CHICAGO — Half of all states had commercial health insurance markets that were less competitive in 2017 than during the previous year, based on data from a newly updated study of competition in the U.S. health insurance industry issued by the American Medical Association (AMA).

“The AMA continues to urge that competition, not consolidation, is the right prescription for health insurance markets,” said AMA President Barbara L. McAneny, M.D. “The slide toward insurance monopolies has created a market imbalance that disadvantages patients and favors powerful health insurers. The prospect of future mergers involving health insurance companies should raise serious antitrust concerns. There is already too little competition among insurers, to the detriment of patients. Networks are already too narrow, and premiums are already too high.”

According to the 2018 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, “the majority of health insurance markets in the United States are highly concentrated. Coupled with evidence on their anticompetitive behavior, this strongly suggests that health insurers are exercising market power in many parts of the country and, in turn, causing competitive harm to consumers and providers of care.”

The AMA study is intended to help policymakers and regulators identify markets where mergers may harm patients and the physicians who care for them. The study also helps identify health insurance markets where antitrust enforcers should monitor for post-merger effects.

Competition in Health Insurance: A Comprehensive Study of U.S. Markets offers the largest and most complete picture of competition in health insurance markets for 50 states and the District of Columbia, as well as 380 metropolitan statistical areas (MSAs). The study is based on 2017 data captured from commercial enrollment in fully and self-insured health maintenance organizations (HMO), preferred provider organizations (PPO) and point-of-service (POS) plans, consumer-driven health plans (CDHP) and public health exchanges.

The AMA’s latest snapshot of competition in the health insurance industry shows:

• The 10 states that experienced the largest decrease in competition levels between 2016 and 2017 were: 1. North Dakota, 2. Alaska, 3. Louisiana, 4. Indiana, 5. Utah, 6. North Carolina, 7. Arkansas, 8. Hawaii, 9. Alabama and 10. Mississippi.

• The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Hawaii, 3. Louisiana, 4. Delaware, 5. South Carolina, 6. Michigan, 7. Alaska, 8. Kentucky, 9. Vermont, and 10. North Carolina. See the 10 states with the least competitive HMO, PPO or POS markets.
• Anthem was the largest insurer in more MSA-level markets than any other insurer. It had the highest market share in 75 MSAs. Health Care Service Corp. was second with a market share lead in 40 MSAs, followed by UnitedHealth Group with a market share lead in 27 MSAs.

Competition in Health Insurance: A Comprehensive Study of U.S. Markets is a vital element to AMA’s continued antitrust advocacy to protect patients and physicians from anti-competitive harm. Health insurance market concentration will continue to be a vital issue of public policy for the AMA, the federation of medicine, and the nation’s physicians and patients. The 2018 updated study is available for download from the AMA’s Competition in Health Insurance Research website.