2018 Obamacare Health Insurance Exchanges: Competition and ... · 2018 Obamacare Health Insurance...

ISSUE BRIEF2018 Obamacare Health Insurance Exchanges: Competition and Choice Continue to ShrinkEdmund F. Haislmaier

No. 4813 | JaNuary 25, 2018

The 2018 plan year is the fifth year of operation for the affordable Care act (aCa, known as Obam-

acare) health insurance exchanges. For the third year in a row, insurer participation has declined. Obamacare exchange customers in more than half of all u.S. counties—including all counties in 10 states—have no insurer choice.

State-Level Insurer Competition in the Exchanges

One way to measure insurer competition is to assess insurer participation on a state-by-state basis. That analysis, summarized in Table 1, shows the number of carriers in each state and the District of Columbia in the individual market in 2013, as well as in the exchanges each year since they began in 2014. Insurers that offer exchange coverage through more than one subsidiary in a state are counted as one carrier (the parent company), while insurers that offer coverage in more than one state are counted for each state (as exchange participation is a state-level decision).

In 2013, the last year before Obamacare’s imple-mentation, 395 insurers sold coverage in the indi-vidual market across all states and the District of Columbia. In 2018, 181 insurers are offering cover-

age in the Obamacare exchanges. That makes the 2018 exchanges as a whole 54 percent less competi-tive than the individual market was before Obam-acare was implemented.

relative to 2017, the number of insurers offer-ing exchange coverage in 2018 declined in 27 states, increased in two states (alabama and New Jersey), and remained the same in 21 states and the District of Columbia.

also, the number of states with only one or two insurers offering Obamacare exchange coverage increased between 2017 and 2018. In 2017 there were five states with only one exchange insurer, while there are eight such states for 2018. Similar-ly, 12 states and the District of Columbia had two exchange insurers in 2017, while 17 states and the District of Columbia have only two exchange insur-ers in 2018.

as Table 1 shows, insurer participation in the Obamacare exchanges at the state level increased in 2015, but then declined in each of the subsequent three years. a more detailed view is provided in Chart 1, which shows the pattern of insurers enter-ing and exiting the exchanges from year to year.

Obamacare defenders claim that the Trump administration’s policies and congressional repub-lican efforts to repeal and replace Obamacare drove away insurers. The data show, however, that fewer insurers exited the exchanges in 2018 than left in either 2016 or 2017 under the Obama administra-tion. Moreover, a few insurers continue to expand their offering of Obamacare exchange coverage into more states.

On net, as Chart 1 shows, in the past three years, the number of insurer exits far exceeded the num-

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ISSUE BRIEF | NO. 4813JaNuary 25, 2018

Pre–ACA* Exchange One–Year Changes in the ExchangeState 2013 2014 2015 2016 2017 2018 2014–2015 2015–2016 2016–2017 2017–2018

Alabama 4 2 3 3 1 2 1 0 –2 1Alaska 4 2 2 1 1 1 0 –1 0 0Arizona 11 8 11 8 2 2 3 –3 –6 0Arkansas 7 3 3 4 3 3 0 1 –1 0California 12 11 10 12 11 11 –1 2 –1 0Colorado 14 10 10 8 7 7 0 –2 –1 0Connecticut 7 3 4 4 2 2 1 0 –2 0Delaware 4 2 2 2 2 1 0 0 0 –1District of Columbia 4 3 3 2 2 2 0 –1 0 0Florida 18 8 10 7 5 4 2 –3 –2 –1Georgia 11 5 9 8 5 4 4 –1 –3 –1Hawaii 2 2 2 2 2 2 0 0 0 0Idaho 5 4 5 5 5 4 1 0 0 –1Illinois 12 5 8 7 5 4 3 –1 –2 –1Indiana 11 4 9 8 4 2 5 –1 –4 –2Iowa 5 4 3 4 4 1 –1 1 0 –3Kansas 9 3 3 3 3 3 0 0 0 0Kentucky 6 3 5 7 3 2 2 2 –4 –1Louisiana 8 4 5 4 3 2 1 –1 –1 –1Maine 4 2 3 3 3 2 1 0 0 –1Maryland 8 4 5 5 3 2 1 0 –2 –1Massachusetts 8 9 10 10 9 7 1 0 –1 –2Michigan 14 9 13 11 9 7 4 –2 –2 –2Minnesota 6 5 4 4 4 4 –1 0 0 0Mississippi 5 2 3 3 2 1 1 0 –1 –1Missouri 12 3 6 6 4 3 3 0 –2 –1Montana 2 3 4 3 3 3 1 –1 0 0Nebraska 4 4 3 4 2 1 –1 1 –2 –1Nevada 5 4 5 3 3 2 1 –2 0 –1New Hampshire 2 1 5 5 4 3 4 0 –1 –1New Jersey 3 3 5 5 2 3 2 0 –3 1New Mexico 3 5 5 4 4 4 0 –1 0 0New York 10 16 16 15 14 12 0 –1 –1 –2North Carolina 12 2 3 3 2 2 1 0 –1 0North Dakota 3 3 3 3 3 2 0 0 0 –1Ohio 12 11 15 14 10 8 4 –1 –4 –2Oklahoma 8 4 4 2 1 1 0 –2 –1 0Oregon 10 11 10 9 6 5 –1 –1 –3 –1Pennsylvania 14 7 9 7 5 5 2 –2 –2 0Rhode Island 2 2 3 3 2 2 1 0 –1 0South Carolina 9 3 4 3 1 1 1 –1 –2 0South Dakota 4 3 3 2 2 2 0 –1 0 0Tennessee 10 4 5 4 3 3 1 –1 –1 0Texas 18 11 14 16 10 8 3 2 –6 –2Utah 9 6 6 4 3 2 0 –2 –1 –1Vermont 3 2 2 2 2 2 0 0 0 0Virginia 10 5 6 7 8 6 1 1 1 –2Washington 7 7 9 10 7 5 2 1 –3 –2West Virginia 4 1 1 2 2 2 0 1 0 0Wisconsin 15 13 15 16 14 11 2 1 –2 –3Wyoming 5 2 2 1 1 1 0 –1 0 0Totals 395 253 308 288 218 181 55 –20 –70 –37

TABLE 1

Number of Health Insurers Participating in the Exchange, by State

* Only includes insurers with at least 1,000 covered individuals in the state.SOURCE: Authors’ calculations based on federal and state information on exchange participation and Mark Farrah Associates insurer regulatory data for pre–ACA market participation.

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ber of entrances, with the Obamacare exchanges becoming less competitive overall as a result. Only in three states are more insurers offering Obam-acare exchange coverage in 2018 than in 2014, while 13 states have the same number, and 34 states and the District of Columbia have fewer. (See Table 1.)

County-Level Insurer Competition in the Obamacare Exchanges

Though state-level data are informative, for con-sumers, the most relevant measure of competition is at the county level. That is because health plans are offered (and priced) on a local basis. Because there are numerous instances of an insurer offering Obamacare exchange coverage in only part of a state, county-level figures provide a more precise picture of the actual choices available to consumers.

Insurer competition in the Obamacare exchang-es at the county level declined significantly in 2017 and further in 2018, as reflected by increases in the percentages of u.S. counties with only one or two insurers. (See Chart 2.) In 2017, nearly one-third of counties (32.8 percent) had only one insurer offer-

ing exchange coverage. In 2018, more than half (51.3 percent) of all counties face that situation. Further-more, 10 states have no exchange competition in any county, and another 19 states and the District of Columbia have no more than two insurers offering exchange coverage in any county.

Patterns of Insurer Exchange Participation

The four large national insurers have now almost entirely exited the Obamacare exchanges. aetna and Humana no longer offer exchange coverage in any state, while Cigna participates in just six states, and united Healthcare offers exchange coverage only in New york and Nevada. after experiencing several years of significant losses, those insurers left the mar-ket. Given that individual-market coverage represents

■ Insurers ENTERING state exchange■ Insurers EXITING state exchange

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SOURCE: Author's calculations based on federal and state information on exchange participation.

More Insurers Now Exiting Exchanges than Entering

CHART 1

2015 2016 2017 2018

64

25

10 79

45

80

44

2014 2015 2016 2017

17%6% 7.2%

32.8%

52%

33%36.2%

69.8%

35%

27% 29%

37%

2018

51.3%

81.8%

30.5%

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Most Counties Have Little or No Insurer Choice in Health Care Exchanges

CHART 2

■ DUOPOLY■ MONOPOLY

Share of U.S. Counties with Insurer

SOURCE: Author's calculations based on federal and state information on county-level insurer exchange o�erings.

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a very small piece of their overall businesses, they are unlikely to resume offering exchange coverage.

anthem, while also a large multi-state insurer, is not a national carrier in the same sense as the other four; it is principally a collection of Blue Cross and Blue Shield licensees in 14 states. Historically, Blue Cross and Blue Shield insurers have had the largest share of individual-market coverage in most states.

Market dominance is one reason why Blue Cross and Blue Shield licensees are the biggest group of insurers still participating in the exchanges. How-ever, even local-market dominance has not been enough to entice all of them to enter or remain in the exchanges.

until this year, anthem participated in the Obamacare exchanges in all 14 of the states where it

In 2018, nearly 82 percent of U.S. counties have only one or two insurers selling coverage on the Obamacare exchanges. Just 7 percent of counties have four or more.

82 Percent of Nation’s Counties Lack Choice and Competition on Obamacare Exchanges

MAP 1

1

2

3

4

5+

NUMBER OFINSURERS

IN COUNTY

1,613

957

353

146

73

COUNTIES

51.3%30.5%11.2%

4.6%2.3%

SHARE OF ALL U.S. COUNTIES

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NOTE: Percentages do not sum to 100 due to rounding.SOURCE: Authors’ calculations based on federal and state information on exchange participation. See Appendix Tables 1 and 2 for more information.

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is the Blue Cross carrier. In 2018, it exited five states. There are now 10 states that do not have a Blue Cross or Blue Shield carrier offering exchange coverage.1 In eight more states, the Blue Cross plan no longer offers exchange coverage statewide.2

Meanwhile some other carriers expanded their Obamacare exchange presence. The for-profit Med-icaid managed-care insurer Centene expanded steadily from eight states in 2014 to 15 states in 2018. Two regional carriers—Minnesota-based Medica and Ohio-based CareSource (a nonprofit Medicaid managed-care company)—have also expanded their exchange offerings to more states in the intervening years.

Most of the remaining Obamacare exchange par-ticipating insurers are sponsored by provider sys-tems (usually hospitals). Those insurers are local—offering exchange coverage only in a single state, or just the part of a state served by their network. The one exception is Kaiser Permanente, which is both an insurer and provider, and offers coverage in the District of Columbia and parts of eight states.

To increase insurer competition, the aCa includ-ed a program of grants and loans to fund the cre-ation of new so-called cooperative health insurers, or co-ops. Of the 24 co-ops funded by that program, only four are still in business.3 In contrast, one new insurer backed by private venture capital, Oscar, entered New york’s Obamacare exchange in 2014 and has since expanded to offering exchange cover-age in portions of six states.

