AMA: 10 states with the strongest insurance monopolies

Annual report finds 72% of markets lack competition

The United States' health insurance market may include a wide variety of insurer choices, but that does not always equate to local competition, according to a new American Medical Association (AMA) report

The annual "Competition in Health Insurance: A Comprehensive Study of U.S. Markets" identifies markets where health insurance mergers and acquisitions may harm competition for patients, physicians, and employers. Researchers examined 2012 data captured from commercial enrollment in fully and self-insured plans, as well as consumer-driven health plans. The data came from 388 metropolitan areas, 50 states, and the District of Columbia.

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The AMA report found that:

  • 72% of metropolitan areas have an "absence of health insurer competition;"
  • 17 states have a single insurer dominating at least 50% of commercial market shares; and
  • 45 states have two insurers that account for at least 50% of commercial market share.

WellPoint had the largest footprint and a commanding presence in about 82 of the metropolitan areas studied. Health Care Service followed with a lead in 37 metropolitan areas, followed by UnitedHealth Group which led 35 metro areas.

The 10 least competitive markets are:

    1. Alabama—Blue Cross Blue Shield (BCBS) of Alabama (84%) and United Healthcare (7%)
    2. Hawaii—Hawaii Medical Services Association/BCBS (65%) and Kaiser Permanente (21%)
    3. Michigan—BCBS of Michigan accounts for (67%) and Spectrum Health (9%)
    4. Delaware—BCBS of Delaware accounts for (62%) and Aetna (20%)
    5. Louisiana—Louisiana Health Services and Indemnity  (62%) and United Healthcare (16%)
    6. South Carolina—BCBS of South Carolina (61%) and United Healthcare (16%)
    7. Alaska—Premera Blue Cross (59%) and Aetna (22%)
    8. Illinois—Health Care Service (61%) and United Healthcare (14%)
    9. Nebraska—BCBS of Nebraska (56%) and United Healthcare (21%)
    10. North Dakota—BCBS of North Dakota (55%) and Aetna (24%)

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Meanwhile, the most competitive markets were in Wisconsin, Pennsylvania, and Oregon (Barnet, Becker's Hospital Review, 10/10; Kaltwasser, Physician's Money Digest, 10/10; AMA release, 10/9).

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