In my travels I often hear the concerns and successes physicians and patients across the country face every day. Perhaps one of the most concerning challenges in today’s health care environment is health insurance competition.
The newest edition of the AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which provides a picture of competition in 388 metropolitan areas, all 50 states and Washington, D.C., gives us a measure of just how concerned we should be.
In 17 states, and in 41 percent of metropolitan areas, a single health insurer had more than one-half of the commercial market. In 45 states, only two health insurers had a combined commercial market share of one-half or more. In nearly three-quarters of the metropolitan areas studied, there is a significant absence of health insurer competition.
WellPoint Inc. had the largest market share in 82 of the metropolitan areas studied, Health Care Services Corp. dominated 37 areas and UnitedHealth Group led 35 metropolitan areas.
Market power of big health insurers increases the risk of anti-competitive behavior. That means higher prices for patients and more pressure on physicians, and it presents a significant barrier to the market success and innovation of of smaller insurance rivals.
The point of the study isn’t merely to raise alarm. It’s a way to inform researchers, policymakers and regulators about where mergers and acquisitions among health insurers could harm patients and physicians. The AMA regularly keeps these groups in the loop about the state of health insurance competition to help them make wise decisions to make sure America’s patients have the access to care they need.
AMA members can access the study for free through the AMA Store. It’s also available for purchase to nonmembers. If you’re not a member, join today.
