AMA study finds significant lack of health insurer competition in 72% of metropolitan areas

October 14, 2014

The lack of competition for health insurance in U.S. metropolitan markets is a cause for concern for the American Medical Association (AMA).

Courtesy of the AMAA NEW ANNUAL STUDY by the American Medical Association (AMA) has found that 72% of U.S. metropolitan areas studied lack significant competition for health insurance, and most were highly concentrated.

The study - Competition in Health Insurance: A Comprehensive Study of U.S. Markets - looked for evidence of highly concentrated areas because they can lead to insurers exercising "market power" including controlling price.

The study found that 17 states have a single health insurer with a commercial market share of 50% or more, and 45 states have two health insurers with a combined commercial market share of 50% or more.

In 90% percent of metropolitan areas, just one insurer holds at least a 30% share of the commercial health insurance market.

WellPoint Inc., soon to be renamed Anthem, is the largest private health insurer by market share in more than one in five metropolitan areas in the U.S., according to study results.

READ: What's in a name: For WellPoint, Everything.

What's in a name? For WellPoint, everything.

It is the largest health insurer by market share in 82 of 388 metropolitan areas examined by the AMA, and holds a share that is more than double its next competitors.

HEALTH CARE SERVICE CORP. has a market share lead in 37 metropolitan areas, giving it the number two ranking, while UNITEDHEALTH GROUP holds the third position with a market share lead in 35 metropolitan areas.

“The AMA is greatly concerned that in 41 percent of metropolitan areas, a single health insurer had at least a 50 percent share of the commercial health insurance market,” said AMA President Robert M. Wah, M.D.

“The dominant market power of big health insurers increases the risk of anti-competitive behavior that harms patients and physicians, and presents a significant barrier to the market success of smaller insurance rivals.”

The AMA survey stems from data captured in 2012 from commercial enrollment in fully and self-insured plans in 388 metropolitan, all 50 states, and the District of Columbia, according to the association. Data are based on commercial enrollment in HMO, PPO, and POS fully and self-insured plans, and include consumer-driven plans.

According to the study, the 10 states with the least competitive commercial health insurance markets are:

1. Alabama
2. Hawaii
3. Michigan
4. Delaware
5. Louisiana
6. South Carolina
7. Alaska
8. Illinois
9. Nebraska and
10. North Dakota.

The 10 states that experienced the biggest drop in competition levels between 2011 and 2012 were:

1. Illinois
2. Louisiana
3. Indiana
4. New Jersey
5. New Hampshire
6. Vermont
7. Montana
8. Wyoming
9. Idaho and
10. Tennessee.

 

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