Why the ACA Has Produced Declining Competition and Choice

Obamacare’s subsidy structure of premium tax credits and payments to insurers to reduce enroll-ee cost sharing is targeted at a relatively narrow segment of lower-income individuals—those with incomes between 100 percent and 250 percent of the federal poverty level (FPL). The law also requires

insurers to offer a comprehensive package of ben-efits. as a result, the exchanges have attracted pre-dominantly lower-income enrollees. For instance, among enrollees receiving premium subsidies, two-thirds (67 percent) are also enrolled in reduced cost-sharing plans available only to enrollees with incomes below 250 percent of the FPL. Insurers have also found that exchange enrollees tend to be in poorer health and use more medical services than the general population. That has forced insurers to repeatedly raise rates.

Given the basic structure of Obamacare’s subsi-dies and coverage requirements and ongoing plan premium increases, there is no reason to expect the exchanges to attract a larger share of enrollees who are more affluent or healthier in the future.

Insurers most likely to continue offering exchange coverage are those with experience providing sub-sidized health insurance to low-income individu-als and controlling costs by limiting access to pro-viders—such as insurers with significant Medicaid managed-care business or ones owned by hospital systems. Indeed, a recent analysis found that since 2015 the share of exchange plans with restrictive provider networks has grown so that 73 percent of exchange plans now have more restrictive networks, while only 27 percent have less restrictive networks.4

The emerging norm appears to be one in which major metropolitan areas have two or three insur-ers offering exchange coverage but less populous areas have only one. However, Obamacare’s subsidy structure makes it unlikely that parts of the coun-try will have no insurers offering coverage. This past summer—when it looked like a number of counties in several states would have no exchange insurer for 2018—some insurers stepped in to fill the gaps, nota-bly Medicaid managed-care insurer Centene.

Due to Obamacare’s design, insurers can make money on Obamacare if they have a monopoly on offering taxpayer-subsidized coverage. While the

1. In 2018, the local Blue Cross carrier is not participating in the exchange in Indiana, Iowa, Maine, Mississippi, Nebraska, Nevada, Ohio, South Dakota, Utah, and Wisconsin.

2. For 2018, the local Blue Cross carrier does not offer exchange coverage in some of the counties it otherwise serves in Arizona, Georgia, Kentucky, Minnesota, Missouri, Tennessee, Virginia, and Washington.

3. The four remaining co-op insurers are Common Ground Healthcare Cooperative (Wisconsin), Maine Community Health Options, Montana Health Cooperative (Montana and Idaho), and New Mexico Health Connections.

4. Caroline F. Pearson and Elizabeth Carpenter, “Plans with More Restrictive Networks Comprise 73% of Exchange Market,” Avalere, November 30, 2017, http://avalere.com/expertise/managed-care/insights/plans-with-more-restrictive-networks-comprise-73-of-exchange-market (accessed January 22, 2018).

http://avalere.com/expertise/managed-care/insights/plans-with-more-restrictive-networks-comprise-73-of-exchange-market

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enrollees will be costly, an insurer with an exchange monopoly does not have to worry about being under-priced by competitors and can set its rates high enough to cover those costs. State and federal regu-lators will face pressure to approve those requests for higher rates so as to avoid responsibility for cre-ating “bare counties” with no insurer offering cov-erage. Furthermore, thanks to the aCa’s subsidy structure, those rate increases generate higher sub-sidy payments, meaning that the higher costs are mainly passed on to federal taxpayers with subsi-dized enrollees largely insulated from the effects.

ConclusionThe data indicate that the number of individu-

als enrolled in subsidized exchange coverage has plateaued in the past couple of years.5 Largely due to Obamacare’s basic design, enrollees are often in poorer health and use more medical services than the general population.

Many insurers have exited the exchanges; ones that remain offer higher premiums and narrow net-work plans. Over half of the counties’ Obamacare exchanges are now a monopoly, offering plans from only one insurer.

a health insurance monopoly offering overly expensive coverage that pays for only a very limited set of providers is deeply unattractive, especially to customers who previously enjoyed choice in both their insurance and medical care.

Not surprisingly, consumers are looking to Con-gress and the President for help in escaping the soar-ing costs and shrinking choices that characterize the aCa exchanges.

—Edmund F. Haislmaier is a Senior Research Fellow in Domestic Policy Studies, of the Institute for Family, Community, and Opportunity, at The Heritage Foundation.

5. Edmund F. Haislmaier and Drew Gonshorowski, “2016 Health Insurance Enrollment: Private Coverage Declined, Medicaid Growth Slowed,” Heritage Foundation Issue Brief No. 4743, July 26, 2017, https://www.heritage.org/sites/default/files/2017-07/IB4743_0.pdf.

https://www.heritage.org/sites/default/files/2017-07/IB4743_0.pdf

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ALABAMAAutauga – 1Baldwin – 1Barbour – 1Bibb – 1Blount – 1Bullock – 1Butler – 1Calhoun – 1Chambers – 1Cherokee – 1Chilton – 1Choctaw – 1Clarke – 1Clay – 1Cleburne – 1Co� ee – 1Colbert – 1Conecuh – 1Coosa – 1Covington – 1Crenshaw – 1Cullman – 1Dale – 1Dallas – 1De Kalb – 1Elmore – 1Escambia – 1Etowah – 1Fayette – 1Franklin – 1Geneva – 1Greene – 1Hale – 1Henry – 1Houston – 1Jackson – 1Je� erson – 2Lamar – 1Lauderdale – 1Lawrence – 1Lee – 1Limestone – 1Lowndes – 1Macon – 1Madison – 1Marengo – 1Marion – 1Marshall – 1Mobile – 1Monroe – 1Montgomery – 1Morgan – 1Perry – 1Pickens – 1Pike – 1

Randolph – 1Russell – 1Saint Clair – 1Shelby – 2Sumter – 1Talladega – 1Tallapoosa – 1Tuscaloosa – 1Walker – 2Washington – 1Wilcox – 1Winston – 1

ALASKAAleutians East – 1Aleutians West – 1Anchorage – 1Bethel – 1Bristol Bay – 1Denali – 1Dillingham – 1Fairbanks North

Star – 1Haines – 1Hoonah

Angoon – 1Juneau – 1Kenai Peninsula – 1Ketchikan

Gateway – 1Kodiak Island – 1Lake And

Peninsula – 1Matanuska

Susitna – 1Nome – 1North Slope – 1Northwest

Arctic – 1Petersburg – 1Prince Of Wales

Hyder – 1Sitka – 1Skagway – 1Southeast

Fairbanks – 1Valdez Cordova – 1Wade Hampton – 1Wrangell – 1Yakutat – 1Yukon Koyukuk – 1

ARIZONAApache – 1Cochise – 1Coconino – 1

Gila – 1Graham – 1Greenlee – 1La Paz – 1Maricopa – 1Mohave – 1Navajo – 1Pima – 1Pinal – 1Santa Cruz – 1Yavapai – 1Yuma – 1

ARKANSASArkansas – 3Ashley – 3Baxter – 3Benton – 3Boone – 3Bradley – 3Calhoun – 3Carroll – 3Chicot – 3Clark – 3Clay – 3Cleburne – 3Cleveland – 3Columbia – 3Conway – 3Craighead – 3Crawford – 3Crittenden – 3Cross – 3Dallas – 3Desha – 3Drew – 3Faulkner – 3Franklin – 3Fulton – 3Garland – 3Grant – 3Greene – 3Hempstead – 3Hot Spring – 3Howard – 3Independence – 3Izard – 3Jackson – 3Je� erson – 3Johnson – 3Lafayette – 3Lawrence – 3Lee – 3Lincoln – 3Little River – 3Logan – 3

Lonoke – 3Madison – 3Marion – 3Miller – 3Mississippi – 3Monroe – 3Montgomery – 3Nevada – 3Newton – 3Ouachita – 3Perry – 3Phillips – 3Pike – 3Poinsett – 3Polk – 3Pope – 3Prairie – 3Pulaski – 3Randolph – 3Saint Francis – 3Saline – 3Scott – 3Searcy – 3Sebastian – 3Sevier – 3Sharp – 3Stone – 3Union – 3Van Buren – 3Washington – 3White – 3Woodru� – 3Yell – 3

CALIFORNIAAlameda – 2Alpine – 2Amador – 3Butte – 2Calaveras – 2Colusa – 2Contra Costa – 3Del Norte – 2El Dorado – 3Fresno – 2Glenn – 2Humboldt – 2Imperial – 3Inyo – 1Kern – 3Kings – 2Lake – 2Lassen – 2Los Angeles – 6Madera – 2Marin – 4

Mariposa – 3Mendocino – 2Merced – 2Modoc – 2Mono – 1Monterey – 1Napa – 4Nevada – 2Orange – 5Placer – 4Plumas – 2Riverside – 4Sacramento – 4San Benito – 1San Bernardino

– 4San Diego – 5San Francisco – 5San Joaquin – 4San Luis

Obispo – 1San Mateo – 4Santa Barbara – 1Santa Clara – 4Santa Cruz – 3Shasta – 2Sierra – 2Siskiyou – 2Solano – 4Sonoma – 4Stanislaus – 4Sutter – 3Tehama – 2Trinity – 2Tulare – 4Tuolumne – 2Ventura – 2Yolo – 4Yuba – 3

COLORADOAdams – 5Alamosa – 2Arapahoe – 6Archuleta – 2Baca – 2Bent – 2Boulder – 4Broomfi eld – 5Cha� ee – 2Cheyenne – 2Clear Creek – 2Conejos – 2Costilla – 2Crowley – 3Custer – 3

Delta – 1Denver – 6Dolores – 1Douglas – 5Eagle – 2El Paso – 4Elbert – 3Fremont – 3Garfi eld – 2Gilpin – 2Grand – 2Gunnison – 1Hinsdale – 1Huerfano – 3Jackson – 1Je� erson – 6Kiowa – 2Kit Carson – 2La Plata – 2Lake – 1Larimer – 3Las Animas – 3Lincoln – 3Logan – 2Mesa – 2Mineral – 2Mo� at – 1Montezuma – 1Montrose – 1Morgan – 3Otero – 3Ouray – 1Park – 2Phillips – 2Pitkin – 1Prowers – 2Pueblo – 2Rio Blanco – 1Rio Grande – 2Routt – 2Saguache – 2San Juan – 1San Miguel – 1Sedgwick – 2Summit – 3Teller – 2Washington – 2Weld – 3Yuma – 2

CONNECTICUTFairfi eld – 2Hartford – 2Litchfi eld – 2Middlesex – 2New Haven – 2

APPENDIX TABLE 1

Number of Health Insurers per County, by State (Page 1 of 10)

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New London – 2Tolland – 2Windham – 2

