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Increasingly, there are two ObamaCares. There’s the one in coastal and northern areas, where the marketplaces include multiple insurers and plans. And there’s the one in southern and rural areas, where there is often little competition, a situation that can lead to higher premiums. (Sullivan, 8/22)

So much for choice. In many parts of the country, Obamacare customers will be down to one insurer when they go to sign up for coverage next year on the public exchanges. A central tenet of the federal health law was to offer a range of affordable health plans through competition among private insurers. But a wave of insurer failures and the recent decision by several of the largest companies, including Aetna, to exit markets are leaving large portions of the country with functional monopolies for next year. According to an analysis done for The Upshot by the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose next year. (Abelson and Sanger-Katz, 8/21)

Pullbacks by national insurers and failed co-op plans are leading to a significant decline in exchange competition for 2017, according to two new analyses of rate filings. Seventeen percent of potential Obamacare customers may have just one insurer selling exchange products in their area, according to the McKinsey Center for U.S. Health System Reforms. That’s up from just 2 percent of customers who had only one coverage option for this year. (Demko, 8/19)

The latest evidence comes in a study from consulting firm Avalere Health, which examined areas, known as rating regions, that insurers use to set premiums and decide where to offer plans to individuals under the Affordable Care Act. According to Avalere, 36 percent of the approximately 500 rating regions in the U.S. may have just one health insurer when the 2017 signup season starts on Nov. 1. Another 19 percent could have just two carriers. There was far more competition this year, with about two-thirds of rating areas having three or more health insurers vying for customers’ business, according to Avalere. (Tracer, 8/19)

It’s an increase over 2016 levels, according to Avalere data, which shows that 4 percent of ratings regions — which are geographic areas used to set insurance premium rates — had just one insurer offering plans on the exchanges in 2016. Pinal County in Arizona is, as of now, the only county in the country expected to have no insurers offer plans next year. (McIntire, 8/19)

With the fourth open-enrollment period set to begin this fall for the marketplaces set up by the Affordable Care Act, it’s becoming clear that the market for health insurance has not evolved as expected, or hoped. The market is smaller than projected. The people who have bought health plans overall are sicker than predicted. And health insurers have incurred larger losses than anticipated. (Boulton, 8/22)

Last week, Minnesota regulators issued a request for proposals from groups that might be willing to step in and sell coverage on the state’s MNsure exchange, particularly in counties outside the Twin Cities metro. It came after Blue Cross and Blue Shield of Minnesota announced in June a pullback that could cut options in 11 rural counties. The request came on the same day that Connecticut-based health insurance giant Aetna announced it would stop selling next year coverage on 11 of 15 state exchanges where it currently competes. (Snowbeck, 8/20)

Blue Cross and Blue Shield of Georgia says it is reassessing the premium increases it has previously proposed for the state health insurance exchange, with an eye to revising them upward. This comes in the wake of Aetna’s pullout from the exchange here. Blue Cross, the state’s largest health insurer, reiterated its stance that it will remain in Georgia’s exchange next year. But it won’t have much time to readjust its rate proposal. (Miller, 8/19)