States that resisted the ACA face the biggest hurdles in 2017

Document titled "Patient Protection and Affordable Care Act"

States that are set to experience reduced competition in their health insurance exchanges also appear to be the ones that were unwilling to lay the groundwork to create a robust marketplace.

The issues that many states are now facing regarding consumer choice and premium pricing were predicated by resistance from Republican politicians, who failed to expand Medicaid or conduct the necessary outreach to enroll healthy individuals into marketplace plans, according to the Los Angeles Times. In fact, eight of the nine states that have the fewest plan options next year refused to expand Medicaid and failed to engage in outreach.

“It’s the same basic lesson I tell my kids,” Joel Ario, a former insurance commissioner in Oregon and Pennsylvania, told the newspaper. “If you put the work into something, you will get results. If you just sit on the sidelines and complain, you shouldn’t be surprised if things don’t work out.”

While states like California--which will see a 13.2 percent premium increase this year--invested heavily in outreach campaigns, Southern, Republican-leaning states rebuffed those same opportunities, and in some cases, placed burdensome restrictions on those selling marketplace plans as a way to undermine the Affordable Care Act. Failure to expand Medicaid drove poorer, sicker patients to marketplace plans, creating a disproportionate risk pool that many insurers have cited as a reason for pulling out of state exchanges.

Last month, President Barack Obama released a list of proposed policy changes to help balance the risk pool within state exchanges. The Department of Health and Human Services has said that even if premiums increase 10 percent this year, more than two-thirds of consumers will be able to purchase coverage for less than $75 a month.