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Ensuring Health Insurance Competition

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Because there is a lack of competition in most health insurance markets, the AMA has, for many years, opposed anticompetitive health insurer mergers.

The AMA’s merger advocacy achieved two significant victories, when a federal judge on Jan. 23 issued a ruling blocking the proposed Aetna-Humana merger, and another federal judge on Feb. 8 blocked the proposed Anthem-Cigna merger.

The AMA expressed its concerns about both the Aetna-Humana and Anthem-Cigna mergers to Congress in testimony shortly after the mergers were announced. The AMA actively opposed both mergers before the U.S. Department of Justice (DOJ), and, with the help of its 17-state medical association antitrust coalition partners, urged state regulators to block the mergers.

Efforts to Block Mergers

Efforts to block the Aetna-Humana and Anthem-Cigna mergers include:

  • Utilizing our updated gold standard Competition in Health Insurance: A Comprehensive Study of U.S. Markets
  • Preparing detailed state-specific market analysis of both the Anthem-Cigna (PDF) and Aetna-Humana (PDF) mergers
  • Sending comprehensive, evidence-based advocacy letters to the DOJ and state regulators after the merger was announced in July 2015
  • Leading the 17-state medical society coalition and engaging likeminded stakeholders like the American Hospital Association and various patient coalitions
  • Engaging the National Association of Attorneys General (AG) in an effort to convince key state AGs to join the DOJ in blocking the mergers
  • Conducting extensive physician surveys to gauge impact on patient care (in conjunction with the AMA’s state medical association partners)
  • Marshalling leading nationally-recognized economists and legal experts in support of our arguments. 

Download the complete timeline (PDF) of campaign events.

Promoting Market Competition

The AMA will continue its antitrust advocacy to protect patient and physician interests. As these lawsuits progress, 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.

High insurance market concentration is an important public policy issue because the anticompetitive effects of dominant insurers’ in highly concentrated health insurance markets poses a substantial risk of harm to patients by:

  • Increasing health insurance premiums rather than lowering health care costs
  • Reducing insurers’ incentives to offer broader networks and to respond to patients’ access needs
  • Limiting patient choice
  • Compromising physician-patient advocacy
  • Undermining access and quality due to physician payments below competitive levels, where such payments: (1) can force physicians to spend less time with patients to meet practice expenses; (2) impair physicians’ ability to invest in practice infrastructure that could improve patient care and accelerate transition to new value-based payment and delivery models; and (3) compel physicians to retire early or seek more rewarding opportunities outside of medicine, at a time when there is already a significant shortage of primary care and specialty physicians.

Model Legislation

Efforts to oppose anticompetitive mergers can occur at the state level through the passage of state legislation.

To this end, the AMA has developed 3 models bills that are designed to bring much needed transparency to merger review, protect physicians from retaliation from health insurers and reduce the influence that the health insurance industry has on state insurance regulators.

The AMA strongly encourages state medical associations to consider introducing one or more of these bills in their respective legislative sessions to help protect physicians and patients from anticompetitive health insurance mergers.

Other Resources

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