DELAWAREKent – 1New Castle – 1Sussex – 1

DISTRICT OF COLUMBIA

DC – 2

FLORIDAAlachua – 2Baker – 1Bay – 1Bradford – 1Brevard – 2Broward – 3Calhoun – 1Charlotte – 2Citrus – 2Clay – 2Collier – 1Columbia – 1De Soto – 1Dixie – 1Duval – 3Escambia – 1Flagler – 2Franklin – 1Gadsden – 1Gilchrist – 1Glades – 1Gulf – 1Hamilton – 1Hardee – 1Hendry – 1Hernando – 2Highlands – 1Hillsborough – 3Holmes – 1Indian River – 2Jackson – 1Je� erson – 1Lafayette – 1Lake – 2Lee – 1Leon – 1Levy – 1Liberty – 1Madison – 1Manatee – 2Marion – 2Martin – 1

Miami-Dade – 3Monroe – 1Nassau – 1Okaloosa – 1Okeechobee – 1Orange – 2Osceola – 3Palm Beach – 3Pasco – 2Pinellas – 3Polk – 3Putnam – 1Saint Johns – 1Saint Lucie – 2Santa Rosa – 1Sarasota – 2Seminole – 3Sumter – 1Suwannee – 1Taylor – 1Union – 1Volusia – 3Wakulla – 1Walton – 1Washington – 1

GEORGIAAppling – 1Atkinson – 1Bacon – 1Baker – 1Baldwin – 1Banks – 1Barrow – 1Bartow – 1Ben Hill – 1Berrien – 1Bibb – 1Bleckley – 1Brantley – 1Brooks – 1Bryan – 1Bulloch – 1Burke – 1Butts – 2Calhoun – 1Camden – 1Candler – 1Carroll – 1Catoosa – 1Charlton – 1Chatham – 1Chattahoochee – 1Chattooga – 1Cherokee – 2Clarke – 1

Clay – 1Clayton – 2Clinch – 1Cobb – 2Co� ee – 1Colquitt – 1Columbia – 1Cook – 1Coweta – 1Crawford – 1Crisp – 1Dade – 1Dawson – 1Decatur – 1Dekalb – 2Dodge – 1Dooly – 1Dougherty – 1Douglas – 2Early – 1Echols – 1E� ngham – 1Elbert – 1Emanuel – 1Evans – 1Fannin – 1Fayette – 2Floyd – 1Forsyth – 2Franklin – 1Fulton – 2Gilmer – 1Glascock – 1Glynn – 1Gordon – 1Grady – 1Greene – 1Gwinnett – 2Habersham – 1Hall – 1Hancock – 1Haralson – 1Harris – 1Hart – 1Heard – 1Henry – 2Houston – 1Irwin – 1Jackson – 1Jasper – 1Je� Davis – 1Je� erson – 1Jenkins – 1Johnson – 1Jones – 1Lamar – 1

Lanier – 1Laurens – 1Lee – 1Liberty – 1Lincoln – 1Long – 1Lowndes – 1Lumpkin – 1Macon – 1Madison – 1Marion – 1Mcdu� e – 1Mcintosh – 1Meriwether – 1Miller – 1Mitchell – 1Monroe – 1Montgomery – 1Morgan – 1Murray – 1Muscogee – 1Newton – 1Oconee – 1Oglethorpe – 1Paulding – 2Peach – 1Pickens – 1Pierce – 1Pike – 1Polk – 1Pulaski – 1Putnam – 1Quitman – 1Rabun – 1Randolph – 1Richmond – 1Rockdale – 1Schley – 1Screven – 1Seminole – 1Spalding – 2Stephens – 1Stewart – 1Sumter – 1Talbot – 1Taliaferro – 1Tattnall – 1Taylor – 1Telfair – 1Terrell – 1Thomas – 1Tift – 1Toombs – 1Towns – 1Treutlen – 1Troup – 1

Turner – 1Twiggs – 1Union – 1Upson – 1Walker – 1Walton – 2Ware – 1Warren – 1Washington – 1Wayne – 1Webster – 1Wheeler – 1White – 1Whitfi eld – 1Wilcox – 1Wilkes – 1Wilkinson – 1Worth – 1

HAWAIIHawaii – 2Honolulu – 2Kauai – 2Maui – 2

IDAHOAda – 4Adams – 4Bannock – 3Bear Lake – 4Benewah – 3Bingham – 4Blaine – 4Boise – 4Bonner – 3Bonneville – 4Boundary – 3Butte – 3Camas – 4Canyon – 4Caribou – 3Cassia – 4Clark – 3Clearwater – 3Custer – 4Elmore – 4Franklin – 4Fremont – 4Gem – 4Gooding – 4Idaho – 3Je� erson – 4Jerome – 4Kootenai – 4Latah – 3Lemhi – 4

Lewis – 3Lincoln – 4Madison – 4Minidoka – 4Nez Perce – 3Oneida – 4Owyhee – 4Payette – 4Power – 3Shoshone – 3Teton – 3Twin Falls – 4Valley – 4Washington – 4

ILLINOISAdams – 2Alexander – 2Bond – 2Boone – 1Brown – 2Bureau – 2Calhoun – 2Carroll – 1Cass – 2Champaign – 2Christian – 2Clark – 2Clay – 2Clinton – 2Coles – 2Cook – 3Crawford – 2Cumberland – 2Dekalb – 1Dewitt – 2Douglas – 2Dupage – 3Edgar – 2Edwards – 2E� ngham – 2Fayette – 2Ford – 2Franklin – 2Fulton – 2Gallatin – 2Greene – 2Grundy – 2Hamilton – 2Hancock – 2Hardin – 2Henderson – 2Henry – 2Iroquois – 2Jackson – 2Jasper – 2

APPENDIX TABLE 1


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Je� erson – 2Jersey – 2Jo Daviess – 1Johnson – 2Kane – 2Kankakee – 3Kendall – 2Knox – 2La Salle – 2Lake – 1Lawrence – 2Lee – 1Livingston – 2Logan – 2Macon – 2Macoupin – 2Madison – 1Marion – 2Marshall – 2Mason – 2Massac – 2Mcdonough – 2Mchenry – 1Mclean – 2Menard – 2Mercer – 2Monroe – 1Montgomery – 2Morgan – 2Moultrie – 2Ogle – 1Peoria – 2Perry – 2Piatt – 2Pike – 2Pope – 2Pulaski – 2Putnam – 2Randolph – 2Richland – 2Rock Island – 2Saint Clair – 1Saline – 2Sangamon – 2Schuyler – 2Scott – 2Shelby – 2Stark – 2Stephenson – 1Tazewell – 2Union – 2Vermilion – 2Wabash – 2Warren – 2Washington – 2Wayne – 2

White – 2Whiteside – 2Will – 2Williamson – 2Winnebago – 1Woodford – 2

INDIANAAdams – 2Allen – 2Bartholomew – 1Benton – 1Blackford – 1Boone – 2Brown – 2Carroll – 1Cass – 2Clark – 1Clay – 1Clinton – 1Crawford – 1Daviess – 1De Kalb – 1Dearborn – 1Decatur – 2Delaware – 1Dubois – 2Elkhart – 2Fayette – 1Floyd – 2Fountain – 1Franklin – 1Fulton – 1Gibson – 2Grant – 1Greene – 1Hamilton – 2Hancock – 2Harrison – 1Hendricks – 2Henry – 2Howard – 2Huntington – 2Jackson – 2Jasper – 1Jay – 1Je� erson – 1Jennings – 1Johnson – 2Knox – 1Kosciusko – 1La Porte – 2Lagrange – 1Lake – 1Lawrence – 1Madison – 2

Marion – 2Marshall – 2Martin – 1Miami – 2Monroe – 2Montgomery – 2Morgan – 2Newton – 1Noble – 1Ohio – 1Orange – 1Owen – 2Parke – 1Perry – 1Pike – 1Porter – 1Posey – 1Pulaski – 1Putnam – 1Randolph – 1Ripley – 1Rush – 1Scott – 1Shelby – 2Spencer – 1St Joseph – 2Starke – 2Steuben – 2Sullivan – 1Switzerland – 1Tippecanoe – 2Tipton – 1Union – 2Vanderburgh – 1Vermillion – 1Vigo – 1Wabash – 1Warren – 1Warrick – 1Washington – 1Wayne – 2Wells – 2White – 1Whitley – 2

IOWAAdair – 1Adams – 1Allamakee – 1Appanoose – 1Audubon – 1Benton – 1Black Hawk – 1Boone – 1Bremer – 1Buchanan – 1

Buena Vista – 1Butler – 1Calhoun – 1Carroll – 1Cass – 1Cedar – 1Cerro Gordo – 1Cherokee – 1Chickasaw – 1Clarke – 1Clay – 1Clayton – 1Clinton – 1Crawford – 1Dallas – 1Davis – 1Decatur – 1Delaware – 1Des Moines – 1Dickinson – 1Dubuque – 1Emmet – 1Fayette – 1Floyd – 1Franklin – 1Fremont – 1Greene – 1Grundy – 1Guthrie – 1Hamilton – 1Hancock – 1Hardin – 1Harrison – 1Henry – 1Howard – 1Humboldt – 1Ida – 1Iowa – 1Jackson – 1Jasper – 1Je� erson – 1Johnson – 1Jones – 1Keokuk – 1Kossuth – 1Lee – 1Linn – 1Louisa – 1Lucas – 1Lyon – 1Madison – 1Mahaska – 1Marion – 1Marshall – 1Mills – 1Mitchell – 1

Monona – 1Monroe – 1Montgomery – 1Muscatine – 1Obrien – 1Osceola – 1Page – 1Palo Alto – 1Plymouth – 1Pocahontas – 1Polk – 1Pottawattamie – 1Poweshiek – 1Ringgold – 1Sac – 1Scott – 1Shelby – 1Sioux – 1Story – 1Tama – 1Taylor – 1Union – 1Van Buren – 1Wapello – 1Warren – 1Washington – 1Wayne – 1Webster – 1Winnebago – 1Winneshiek – 1Woodbury – 1Worth – 1Wright – 1

KANSASAllen – 2Anderson – 2Atchison – 2Barber – 2Barton – 2Bourbon – 2Brown – 2Butler – 2Chase – 2Chautauqua – 2Cherokee – 2Cheyenne – 2Clark – 2Clay – 2Cloud – 2Co� ey – 2Comanche – 2Cowley – 2Crawford – 2Decatur – 2Dickinson – 2

Doniphan – 2Douglas – 2Edwards – 2Elk – 2Ellis – 2Ellsworth – 2Finney – 2Ford – 2Franklin – 2Geary – 2Gove – 2Graham – 2Grant – 2Gray – 2Greeley – 2Greenwood – 2Hamilton – 2Harper – 2Harvey – 2Haskell – 2Hodgeman – 2Jackson – 2Je� erson – 2Jewell – 2Johnson – 2Kearny – 2Kingman – 2Kiowa – 2Labette – 2Lane – 2Leavenworth – 2Lincoln – 2Linn – 2Logan – 2Lyon – 2Marion – 2Marshall – 2Mcpherson – 2Meade – 2Miami – 2Mitchell – 2Montgomery – 2Morris – 2Morton – 2Nemaha – 2Neosho – 2Ness – 2Norton – 2Osage – 2Osborne – 2Ottawa – 2Pawnee – 2Phillips – 2Pottawatomie – 2Pratt – 2Rawlins – 2

