AMA: Competition is dwindling for U.S. health insurers

A study conducted by the American Medical Association (AMA) found that within 24 of the 43 reporting states in the study, two large insurance payors had a combined market share of 70 percent or more, and that overall competition in the health insurance industry is decreasing.

"As demonstrated by proposed rate hikes in California and other states, health insurers have not shown greater efficiency and lower healthcare costs," said AMA President J. James Rohack, MD. “Instead, patient premiums, deductibles and co-payments have soared without an increase in benefits in these increasingly consolidated markets."

The number of states reporting a declining health insurance market this year contrasts with last year's findings, with 18 of 42 participating states having two insurers with a combined market share of 70 percent or more, said the Chicago-based association.

The study, which analyzed 43 states and 313 metropolitan markets, reviewed enrollments in private health maintenance organizations and preferred provider organizations.

Findings indicated by the study included:

  • Ninety-nine percent of metropolitan markets are "highly concentrated" (areas of the country where insurer consolidation may have harmful effects on patients, physicians, employers and the economy--up from 94 percent the year before;
  • In 54 percent of metropolitan markets at least one insurer had a market share of 50 percent or greater--which is up from 40 percent last year; and
  • In 92 percent of the metropolitan markets, at least one insurer had a market share of 30 percent or greater, up from 89 percent of metropolitan markets the year before.

Noting in the study that the absence of competition in health insurance markets is not in the best economic interest of patients, the AMA has urged the Department of Justice (DoJ) to consider the following steps:

  • Perform a retrospective study of health insurance mergers similar to that performed by the Federal Trade Commission on hospital mergers;
  • Commission new research to identify causes and consequences of health insurer market power; and
  • Create a system for predicting the effects health insurer mergers will have on consumer and provider markets.

“The near total collapse of competitive and dynamic health insurance markets has not helped patients," said Rohack. 

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