While competition is intense in many populous regions, rural areas and small towns have far fewer carriers offering plans in the law’s online exchanges.I'm impressed at the investigative reporting here. They got into the online exchanges and got to the point where they could find out what's on offer in many places? Apparently. But some of the analysis is based on a list from the Department of Health and Human Services showing which insurance companies are serving various counties. 58% of the counties have 2 or only 1 company offering insurance.
The analysis suggests that the ambitions of the Affordable Care Act to increase competition have unfolded unevenly, at least in the early going, and have not addressed many of the factors that contribute to high prices. Insurance companies are reluctant to enter challenging new markets, experts say, because medical costs are high, dominant insurers are difficult to unseat, and powerful hospital systems resist efforts to lower rates.This feels like a foundation for the argument that markets don't work and therefore a fully government-run health care program is needed.
It is unclear how the online marketplaces might evolve over time. Many large insurers are closely watching what happens in the first year to decide whether to more aggressively pursue new markets. In the meantime, problems with the healthcare.gov Web site are making it harder for them to know whether the exchanges’ slow start is the result of technical difficulties or more serious underlying problems, such as a lack of consumer demand, that would discourage them from entering.This seems to set up an argument that we never got to see what private companies would do in the marketplace, since the promised marketplace was never there in a form where it could be observed and intelligently responded to.
(There's much more in the linked article.)