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Reno – 2Republic – 2Rice – 2Riley – 2Rooks – 2Rush – 2Russell – 2Saline – 2Scott – 2Sedgwick – 2Seward – 2Shawnee – 2Sheridan – 2Sherman – 2Smith – 2Sta� ord – 2Stanton – 2Stevens – 2Sumner – 2Thomas – 2Trego – 2Wabaunsee – 2Wallace – 2Washington – 2Wichita – 2Wilson – 2Woodson – 2Wyandotte – 2

KENTUCKYAdair – 1Allen – 1Anderson – 1Ballard – 1Barren – 1Bath – 1Bell – 1Boone – 1Bourbon – 1Boyd – 1Boyle – 1Bracken – 1Breathitt – 1Breckinridge – 1Bullitt – 1Butler – 1Caldwell – 1Calloway – 1Campbell – 1Carlisle – 1Carroll – 1Carter – 1Casey – 1Christian – 1Clark – 1Clay – 1

Clinton – 1Crittenden – 1Cumberland – 1Daviess – 1Edmonson – 1Elliott – 1Estill – 1Fayette – 1Fleming – 1Floyd – 1Franklin – 1Fulton – 1Gallatin – 1Garrard – 1Grant – 1Graves – 1Grayson – 1Green – 1Greenup – 1Hancock – 1Hardin – 1Harlan – 1Harrison – 1Hart – 1Henderson – 1Henry – 1Hickman – 1Hopkins – 1Jackson – 1Je� erson – 1Jessamine – 1Johnson – 1Kenton – 1Knott – 1Knox – 1Larue – 1Laurel – 1Lawrence – 1Lee – 1Leslie – 1Letcher – 1Lewis – 1Lincoln – 1Livingston – 1Logan – 1Lyon – 1Madison – 1Mago� n – 1Marion – 1Marshall – 1Martin – 1Mason – 1Mccracken – 1Mccreary – 1Mclean – 1Meade – 1

Menifee – 1Mercer – 1Metcalfe – 1Monroe – 1Montgomery – 1Morgan – 1Muhlenberg – 1Nelson – 1Nicholas – 1Ohio – 1Oldham – 1Owen – 1Owsley – 1Pendleton – 1Perry – 1Pike – 1Powell – 1Pulaski – 1Robertson – 1Rockcastle – 1Rowan – 1Russell – 1Scott – 1Shelby – 1Simpson – 1Spencer – 1Taylor – 1Todd – 1Trigg – 1Trimble – 1Union – 1Warren – 1Washington – 1Wayne – 1Webster – 1Whitley – 1Wolfe – 1Woodford – 1

LOUISIANAAcadia – 2Allen – 2Ascension – 2Assumption – 2Avoyelles – 2Beauregard – 2Bienville – 2Bossier – 2Caddo – 2Calcasieu – 2Caldwell – 2Cameron – 2Catahoula – 2Claiborne – 2Concordia – 2De Soto – 2

East Baton Rouge – 2

East Carroll – 2East Feliciana – 2Evangeline – 2Franklin – 2Grant – 2Iberia – 2Iberville – 2Jackson – 2Je� erson – 2Je� erson Davis – 2La Salle – 2Lafayette – 2Lafourche – 2Lincoln – 2Livingston – 2Madison – 2Morehouse – 2Natchitoches – 2Orleans – 2Ouachita – 2Plaquemines – 2Pointe Coupee – 2Rapides – 2Red River – 2Richland – 2Sabine – 2Saint Bernard – 2Saint Charles – 2Saint Helena – 2Saint James – 2Saint Landry – 2Saint Martin – 2Saint Mary – 2Saint Tammany

– 2St John The

Baptist – 2Tangipahoa – 2Tensas – 2Terrebonne – 2Union – 2Vermilion – 2Vernon – 2Washington – 2Webster – 2West Baton

Rouge – 2West Carroll – 2West Feliciana – 2Winn – 2

MAINEAndroscoggin – 2Aroostook – 2

Cumberland – 2Franklin – 2Hancock – 2Kennebec – 2Knox – 2Lincoln – 2Oxford – 2Penobscot – 2Piscataquis – 2Sagadahoc – 2Somerset – 2Waldo – 2Washington – 2York – 2

MARYLANDAllegany – 1Anne Arundel – 2Baltimore – 2Baltimore City – 2Calvert – 2Caroline – 1Carroll – 2Cecil – 1Charles – 2Dorchester – 1Frederick – 2Garrett – 1Harford – 2Howard – 2Kent – 1Montgomery – 2Prince George’s

– 2Queen Anne’s – 1Saint Mary’s – 1Somerset – 1Talbot – 1Washington – 1Wicomico – 1Worcester – 1

MASSACHUSETTSBarnstable – 5Berkshire – 5Bristol – 6Dukes – 3Essex – 6Franklin – 6Hampden – 7Hampshire – 6Middlesex – 7Nantucket – 3Norfolk – 6Plymouth – 6Su� olk – 6

Worcester – 7

MICHIGANAlcona – 3Alger – 1Allegan – 4Alpena – 3Antrim – 3Arenac – 3Baraga – 1Barry – 4Bay – 3Benzie – 3Berrien – 3Branch – 3Calhoun – 3Cass – 3Charlevoix – 3Cheboygan – 3Chippewa – 1Clare – 3Clinton – 4Crawford – 3Delta – 1Dickinson – 1Eaton – 4Emmet – 3Genesee – 5Gladwin – 3Gogebic – 1Grand Traverse – 3Gratiot – 4Hillsdale – 4Houghton – 1Huron – 3Ingham – 5Ionia – 4Iosco – 3Iron – 1Isabella – 4Jackson – 3Kalamazoo – 4Kalkaska – 3Kent – 5Keweenaw – 1Lake – 4Lapeer – 4Leelanau – 3Lenawee – 3Livingston – 3Luce – 1Mackinac – 1Macomb – 6Manistee – 3Marquette – 1Mason – 4

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Mecosta – 4Menominee – 1Midland – 3Missaukee – 3Monroe – 4Montcalm – 5Montmorency – 3Muskegon – 3Newaygo – 4Oakland – 6Oceana – 4Ogemaw – 4Ontonagon – 1Osceola – 4Oscoda – 4Otsego – 3Ottawa – 4Presque Isle – 3Roscommon – 4Saginaw – 3Saint Clair – 3Saint Joseph – 4Sanilac – 4Schoolcraft – 1Shiawassee – 4Tuscola – 3Van Buren – 4Washtenaw – 5Wayne – 6Wexford – 3

MINNESOTAAitkin – 3Anoka – 4Becker – 2Beltrami – 2Benton – 3Big Stone – 2Blue Earth – 2Brown – 2Carlton – 3Carver – 4Cass – 3Chippewa – 2Chisago – 3Clay – 2Clearwater – 2Cook – 3Cottonwood – 2Crow Wing – 2Dakota – 4Dodge – 2Douglas – 2Faribault – 2Fillmore – 2Freeborn – 2

Goodhue – 2Grant – 2Hennepin – 4Houston – 2Hubbard – 2Isanti – 3Itasca – 3Jackson – 2Kanabec – 3Kandiyohi – 2Kittson – 1Koochiching – 3Lac Qui Parle – 2Lake – 3Lake of the

Woods – 1Le Sueur – 2Lincoln – 2Lyon – 2Mahnomen – 2Marshall – 2Martin – 2McLeod – 2Meeker – 1Mille Lacs – 2Morrison – 2Mower – 2Murray – 2Nicollet – 2Nobles – 2Norman – 2Olmsted – 2Otter Tail – 2Pennington – 2Pine – 3Pipestone – 2Polk – 2Pope – 2Ramsey – 4Red Lake – 2Redwood – 2Renville – 2Rice – 2Rock – 2Roseau – 1SAINT Louis – 3Scott – 4Sherburne – 4Sibley – 2Stearns – 3Steele – 2Stevens – 2Swift – 2Todd – 1Traverse – 2Wabasha – 2

Wadena – 2Waseca – 2Washington – 4Watonwan – 2Wilkin – 2Winona – 2Wright – 4Yellow Medicine

– 2

MISSISSIPPIAdams – 1Alcorn – 1Amite – 1Attala – 1Benton – 1Bolivar – 1Calhoun – 1Carroll – 1Chickasaw – 1Choctaw – 1Claiborne – 1Clarke – 1Clay – 1Coahoma – 1Copiah – 1Covington – 1Desoto – 1Forrest – 1Franklin – 1George – 1Greene – 1Grenada – 1Hancock – 1Harrison – 1Hinds – 1Holmes – 1Humphreys – 1Issaquena – 1Itawamba – 1Jackson – 1Jasper – 1Je� erson – 1Je� erson Davis – 1Jones – 1Kemper – 1Lafayette – 1Lamar – 1Lauderdale – 1Lawrence – 1Leake – 1Lee – 1Lefl ore – 1Lincoln – 1Lowndes – 1Madison – 1

Marion – 1Marshall – 1Monroe – 1Montgomery – 1Neshoba – 1Newton – 1Noxubee – 1Oktibbeha – 1Panola – 1Pearl River – 1Perry – 1Pike – 1Pontotoc – 1Prentiss – 1Quitman – 1Rankin – 1Scott – 1Sharkey – 1Simpson – 1Smith – 1Stone – 1Sunfl ower – 1Tallahatchie – 1Tate – 1Tippah – 1Tishomingo – 1Tunica – 1Union – 1Walthall – 1Warren – 1Washington – 1Wayne – 1Webster – 1Wilkinson – 1Winston – 1Yalobusha – 1Yazoo – 1

MISSOURIAdair – 1Andrew – 1Atchison – 1Audrain – 1Barry – 1Barton – 1Bates – 1Benton – 1Bollinger – 1Boone – 1Buchanan – 1Butler – 1Caldwell – 1Callaway – 1Camden – 1Cape Girardeau – 1Carroll – 1

Carter – 1Cass – 2Cedar – 1Chariton – 1Christian – 1Clark – 1Clay – 2Clinton – 1Cole – 1Cooper – 1Crawford – 1Dade – 1Dallas – 1Daviess – 1Dekalb – 1Dent – 1Douglas – 1Dunklin – 1Franklin – 2Gasconade – 1Gentry – 1Greene – 1Grundy – 1Harrison – 1Henry – 1Hickory – 1Holt – 1Howard – 1Howell – 1Iron – 1Jackson – 2Jasper – 1Je� erson – 2Johnson – 1Knox – 1Laclede – 1Lafayette – 1Lawrence – 1Lewis – 1Lincoln – 1Linn – 1Livingston – 1Macon – 1Madison – 1Maries – 1Marion – 1Mcdonald – 1Mercer – 1Miller – 1Mississippi – 1Moniteau – 1Monroe – 1Montgomery – 1Morgan – 1New Madrid – 1Newton – 1

