Topics: Obamacare

If you like more competition between insurers, you can't have it

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David Freddoso,Columnists,Barack Obama,Obamacare,Health and Human Services,Health Care,Analysis,Healthcare.gov

First, President Obama said that if you like your health care plan, you can keep it. Now he has shifted to arguing that you shouldn't have liked it, but he's sorry if his deception caused you any inconvenience.

Not to say this argument is going over well, but it might be harder still to defend his promise that you could keep your doctor.

At some point, the various government health insurance exchange websites will work. Consumers will discover that in addition to the other things insurers are doing to cope with the Affordable Care Act's burdensome regulations (raising premiums, deductibles, and out of pocket costs, for example) they are also paring down provider networks.

Perhaps Obama will defend this breach by vilifying “junk doctors” – tonsil-thieves who perform needless surgeries and prescribe unnecessary medications in an effort to enrich themselves.

These deceptions will not be the last shoes to fall. Obamacare is a centipede of broken promises. The promises about health plans and doctors were the most explicit and frequent, but they were not the only ones made, nor will they be the only ones broken.

Obama made one promise you may not remember - an implicit promise - while speaking before Congress in September 2009.

He decried the fact that “in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down.”

He was clearly implying that his health care reform law would improve this situation. Today, we can see whether it has.

Alyene Senger, a researcher at the Heritage Foundation, performed the simple but time-consuming task of looking at every ACA exchange market to see just how well this promise has fared.

With Obamacare's market segmented into counties and regions within states rather than within states themselves, it is hard to draw a direct comparison to Obama's complaint of the number of state oligopolies.

But the data certainly do not support the idea that Obamacare is creating a more diverse and competitive marketplace for health insurance.

In Obamacare's first year, consumers in only 313 of the 3,135 U.S. counties will have more than five insurers available through the ACA exchange.

Lest you think this number is used as some kind of trick, note that this does not include such major U.S. cities such as Atlanta, Chicago, Philadelphia, Pittsburgh, Raleigh, Louisville, Indianapolis, Columbus, Kansas City, Saint Louis ... well, let's just say a whole bunch of big and important cities have less than five insurers.

In 78 percent of U.S. counties, customers have a choice between three ACA insurers or fewer. And in 17 percent of U.S. counties – including all counties in New Hampshire and West Virginia – just one insurer has a monopoly on the subsidized exchanges.

In 31 of the 50 states, not a single customer has a choice on the exchange of more than four insurance companies.

In 21 states (including five of the six New England states and five Southern states), no customer has a choice of more than three insurers.

In Alabama – which President Obama had gone out of his way to mention in 2009 – customers in only three counties (around Birmingham and Huntsville) enjoy the luxury of a choice between two.

In the rest of the state – including the metropolitan areas of Mobile and Montgomery – a single insurer has a monopoly on ACA customers.

With more important promises being broken, this implicit promise – that government could wave a magic wand and suddenly create competition – may go unnoticed.

But it demonstrates yet another clash between reality and the arguments used to sell the Affordable Care Act.

DAVID FREDDOSO, a Washington Examiner columnist, is the former Editorial Page Editor for the Examiner and the New York Times-bestselling author of "Spin Masters: How the Media Ignored the Real News and Helped Re-elect Barack Obama." He has also written two other books, "The Case Against Barack Obama" (2008) and "Gangster Government" (2011).
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