GAO report finds concentration of insurers, lack of competition in most state markets

December 8, 2014

In at least 37 states, the three largest insures account for 80% of total health plan enrollment, according to a new study by the U.S. Government Accountability Office (GAO).

In at least 37 states, the three largest insures account for 80% of total health plan enrollment, according to a new study by the U.S. Government Accountability Office (GAO).

In ten states, a single insurer had more than half of all enrollees, and in five states, one insurer had at least 90% of either the individual, small group or large group enrollee segment, according to the report.

A highly concentrated market, where a small number of insurers enroll a significant portion of the population, can lead to lack of competition that could affect consumers’ choice of health plans and premiums.

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

GAO analyzed enrollment data from 2010 to 2013 that was reported to the National Association of Insurance Commissioners (NAIC) and the Centers for Medicare and Medicaid Services (CMS). The agency provided the report to the U.S. Health and Human Services Department (HHS), but didn’t make any recommendations or comments.

The report also found that insurers’ concentration in the three market segments – individual, small group and large group – remained relatively unchanged form 2010 to 2013. On average, twice as many insurers participated in the individual segment than in the small group or large group. 

In 12 states where there was less market dominance, there was an average 30 insurers in the individual market, 16 in the small group market, and 17 in the large group market. In nearly all of these states’ market segments, the largest insurer had less than half of the total enrollment, according to GAO.