Nodaway – 1Oregon – 1Osage – 1Ozark – 1Pemiscot – 1Perry – 1Pettis – 1Phelps – 1Pike – 1Platte – 2Polk – 1Pulaski – 1Putnam – 1Ralls – 1Randolph – 1Ray – 1Reynolds – 1Ripley – 1Saint Charles – 2Saint Clair – 1Saint Francois – 1Saint Louis – 2Saint Louis

City – 2Sainte

Genevieve – 1Saline – 1Schuyler – 1Scotland – 1Scott – 1Shannon – 1Shelby – 1Stoddard – 1Stone – 1Sullivan – 1Taney – 1Texas – 1Vernon – 1Warren – 1Washington – 1Wayne – 1Webster – 1Worth – 1Wright – 1

MONTANABeaverhead – 3Big Horn – 3Blaine – 3Broadwater – 3Carbon – 3Carter – 3Cascade – 3Chouteau – 3Custer – 3Daniels – 3

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Dawson – 3Deer Lodge – 3Fallon – 3Fergus – 3Flathead – 3Gallatin – 3Garfi eld – 3Glacier – 3Golden Valley – 3Granite – 3Hill – 3Je� erson – 3Judith Basin – 3Lake – 3Lewis And

Clark – 3Liberty – 3Lincoln – 3Madison – 3Mccone – 3Meagher – 3Mineral – 3Missoula – 3Musselshell – 3Park – 3Petroleum – 3Phillips – 3Pondera – 3Powder River – 3Powell – 3Prairie – 3Ravalli – 3Richland – 3Roosevelt – 3Rosebud – 3Sanders – 3Sheridan – 3Silver Bow – 3Stillwater – 3Sweet Grass – 3Teton – 3Toole – 3Treasure – 3Valley – 3Wheatland – 3Wibaux – 3Yellowstone – 3

NEBRASKAAdams – 1Antelope – 1Arthur – 1Banner – 1Blaine – 1Boone – 1

Box Butte – 1Boyd – 1Brown – 1Bu� alo – 1Burt – 1Butler – 1Cass – 1Cedar – 1Chase – 1Cherry – 1Cheyenne – 1Clay – 1Colfax – 1Cuming – 1Custer – 1Dakota – 1Dawes – 1Dawson – 1Deuel – 1Dixon – 1Dodge – 1Douglas – 1Dundy – 1Fillmore – 1Franklin – 1Frontier – 1Furnas – 1Gage – 1Garden – 1Garfi eld – 1Gosper – 1Grant – 1Greeley – 1Hall – 1Hamilton – 1Harlan – 1Hayes – 1Hitchcock – 1Holt – 1Hooker – 1Howard – 1Je� erson – 1Johnson – 1Kearney – 1Keith – 1Keya Paha – 1Kimball – 1Knox – 1Lancaster – 1Lincoln – 1Logan – 1Loup – 1Madison – 1Mcpherson – 1Merrick – 1

Morrill – 1Nance – 1Nemaha – 1Nuckolls – 1Otoe – 1Pawnee – 1Perkins – 1Phelps – 1Pierce – 1Platte – 1Polk – 1Red Willow – 1Richardson – 1Rock – 1Saline – 1Sarpy – 1Saunders – 1Scotts Blu� – 1Seward – 1Sheridan – 1Sherman – 1Sioux – 1Stanton – 1Thayer – 1Thomas – 1Thurston – 1Valley – 1Washington – 1Wayne – 1Webster – 1Wheeler – 1York – 1

NEVADACarson City – 1Churchill – 1Clark – 2Douglas – 1Elko – 1Esmeralda – 1Eureka – 1Humboldt – 1Lander – 1Lincoln – 1Lyon – 1Mineral – 1Nye – 2Pershing – 1Storey – 1Washoe – 2White Pine – 1

NEW HAMPSHIREBelknap – 2Carroll – 2

Cheshire – 3Coos – 3Grafton – 3Hillsborough – 3Merrimack – 3Rockingham – 3Stra� ord – 3Sullivan – 3

NEW JERSEYAtlantic – 2Bergen – 3Burlington – 2Camden – 2Cape May – 2Cumberland – 2Essex – 3Gloucester – 2Hudson – 3Hunterdon – 3Mercer – 3Middlesex – 3Monmouth – 3Morris – 3Ocean – 3Passaic – 3Salem – 2Somerset – 3Sussex – 3Union – 3Warren – 3

NEW MEXICOBernalillo – 4Catron – 4Chaves – 4Cibola – 4Colfax – 4Curry – 4De Baca – 4Dona Ana – 4Eddy – 4Grant – 4Guadalupe – 4Harding – 4Hidalgo – 4Lea – 4Lincoln – 4Los Alamos – 4Luna – 4Mckinley – 4Mora – 4Otero – 4Quay – 4Rio Arriba – 4

Roosevelt – 4San Juan – 4San Miguel – 4Sandoval – 4Santa Fe – 4Sierra – 4Socorro – 4Taos – 4Torrance – 4Union – 4Valencia – 4

NEW YORKAlbany – 6Allegany – 4Bronx – 7Broome – 5Cattaraugus – 4Cayuga – 3Chautauqua – 4Chemung – 2Chenango – 4Clinton – 4Columbia – 6Cortland – 3Delaware – 6Dutchess – 6Erie – 4Essex – 6Franklin – 3Fulton – 7Genesee – 5Greene – 6Hamilton – 4Herkimer – 3Je� erson – 3Kings – 7Lewis – 3Livingston – 3Madison – 4Monroe – 3Montgomery – 6Nassau – 6New York – 7Niagara – 4Oneida – 4Onondaga – 3Ontario – 3Orange – 6Orleans – 5Oswego – 3Otsego – 4Putnam – 5Queens – 7Rensselaer – 6

Richmond – 7Rockland – 6Saint Lawrence – 3Saratoga – 6Schenectady – 6Schoharie – 4Schuyler – 2Seneca – 3Steuben – 3Su� olk – 6Sullivan – 5Tioga – 4Tompkins – 2Ulster – 6Warren – 6Washington – 6Wayne – 3Westchester – 6Wyoming – 5Yates – 3

NORTH CAROLINA

Alamance – 1Alexander – 1Alleghany – 1Anson – 1Ashe – 1Avery – 1Beaufort – 1Bertie – 1Bladen – 1Brunswick – 1Buncombe – 1Burke – 1Cabarrus – 1Caldwell – 1Camden – 1Carteret – 1Caswell – 1Catawba – 1Chatham – 2Cherokee – 1Chowan – 1Clay – 1Cleveland – 1Columbus – 1Craven – 1Cumberland – 1Currituck – 1Dare – 1Davidson – 1Davie – 1Duplin – 1Durham – 1

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Edgecombe – 1Forsyth – 1Franklin – 1Gaston – 1Gates – 1Graham – 1Granville – 1Greene – 1Guilford – 1Halifax – 1Harnett – 1Haywood – 1Henderson – 1Hertford – 1Hoke – 1Hyde – 1Iredell – 1Jackson – 1Johnston – 2Jones – 1Lee – 1Lenoir – 1Lincoln – 1Macon – 1Madison – 1Martin – 1Mcdowell – 1Mecklenburg – 1Mitchell – 1Montgomery – 1Moore – 1Nash – 2New Hanover – 1Northampton – 1Onslow – 1Orange – 2Pamlico – 1Pasquotank – 1Pender – 1Perquimans – 1Person – 1Pitt – 1Polk – 1Randolph – 1Richmond – 1Robeson – 1Rockingham – 1Rowan – 1Rutherford – 1Sampson – 1Scotland – 1Stanly – 1Stokes – 1Surry – 1Swain – 1Transylvania – 1

Tyrrell – 1Union – 1Vance – 1Wake – 2Warren – 1Washington – 1Watauga – 1Wayne – 1Wilkes – 1Wilson – 1Yadkin – 1Yancey – 1

NORTH DAKOTAAdams – 1Barnes – 1Benson – 1Billings – 1Bottineau – 1Bowman – 1Burke – 1Burleigh – 2Cass – 2Cavalier – 1Dickey – 1Divide – 1Dunn – 1Eddy – 1Emmons – 1Foster – 1Golden Valley – 1Grand Forks – 1Grant – 1Griggs – 1Hettinger – 1Kidder – 1Lamoure – 1Logan – 1Mchenry – 1Mcintosh – 1Mckenzie – 1Mclean – 1Mercer – 1Morton – 2Mountrail – 1Nelson – 1Oliver – 2Pembina – 1Pierce – 1Ramsey – 1Ransom – 1Renville – 1Richland – 1Rolette – 1Sargent – 1Sheridan – 1

Sioux – 1Slope – 1Stark – 1Steele – 1Stutsman – 1Towner – 1Traill – 2Walsh – 1Ward – 1Wells – 1Williams – 1

OHIOAdams – 1Allen – 2Ashland – 2Ashtabula – 3Athens – 2Auglaize – 1Belmont – 1Brown – 2Butler – 4Carroll – 2Champaign – 2Clark – 4Clermont – 3Clinton – 1Columbiana – 3Coshocton – 1Crawford – 1Cuyahoga – 5Darke – 1Defi ance – 3Delaware – 2Erie – 1Fairfi eld – 3Fayette – 1Franklin – 3Fulton – 3Gallia – 1Geauga – 3Greene – 3Guernsey – 1Hamilton – 4Hancock – 2Hardin – 1Harrison – 1Henry – 3Highland – 1Hocking – 1Holmes – 1Huron – 2Jackson – 1Je� erson – 1Knox – 1Lake – 5

Lawrence – 1Licking – 3Logan – 1Lorain – 5Lucas – 5Madison – 2Mahoning – 4Marion – 1Medina – 5Meigs – 1Mercer – 1Miami – 1Monroe – 1Montgomery – 3Morgan – 1Morrow – 2Muskingum – 1Noble – 1Ottawa – 1Paulding – 1Perry – 1Pickaway – 2Pike – 1Portage – 4Preble – 2Putnam – 1Richland – 1Ross – 2Sandusky – 2Scioto – 2Seneca – 2Shelby – 1Stark – 5Summit – 5Trumbull – 4Tuscarawas – 1Union – 2Van Wert – 1Vinton – 1Warren – 2Washington – 1Wayne – 2Williams – 1Wood – 4Wyandot – 1

OKLAHOMAAdair – 1Alfalfa – 1Atoka – 1Beaver – 1Beckham – 1Blaine – 1Bryan – 1Caddo – 1Canadian – 1

Carter – 1Cherokee – 1Choctaw – 1Cimarron – 1Cleveland – 1Coal – 1Comanche – 1Cotton – 1Craig – 1Creek – 1Custer – 1Delaware – 1Dewey – 1Ellis – 1Garfi eld – 1Garvin – 1Grady – 1Grant – 1Greer – 1Harmon – 1Harper – 1Haskell – 1Hughes – 1Jackson – 1Je� erson – 1Johnston – 1Kay – 1Kingfi sher – 1Kiowa – 1Latimer – 1Le Flore – 1Lincoln – 1Logan – 1Love – 1Major – 1Marshall – 1Mayes – 1Mcclain – 1Mccurtain – 1Mcintosh – 1Murray – 1Muskogee – 1Noble – 1Nowata – 1Okfuskee – 1Oklahoma – 1Okmulgee – 1Osage – 1Ottawa – 1Pawnee – 1Payne – 1Pittsburg – 1Pontotoc – 1Pottawatomie – 1Pushmataha – 1Roger Mills – 1

