COLUMBIA, S.C. -- People in this city had their pick of four health insurers last year when they shopped for policies during the Affordable Care Act's open enrollment.
This time they have just one: Blue Cross Blue Shield of South Carolina, which had the most Obamacare consumers in Richland County in 2016 due to its low prices.
It's a change that's been repeated around the country after big health insurers such as Aetna, Humana and United Healthcare pulled out of dozens of Obamacare marketplaces that they judged unprofitable.
Almost a third of all counties in the United States have one insurer in the marketplace for people buying individual coverage for 2017. Last year, just 7 percent had one insurer, according to a Kaiser Family Foundation analysis. Twenty percent of Obamacare consumers will choose 2017 plans in counties served by a single insurer, according to the government. (Kaiser Health News is an editorially independent program of the foundation.)
But there's a surprising bottom line: Although prices are going up in almost all areas, they're not significantly higher than they are for people living in areas served by multiple insurers, according to data reviewed by consulting firm Avalere Health.
"A lack of competition is bad for the insurance market in the long term but in counties that have only one plan, it hasn't proven to be catastrophic for consumers for 2017," said Caroline Pearson, a senior vice president with Avalere.
"We expected to see the biggest price hikes in areas without competition."
She suggested that didn't happen because insurers had to file their initial 2017 rates to regulators earlier in 2016, before they knew exactly where competitors were dropping out.
"Those rates could be adjusted, but broadly the pricing was set in the absence of full competitive information," Pearson said. When open enrollment for 2018 begins in the fall, "you could see big price increases in regions without competition."
Uncertainty surrounds the future of the exchanges after the Trump administration and Republican-led Congress take power. Worries about the future of Obamacare may be spurring a burst in enrollments, which reached 8.8 million from Nov. 1 to Dec. 31, up about 154,000 from the same period last year, the government reported.