Small nonprofits offering insurance plans on California's health care exchange are lagging well behind major insurers in sign-ups.
That has the potential to undermine a key goal of the federal Affordable Care Act, which sought to drive down costs by increasing competition.
Nonprofits accounted for less than 5 percent of the 880,000 enrollments on the state's health insurance exchange by the end of February, the most recent figures made available that break down enrollment by insurer. Since then, sign-ups have topped 1.2 million.
Four large national insurers dominate the market: Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net.
With open enrollment nearly over in the state, the small insurers are looking beyond the sign-up figures to determine whether the exchanges will be financially viable for them.