Rogers – 1Seminole – 1Sequoyah – 1Stephens – 1Texas – 1Tillman – 1Tulsa – 1Wagoner – 1Washington – 1Washita – 1Woods – 1Woodward – 1

OREGONBaker – 2Benton – 2Clackamas – 5Clatsop – 2Columbia – 3Coos – 2Crook – 3Curry – 2Deschutes – 3Douglas – 1Gilliam – 2Grant – 2Harney – 2Hood River – 3Jackson – 2Je� erson – 3Josephine – 2Klamath – 2Lake – 2Lane – 2Lincoln – 1Linn – 2Malheur – 2Marion – 3Morrow – 2Multnomah – 5Polk – 3Sherman – 2Tillamook – 2Umatilla – 2Union – 2Wallowa – 2Wasco – 2Washington – 5Wheeler – 2Yamhill – 3

PENNSYLVANIAAdams – 2Allegheny – 2Armstrong – 1Beaver – 2

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Bedford – 1Berks – 4Blair – 3Bradford – 2Bucks – 2Butler – 2Cambria – 3Cameron – 2Carbon – 2Centre – 3Chester – 2Clarion – 1Clearfi eld – 2Clinton – 2Columbia – 2Crawford – 2Cumberland – 3Dauphin – 3Delaware – 2Elk – 1Erie – 2Fayette – 1Forest – 1Franklin – 2Fulton – 2Greene – 1Huntingdon – 2Indiana – 1Je� erson – 2Juniata – 2Lackawanna – 2Lancaster – 3Lawrence – 1Lebanon – 1Lehigh – 3Luzerne – 2Lycoming – 2Mckean – 1Mercer – 1Mi� in – 2Monroe – 2Montgomery – 2Montour – 1Northampton – 3Northumberland

– 2Perry – 3Philadelphia – 2Pike – 2Potter – 2Schuylkill – 3Snyder – 2Somerset – 3Sullivan – 2Susquehanna – 2Tioga – 3

Union – 2Venango – 1Warren – 1Washington – 2Wayne – 2Westmoreland – 2Wyoming – 2York – 2

RHODE ISLANDBristol – 2Kent – 2Newport – 2Providence – 2Washington – 2

SOUTH CAROLINA

Abbeville – 1Aiken – 1Allendale – 1Anderson – 1Bamberg – 1Barnwell – 1Beaufort – 1Berkeley – 1Calhoun – 1Charleston – 1Cherokee – 1Chester – 1Chesterfi eld – 1Clarendon – 1Colleton – 1Darlington – 1Dillon – 1Dorchester – 1Edgefi eld – 1Fairfi eld – 1Florence – 1Georgetown – 1Greenville – 1Greenwood – 1Hampton – 1Horry – 1Jasper – 1Kershaw – 1Lancaster – 1Laurens – 1Lee – 1Lexington – 1Marion – 1Marlboro – 1Mccormick – 1Newberry – 1Oconee – 1Orangeburg – 1

Pickens – 1Richland – 1Saluda – 1Spartanburg – 1Sumter – 1Union – 1Williamsburg – 1York – 1

SOUTH DAKOTAAurora – 2Beadle – 2Bennett – 2Bon Homme – 2Brookings – 2Brown – 2Brule – 2Bu� alo – 2Butte – 2Campbell – 2Charles Mix – 2Clark – 2Clay – 2Codington – 2Corson – 2Custer – 2Davison – 2Day – 2Deuel – 2Dewey – 2Douglas – 2Edmunds – 2Fall River – 2Faulk – 2Grant – 2Gregory – 2Haakon – 2Hamlin – 2Hand – 2Hanson – 2Harding – 2Hughes – 2Hutchinson – 2Hyde – 2Jackson – 2Jerauld – 2Jones – 2Kingsbury – 2Lake – 2Lawrence – 2Lincoln – 2Lyman – 2Marshall – 2Mccook – 2Mcpherson – 2Meade – 2

Mellette – 2Miner – 2Minnehaha – 2Moody – 2Pennington – 2Perkins – 2Potter – 2Roberts – 2Sanborn – 2Shannon – 2Spink – 2Stanley – 2Sully – 2Todd – 2Tripp – 2Turner – 2Union – 2Walworth – 2Yankton – 2Ziebach – 2

TENNESSEEAnderson – 1Bedford – 1Benton – 1Bledsoe – 1Blount – 1Bradley – 1Campbell – 1Cannon – 1Carroll – 1Carter – 2Cheatham – 2Chester – 1Claiborne – 1Clay – 1Cocke – 1Co� ee – 1Crockett – 1Cumberland – 1Davidson – 2Decatur – 1Dekalb – 1Dickson – 1Dyer – 1Fayette – 2Fentress – 1Franklin – 1Gibson – 1Giles – 1Grainger – 1Greene – 2Grundy – 1Hamblen – 1Hamilton – 1Hancock – 2

Hardeman – 1Hardin – 1Hawkins – 2Haywood – 1Henderson – 1Henry – 1Hickman – 1Houston – 1Humphreys – 1Jackson – 1Je� erson – 1Johnson – 2Knox – 1Lake – 1Lauderdale – 2Lawrence – 1Lewis – 1Lincoln – 1Loudon – 1Macon – 1Madison – 1Marion – 1Marshall – 1Maury – 1Mcminn – 1Mcnairy – 1Meigs – 1Monroe – 1Montgomery – 2Moore – 1Morgan – 1Obion – 1Overton – 1Perry – 1Pickett – 1Polk – 1Putnam – 1Rhea – 1Roane – 1Robertson – 2Rutherford – 2Scott – 1Sequatchie – 1Sevier – 1Shelby – 1Smith – 1Stewart – 1Sullivan – 2Sumner – 2Tipton – 1Trousdale – 2Unicoi – 2Union – 1Van Buren – 1Warren – 1Washington – 2

Wayne – 1Weakley – 1White – 1Williamson – 2Wilson – 2

TEXASAnderson – 1Andrews – 2Angelina – 1Aransas – 2Archer – 1Armstrong – 2Atascosa – 1Austin – 1Bailey – 1Bandera – 2Bastrop – 3Baylor – 1Bee – 2Bell – 2Bexar – 3Blanco – 2Borden – 2Bosque – 2Bowie – 2Brazoria – 3Brazos – 2Brewster – 2Briscoe – 2Brooks – 3Brown – 1Burleson – 2Burnet – 3Caldwell – 3Calhoun – 1Callahan – 2Cameron – 3Camp – 1Carson – 2Cass – 2Castro – 2Chambers – 2Cherokee – 2Childress – 2Clay – 1Cochran – 1Coke – 2Coleman – 2Collin – 3Collingsworth – 2Colorado – 1Comal – 3Comanche – 2Concho – 2Cooke – 1

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Coryell – 1Cottle – 2Crane – 2Crockett – 1Crosby – 2Culberson – 1Dallam – 2Dallas – 3Dawson – 2De Witt – 1Deaf Smith – 2Delta – 1Denton – 2Dickens – 2Dimmit – 1Donley – 2Duval – 1Eastland – 2Ector – 2Edwards – 1El Paso – 3Ellis – 1Erath – 1Falls – 2Fannin – 2Fayette – 3Fisher – 2Floyd – 2Foard – 1Fort Bend – 3Franklin – 1Freestone – 2Frio – 1Gaines – 2Galveston – 2Garza – 2Gillespie – 2Glasscock – 2Goliad – 1Gonzales – 1Gray – 2Grayson – 1Gregg – 1Grimes – 2Guadalupe – 1Hale – 2Hall – 2Hamilton – 2Hansford – 2Hardeman – 1Hardin – 2Harris – 4Harrison – 1Hartley – 2Haskell – 2Hays – 4

Hemphill – 2Henderson – 1Hidalgo – 3Hill – 2Hockley – 2Hood – 1Hopkins – 1Houston – 1Howard – 2Hudspeth – 1Hunt – 1Hutchinson – 2Irion – 1Jack – 1Jackson – 1Jasper – 2Je� Davis – 1Je� erson – 4Jim Hogg – 1Jim Wells – 2Johnson – 1Jones – 2Karnes – 2Kaufman – 1Kendall – 2Kenedy – 2Kent – 2Kerr – 2Kimble – 1King – 2Kinney – 1Kleberg – 2Knox – 2La Salle – 1Lamar – 1Lamb – 2Lampasas – 1Lavaca – 1Lee – 3Leon – 1Liberty – 2Limestone – 2Lipscomb – 2Live Oak – 2Llano – 2Loving – 2Lubbock – 2Lynn – 2Madison – 2Marion – 1Martin – 2Mason – 2Matagorda – 1Maverick – 1Mcculloch – 3Mclennan – 3

Mcmullen – 1Medina – 2Menard – 2Midland – 2Milam – 1Mills – 2Mitchell – 2Montague – 1Montgomery – 3Moore – 2Morris – 1Motley – 2Nacogdoches – 1Navarro – 2Newton – 2Nolan – 2Nueces – 2Ochiltree – 2Oldham – 2Orange – 2Palo Pinto – 1Panola – 1Parker – 1Parmer – 2Pecos – 2Polk – 1Potter – 2Presidio – 1Rains – 1Randall – 2Reagan – 2Real – 1Red River – 2Reeves – 2Refugio – 2Roberts – 2Robertson – 1Rockwall – 2Runnels – 2Rusk – 1Sabine – 1San Augustine – 1San Jacinto – 1San Patricio – 2San Saba – 2Schleicher – 1Scurry – 2Shackelford – 2Shelby – 1Sherman – 2Smith – 2Somervell – 2Starr – 2Stephens – 2Sterling – 1Stonewall – 2

Sutton – 1Swisher – 2Tarrant – 2Taylor – 2Terrell – 1Terry – 2Throckmorton – 2Titus – 1Tom Green – 1Travis – 4Trinity – 1Tyler – 2Upshur – 1Upton – 2Uvalde – 1Val Verde – 1Van Zandt – 1Victoria – 1Walker – 1Waller – 2Ward – 2Washington – 1Webb – 2Wharton – 1Wheeler – 2Wichita – 1Wilbarger – 1Willacy – 2Williamson – 4Wilson – 1Winkler – 2Wise – 1Wood – 2Yoakum – 2Young – 1Zapata – 1Zavala – 1

UTAHBeaver – 2Box Elder – 2Cache – 2Carbon – 2Daggett – 2Davis – 2Duchesne – 2Emery – 2Garfi eld – 2Grand – 2Iron – 2Juab – 2Kane – 2Millard – 2Morgan – 2Piute – 2Rich – 2

Salt Lake – 2San Juan – 2Sanpete – 2Sevier – 2Summit – 2Tooele – 2Uintah – 2Utah – 2Wasatch – 2Washington – 2Wayne – 2Weber – 2

