As more states show their cards on health exchange participation, their hands seem to match their existing insurance markets.

New Hampshire has only has one insurer (Anthem Blue Cross and Blue Shield of New Hampshire) planning to participate in the exchange, not surprising given Anthem's dominance there. California has 13, Minnesota has nine and even Georgia's federally facilitated exchange will include seven carriers.

Colorado's exchange had to fight for its existence back in 2011, and from those struggles, a healthy exchange market has emerged. Colorado landed 11 plans, including every large player except Aetna (which previously withdrew from the state's individual and small-group markets) and strong participation from regional plans. Colorado consumers will have around 250 plan designs from which to pick. The choice of Kaiser Permanente Colorado's small-group plan as its benchmark ensures that plans can offer a tighter benefits package and narrow formularies adjacent to more generous plans.

UnitedHealthcare won't have a major presence in the Colorado exchange and will offer a handful of designs from its subsidiary, All Savers Insurance Co. Navigate, UnitedHealth's tiered-network product, will be sold outside the exchange, but that won't allow the carrier to tap into the pool of individuals and businesses eligible for subsidies and tax breaks.

UnitedHealth's decision provides a potential opening to smaller regional plans like Rocky Mountain Health Plans, SeeChange Health and Colorado Choice Health Plans. Rocky Mountain could step ahead of the narrow-network curve with three HMOs built around high-performing physician groups in Denver, Colorado Springs and Grand Junction. With benefits the same among carriers, network design will mean everything to people buying policies through the exchanges.

The biggest changes in some states are exchange offerings from MCOs new to the commercial market. Those Medicaid and Medicare Advantage carriers should gain enrollment from people whose incomes put them close to the Medicaid eligibility threshold.

It's hard not to look at what Colorado has built over the past two years and think of the lost opportunities in states that couldn't establish their own exchanges. At times, negotiations in a politically divided Legislature nearly blew up in Colorado. Without the difficult early steps in 2011, Colorado could be in the same predicament as New Mexico and Idaho, two states that adopted state-run health exchanges early in 2013. Both have essentially run out of time to fully implement their own exchanges and will partner with the feds in 2014.

But come October, Colorado's uninsured will have a plethora of health designs from which to pick. Getting overwhelmed by the volume of choices may be a good problem in a competitive health exchange.

Follow Bill Melville on Twitter at @BillMelvilleHLI


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