Hawaii's commercial health insurance market remains highly consolidated, with Hawaii Medical Service Association (an independent licensee of Blue Cross Blue Shield) and Kaiser Foundation Health Plan controlling more than 80 percent of the market's commercial enrollment. There is little room for smaller insurers such as Hawaii Medical Assurance Association and University Health Alliance to gain significant market growth. Hawaii's low enrollment pushed the state's health insurance exchange to move to HealthCare.gov, and a successful petition for a 1332 waiver ended the state's participation in the SHOP exchange. Meanwhile, enrollment in Medicare Advantage plans continues to increase as more baby boomers age into the program and elect to enroll.

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