VERMONTAddison – 2Bennington – 2Caledonia – 2Chittenden – 2Essex – 2Franklin – 2Grand Isle – 2Lamoille – 2Orange – 2Orleans – 2Rutland – 2Washington – 2Windham – 2Windsor – 2

VIRGINIAAccomack – 1Albemarle – 1Alexandria City – 3Alleghany – 1Amelia – 1Amherst – 1Appomattox – 1Arlington – 3Augusta – 1Bath – 1Bedford – 1Bedford City – 1Bland – 1Botetourt – 1Bristol – 1Brunswick – 1Buchanan – 1Buckingham – 1Buena Vista City – 1Campbell – 1Caroline – 2Carroll – 1Charles City – 1Charlotte – 1Charlottesville

City – 1

Chesapeake City – 1

Chesterfi eld – 1Clarke – 1Colonial Heights

City – 1Covington City – 1Craig – 1Culpeper – 2Cumberland – 1Danville City – 1Dickenson – 1Dinwiddie – 1Emporia City – 1Essex – 1Fairfax – 3Fairfax City – 3Falls Church

City – 3Fauquier – 2Floyd – 1Fluvanna – 1Franklin – 1Franklin City – 2Frederick – 1Fredericksburg

City – 1Galax City – 1Giles – 1Gloucester – 1Goochland – 1Grayson – 1Greene – 1Greensville – 1Halifax – 2Hampton City – 1Hanover – 2Harrisonburg

City – 1Henrico – 1Henry – 1Highland – 1Hopewell City – 1Isle Of Wight – 1James City – 1King And

Queen – 1King George – 1King William – 1Lancaster – 1Lee – 1Lexington City – 1Loudoun – 3Louisa – 2Lunenburg – 1Lynchburg City – 1

APPENDIX TABLE 1


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Madison – 2Manassas City – 2Manassas Park

City – 2Martinsville

City – 1Mathews – 1Mecklenburg – 2Middlesex – 1Montgomery – 1Nelson – 2New Kent – 2Newport News

City – 1Norfolk City – 1Northampton – 1Northumberland

– 1Norton City – 1Nottoway – 1Orange – 2Page – 2Patrick – 1Petersburg City – 1Pittsylvania – 1Poquoson City – 1Portsmouth

City – 1Powhatan – 1Prince Edward – 1Prince George – 1Prince William – 3Pulaski – 1Radford – 1Rappahannock – 1Richmond – 1Richmond City – 1Roanoke – 1Roanoke City – 1Rockbridge – 1Rockingham – 1Russell – 1Salem – 1Scott – 1Shenandoah – 1Smyth – 1Southampton – 2

Spotsylvania – 1Sta� ord – 2Staunton City – 1Su� olk City – 1Surry – 1Sussex – 1Tazewell – 1Virginia Beach

City – 1Warren – 1Washington – 1Waynesboro

City – 1Westmoreland – 2Williamsburg

City – 1Winchester

City – 1Wise – 1Wythe – 1York – 1

WASHINGTONAdams – 2Asotin – 1Benton – 3Chelan – 1Clallam – 1Clark – 3Columbia – 3Cowlitz – 2Douglas – 1Ferry – 1Franklin – 3Garfi eld – 1Grant – 2Grays Harbor – 1Island – 1Je� erson – 2King – 4Kitsap – 2Kittitas – 2Klickitat – 2Lewis – 2Lincoln – 2Mason – 2Okanogan – 1

Pacifi c – 1Pend Oreille – 1Pierce – 4San Juan – 1Skagit – 1Skamania – 1Snohomish – 3Spokane – 4Stevens – 2Thurston – 4Wahkiakum – 1Walla Walla – 3Whatcom – 2Whitman – 2Yakima – 2

WEST VIRGINIABarbour – 2Berkeley – 1Boone – 2Braxton – 1Brooke – 2Cabell – 2Calhoun – 2Clay – 2Doddridge – 2Fayette – 2Gilmer – 2Grant – 1Greenbrier – 1Hampshire – 1Hancock – 2Hardy – 1Harrison – 2Jackson – 2Je� erson – 1Kanawha – 2Lewis – 1Lincoln – 2Logan – 2Marion – 2Marshall – 2Mason – 2Mcdowell – 1Mercer – 1Mineral – 1Mingo – 1

Monongalia – 2Monroe – 1Morgan – 1Nicholas – 1Ohio – 2Pendleton – 1Pleasants – 2Pocahontas – 1Preston – 2Putnam – 2Raleigh – 2Randolph – 1Ritchie – 2Roane – 2Summers – 1Taylor – 2Tucker – 1Tyler – 2Upshur – 1Wayne – 2Webster – 1Wetzel – 2Wirt – 2Wood – 2Wyoming – 1

WISCONSINAdams – 5Ashland – 2Barron – 2Bayfi eld – 2Brown – 1Bu� alo – 3Burnett – 3Calumet – 2Chippewa – 2Clark – 2Columbia – 3Crawford – 3Dane – 3Dodge – 3Door – 1Douglas – 3Dunn – 2Eau Claire – 2Florence – 2Fond Du Lac – 3

Forest – 2Grant – 2Green – 4Green Lake – 2Iowa – 3Iron – 2Jackson – 3Je� erson – 3Juneau – 5Kenosha – 2Kewaunee – 1La Crosse – 2Lafayette – 3Langlade – 2Lincoln – 2Manitowoc – 1Marathon – 3Marinette – 1Marquette – 2Menominee – 1Milwaukee – 3Monroe – 2Oconto – 1Oneida – 2Outagamie – 2Ozaukee – 3Pepin – 2Pierce – 2Polk – 2Portage – 2Price – 2Racine – 3Richland – 3Rock – 4Rusk – 1Saint Croix – 2Sauk – 3Sawyer – 2Shawano – 3Sheboygan – 1Taylor – 2Trempealeau – 3Vernon – 4Vilas – 2Walworth – 4Washburn – 2Washington – 3

Waukesha – 5Waupaca – 1Waushara – 1Winnebago – 2Wood – 2

WYOMINGAlbany – 1Big Horn – 1Campbell – 1Carbon – 1Converse – 1Crook – 1Fremont – 1Goshen – 1Hot Springs – 1Johnson – 1Laramie – 1Lincoln – 1Natrona – 1Niobrara – 1Park – 1Platte – 1Sheridan – 1Sublette – 1Sweetwater – 1Teton – 1Uinta – 1Washakie – 1Weston – 1

APPENDIX TABLE 1


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NOTE: All fi gures are at the parent company level (i.e., data for all subsidiaries of a company are aggregated under the parent company).SOURCES: Data for the states using the federal exchange platform are from HealthCare.gov (data.healthcare.gov). Data for the states and District of Columbia with a state-based exchange are from either the state’s insurance department or state’s exchange.

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Alabama Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of AlabamaBright Health, Inc. Bright Health Insurance Company

Alaska Premera Premera Blue Cross Blue Shield of Alaska

Arizona Blue Cross Blue Shield of Arizona, Inc. Blue Cross Blue Shield of Arizona, Inc.Centene Corporation Health Net of Arizona, Inc.

Arkansas Catholic Health Initiatives QualChoice Life & Health Insurance Company, Inc., QCA Health Plan, Inc.Centene Corporation Celtic Insurance CompanyUSAble Mutual Insurance Company USAble Mutual Insurance Company

California Anthem, Inc. Anthem Blue Cross of CaliforniaBlue Shield of California Blue Shield of CaliforniaCentene Corporation Health Net of California, Inc., Health Net Life Insurance CompanyChinese Hospital Association Chinese Community Health PlanKaiser Permanente Kaiser PermanenteLocal Initiative Health Authority

for Los Angeles CountyL.A. Care Health Plan

Molina Healthcare, Inc. Molina HealthcareMulberry Health, Inc. Oscar Health Plan of CaliforniaSharp HealthCare Sharp Health PlanValley Health Plan Valley Health PlanWestern Health Advantage Western Health Advantage

Colorado Anthem, Inc. Anthem Blue Cross Blue Shield (HMO Colorado, Inc.)Bright Health, Inc. Bright Health PlanCigna Corporation Cigna Health and Life Insurance Co.Denver Health and Hospital Authority Denver Health Medical Plan, Inc.Friday Health Plans Colorado Choice Health PlansKaiser Permanente Kaiser Foundation Health Plan of ColoradoRocky Mountain Health Maintenance

Organization, Inc.Rocky Mountain Health Maintenance Organization, Inc.

Connecticut Anthem, Inc. Anthem Blue Cross Blue ShieldEmblemHealth, Inc. ConnectiCare Benefi ts, Inc.

Delaware Highmark, Inc. Highmark BCBSD, Inc.

District of Columbia CareFirst, Inc. CareFirst

Kaiser Permanente Kaiser

Florida Centene Corporation Celtic Insurance Company

GuideWell Mutual Holding CorporationBlue Cross and Blue Shield of Florida, Florida Health

Care Plan, Inc., Health Options, Inc.Health First, Inc. Health First Commercial Plans, Inc.Molina Healthcare, Inc. Molina Healthcare of Florida, Inc

Georgia Anthem, Inc. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.Centene Corporation Ambetter of Peach State, Inc.Health One Alliance, LLC Alliant Health PlansKaiser Permanente Kaiser Foundation Health Plan of Georgia

State Parent Company Name(s) Appearing on Exchange (Including Trade Names and Subsidiaries)

APPENDIX TABLE 2

Health Insurers Participating in Exchanges in 2018 (Page 1 of 6)

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Hawaii Hawaii Medical Service Association Hawaii Medical Service AssociationKaiser Permanente Kaiser Foundation Health Plan, Inc.

Idaho Blue Cross of Idaho Health Service, Inc. Blue Cross of IdahoIntermountain Health Care, Inc. SelectHealth, Inc.Montana Health Cooperative Mountain Health CO-OP Pacifi cSource Health Plans Pacifi cSource

Illinois Carle Foundation Health Alliance Medical Plans, Inc.Centene Corporation Celtic Insurance CompanyCigna Corporation Cigna HealthCare of Illinois, Inc.Health Care Service Corporation Blue Cross and Blue Shield of Illinois

Indiana CareSource Management Group Company CareSource Indiana, Inc.Centene Corporation Celtic Insurance Company

Iowa Medica Holding Company Medica Insurance Company

Kansas Blue Cross and Blue Shield of Kansas, Inc. Blue Cross and Blue Shield of Kansas, Inc.Centene Corporation Sunfl ower State Health Plan, IncMedica Holding Company Medica Insurance Company

Kentucky Anthem, Inc. Anthem Health Plans of KY (Anthem BCBS)CareSource Management Group Company CareSource Kentucky Co.

Louisiana Louisiana Health Service & Indemnity Company

Louisiana Health Service & Indemnity Company, HMO Louisiana, Inc.

Vantage Health Plan, Inc. Vantage Health Plan, Inc.

