant QHPs directly without doing so on the exchanges at all.

Four million? Hell, we could be talking six or seven million for all I know.

And yes, the article I linked to above may be outdated (it's from last August); perhaps some of the companies listed ended up joining the exchanges in one or more states after all, but that's not really the point. The point is that there's a bunch of companies selling QHPs to people off-exchange exclusively, some of which are quite large.

Anyway, read his piece; it's a bit lengthy, but so was mine, and if you've read this entry all the way to the end you're probably wonky enough to read his as well :)