What Does the Failure of Some Co-ops and the Possible Pullout of United Healthcare Mean for the Affordable Care Act?


Co-ops and United Healthcare (United) exiting the marketplaces may not be the shake-up many predicted because Blue Cross insurers, managed care plans, and others dominate low-cost marketplace offerings.

The Issue

The report examines 81 of the most populous areas of the country to find which insurers offer the lowest-cost silver plans, which typically have the highest rates of enrollment among marketplace plans.

Key Findings

  • Of the 81 rating regions studied: co-ops are active in more than a quarter of the regions (22) in 2016; while United, which recently announced its intentions to exit the marketplaces in 2017, operates in roughly 60 percent (48).

  • Co-ops are the lowest- or second-lowest-cost insurer in 14 of the 81 rating regions studied. United is the lowest-cost or second-lowest-cost insurer in 15 of the 81 regions studied.

  • Blue Cross insurers and managed care organizations previously offering insurance to Medicaid beneficiaries but new to the private market are the most price-competitive.

  • Blue Cross and Medicaid managed care organizations are among the lowest-cost insurers in 34 and 44 of the 81 regions, respectively.


The authors of the report note the effects of the potential United exit and any future exits by co-ops would be felt mostly in regions where they are one of the more price-competitive insurers, noting that regions in which they are more expensive than their competitors likely signals low enrollment in the plans. 

About the Urban Institute

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