Maine Harvard Pilgrim Health Care, Inc. Harvard Pilgrim Health Care, Inc.Maine Community Health Options Maine Community Health Options

Maryland CareFirst, Inc. CareFirst BlueCross BlueShieldKaiser Permanente Kaiser Permanente

Massachusetts Baystate Health Health New EnglandBlue Cross Blue Shield of Massachusetts Blue Cross Blue Shield of MassachusettsBMC Health System, Inc. Boston Medical Center HealthNet PlanFallon Community Health Plan Fallon HealthHarvard Pilgrim Health Care, Inc. Harvard Pilgrim Health CarePartners HealthCare System, Inc. Neighborhood Health PlanTufts Associated Health Plans, Inc. Tufts Health Plan

Michigan Blue Cross Blue Shield of Michigan Mutual Insurance Company

Blue Cross Blue Shield of Michigan Mutual Insurance Company, Blue Care Network of Michigan

Caidan Enterprises, Inc. Meridian Health Plan of Michigan, Inc.McLaren Health Care Corporation McLaren Health Plan CommunityMolina Healthcare, Inc. Molina Healthcare of Michigan, Inc.Sparrow Health System Physicians Health Plan Spectrum Health System Priority HealthTotal Health Care, Inc. Total Health Care USA, Inc.


APPENDIX TABLE 2


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Minnesota Aware Integrated, Inc. Blue PlusHealthPartners, Inc. HealthPartnersMedica Holding Company MedicaUCare Minnesota UCare Minnesota

Mississippi Centene Corporation Ambetter of Magnolia, Inc.

Missouri Anthem, Inc. Healthy Alliance Life Co. (Anthem BCBS)Centene Corporation Celtic Insurance CompanyCigna Corporation Cigna Health and Life Insurance Company

Montana Health Care Service Corporation Blue Cross and Blue Shield of MontanaMontana Health Cooperative Montana Health CooperativePacifi cSource Health Plans Pacifi cSource Health Plans

Nebraska Medica Holding Company Medica Insurance Company

Nevada Centene Corporation SilverSummit Healthplan, Inc.UnitedHealth Group, Inc. Health Plan of Nevada, Inc.

New Hampshire Anthem, Inc. Matthew Thornton Hlth Plan (Anthem BCBS)Centene Corporation Celtic Insurance CompanyHarvard Pilgrim Health Care, Inc. Harvard Pilgrim Health Care of NE

New Jersey Horizon Blue Cross Blue Shield of New Jersey

Horizon Healthcare Services, Inc.

Independence Health Group, Inc. AmeriHealth HMO, Inc., AmeriHealth Ins Company of New JerseyMulberry Health, Inc. Oscar Garden State Insurance Corporation

New Mexico CHRISTUS Health CHRISTUS Health PlanHealth Care Service Corporation Blue Cross Blue Shield of New MexicoMolina Healthcare, Inc. Molina Health Care of New Mexico, Inc.New Mexico Health Connections New Mexico Health Connections

New York Anthem, Inc. Empire Blue Cross, Empire BlueCross BlueShieldCapital District Physicians' Health Plan, Inc. Capital District Physicians Health PlanEmblemHealth, Inc. Health Insurance Plan of Greater New YorkHealthfi rst PHSP, Inc. Healthfi rst New YorkHealthNow Systems, Inc. BlueShield of Northeastern New York, BlueCross BlueShield of Western New YorkIndependent Health Association, Inc. Independent HealthLifetime Healthcare, Inc. Excellus Blue Cross Blue Shield, Univera HealthcareMulberry Health, Inc. Oscar Insurance MVP Health Care, Inc. MVP Health PlanNew York City Health and

Hospitals CorporationMetroPlus Health Plan

New York State Catholic Health Plan, Inc. Fidelis CareUnitedHealth Group, Inc. United Healthcare

North Carolina Blue Cross and Blue Shield of North Carolina

Blue Cross and Blue Shield of NC

Cigna Corporation Cigna HealthCare of North Carolina, Inc.

North Dakota Noridian Mutual Insurance Company Blue Cross Blue Shield of North DakotaSanford Health Sanford Health Plan


APPENDIX TABLE 2


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Ohio Aultman Health Foundation AultCare Insurance CompanyCareSource Management Group Company CareSourceCentene Corporation Buckeye Community Health PlanMedical Mutual of Ohio Medical Health Insuring Corp. of OhioMolina Healthcare, Inc. Molina Healthcare of Ohio, Inc.Mulberry Health, Inc. Oscar Insurance Corporation of OhioProMedica Health System, Inc. Paramount Insurance CompanySumma Health System Summa Insurance Company, Inc.

Oklahoma Health Care Service Corporation Blue Cross Blue Shield of Oklahoma

Oregon Cambia Health Solutions, Inc. BridgeSpan Health CompanyKaiser Permanente Kaiser Foundation Healthplan of the NWModa Health Moda Health Plan, Inc.Pacifi cSource Health Plans Pacifi cSource Health PlansProvidence Health & Services Providence Health Plan

Pennsylvania Capital BlueCross Capital Advantage Assurance Company, Keystone Health Plan East, IncGeisinger Health System Foundation Geisinger Health Plan

Highmark, Inc.Highmark Health Insurance Company, Highmark Choice

Company, Highmark, Inc., First Priority HealthIndependence Health Group, Inc. Independence Blue Cross (QCC Ins. Co.)University of Pittsburgh Medical Center UPMC Health Options, Inc.

Rhode Island Blue Cross & Blue Shield of Rhode Island Blue Cross & Blue Shield of Rhode IslandNeighborhood Health Plan

of Rhode Island, Inc.Neighborhood Health Plan of Rhode Island

South Carolina BlueCross BlueShield of South Carolina Blue Cross and Blue Shield of South Carolina

South Dakota Avera Health Avera Health Plans, Inc.Sanford Health Sanford Health Plan

Tennessee Blue Cross Blue Shield of Tennessee BlueCross BlueShield of TennesseeCigna Corporation Cigna Health and Life Insurance CompanyMulberry Health, Inc. Oscar Insurance Company of Texas

Texas Centene Corporation Celtic Insurance CompanyCHRISTUS Health CHRISTUS Health PlanCommunity Health Choice, Inc. Community Health Choice, Inc.Health Care Service Corporation Blue Cross Blue Shield of TexasMolina Healthcare, Inc. Molina Healthcare of Texas, Inc.Mulberry Health, Inc. Oscar Insurance Company of TexasSendero Health Plans, Inc. Sendero Health Plans, Inc. SHA, LLC SHA, LLC DBA FirstCare Health Plans

Utah Intermountain Health Care, Inc. SelectHealthUniversity of Utah University of Utah Health Insurance Plans

Vermont Blue Cross Blue Shield of Vermont BlueCross BlueShield of VermontMVP Health Care, Inc. MVP Health Care


APPENDIX TABLE 2


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Virginia Anthem, Inc. HealthKeepers, Inc.CareFirst, Inc. CareFirst BlueChoice, Inc., Group Hospitalization and Medical Services, Inc.Centra Health Piedmont Community HealthCare HMO, Inc.Cigna Corporation Cigna Health and Life Insurance CompanyKaiser Permanente Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.Sentara Healthcare, Inc. Optima Health Plan

Washington Cambia Health Solutions, Inc. BridgeSpan Health CompanyCentene Corporation Coordinated Care

Kaiser PermanenteKaiser Foundation Health Plan of the Northwest, Kaiser

Foundation Health Plan of WashingtonMolina Healthcare, Inc. Molina Healthcare of Washington, Inc.Premera Premera Blue Cross, LifeWise Health Plan of Washington

West Virginia CareSource Management Group Company CareSource West Virginia Co.Highmark, Inc. Highmark Blue Cross Blue Shield West Virginia

Wisconsin Aspirus, Inc. Aspirus Arise Health Plan of Wisconsin, Inc.Children's Hospital and Health System Children's Community Health PlanCommon Ground Healthcare Cooperative Common Ground Healthcare CooperativeGroup Health Cooperative of

South Central WisconsinGroup Health Cooperative of South Central Wisconsin

HealthPartners, Inc. HealthPartners Insurance CompanyInterstate Alliance, Inc. MercyCare HMO, Inc.Marshfi eld Clinic Health System, Inc. Security Health Plan of Wisconsin, Inc.Medica Holding Company Medica Health Plans of WisconsinNetwork Health, Inc. Network Health PlanSSM Health Care Corporation Dean Health PlanUniversity Health Care, Inc. Unity Health Plans Insurance Corporation

Wyoming Blue Cross Blue Shield of Wyoming Blue Cross Blue Shield of Wyoming

Virginia Aetna, Inc. Aetna Health, Inc. (a PA corp.), Innovation Health Insurance CompanyAnthem, Inc. HealthKeepers, Inc.CareFirst, Inc. CareFirst BlueChoice, Inc., Group Hospitalization and Medical Services, Inc.

Centra HealthPiedmont Community HealthCare HMO, Inc.,

Piedmont Community HealthCare, Inc.Kaiser Permanente Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.Sentara Healthcare, Inc. Optima Health PlanUnitedHealth Group, Inc. UnitedHealthcare of the Mid-Atlantic, Inc.Cigna Corporation Cigna Health and Life Insurance Company

Washington Cambia Health Solutions, Inc. BridgeSpan Health Company, Regence BlueShieldCentene Corporation Coordinated Care CorporationCommunity Health Network

of WashingtonCommunity Health Plan of Washington

Group Health Cooperative Group Health CooperativeKaiser Permanente Kaiser Foundation Health Plan of the NorthwestMolina Healthcare, Inc. Molina Healthcare of WashingtonPremera Premera Blue Cross, Lifewise Health Plan of Washington

West Virginia CareSource Management Group Company CareSource West Virginia Co.Highmark, Inc. Highmark Blue Cross Blue Shield West Virginia


APPENDIX TABLE 2


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Wisconsin Anthem, Inc. Compcare Health Serv Ins Co (Anthem BCBS)Children's Hospital and Health System Children's Community Health PlanCommon Ground Healthcare Cooperative Common Ground Healthcare CooperativeGroup Health Cooperative of

South Central WisconsinGroup Health Cooperative of South Central Wisconsin

Interstate Alliance, Inc. MercyCare HMO, Inc.Marshfi eld Clinic Health System, Inc. Security Health Plan of Wisconsin, Inc.Mayo Holding Company Health Tradition Health PlanMedica Holding Company Medica Health Plans of WisconsinMolina Healthcare, Inc. Molina Healthcare of Wisconsin, Inc.Network Health, Inc. Network Health PlanSSM Health Care Corporation Dean Health PlanUniversity Health Care, Inc. Unity Health Plans Insurance Corporation, Gundersen Health SystemAspirus, Inc. Aspirus Arise Health Plan of Wisconsin, Inc.HealthPartners, Inc. HealthPartners Insurance Company

Wyoming Blue Cross Blue Shield of Wyoming Blue Cross Blue Shield of Wyoming


APPENDIX TABLE 2


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NOTE: All fi gures are at the parent company level (i.e., data for all subsidiaries of a company are aggregated under the parent company).SOURCES: Data for the states using the federal exchange platform are from HealthCare.gov (data.healthcare.gov). Data for the states and District of Columbia with a state-based exchange are from either the state’s insurance department or state’s exchange.

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