Identifies states with the least competitive health insurance markets
"The broad scope of the new AMA analysis provides the most complete picture of the consolidation trend in health insurance markets," said AMA President Jeremy A. Lazarus, M.D. "The new data demonstrate that most areas of the country have a single health insurer with an anticompetitive share of the HMO, PPO or POS market."
The 2012 edition of AMA's Competition in Health Insurance: A Comprehensive Study of U.S. Markets is the largest analysis of its kind, reporting commercial health insurance market shares and market concentration levels for 385 metropolitan areas in all 50 states and the District of Columbia.
The AMA's latest findings regarding competition in the health insurance industry include:
- A significant absence of health insurer competition is present in 70 percent of the metropolitan areas studied by the AMA. These markets are rated "highly concentrated," based on the 2010 Horizontal Merger Guidelines issued by the U.S. Department of Justice and Federal Trade Commission.
- In 67 percent of the metropolitan areas studied by the AMA, at least one health insurer had an HMO market share of 50 percent or greater.
- In 68 percent of the metropolitan areas studied by the AMA, at least one health insurer had a PPO market share of 50 percent or greater.
- In 68 percent of the metropolitan areas studied by the AMA, at least one health insurer had a POS market share of 50 percent or greater.
- The top 10 states with the least competitive commercial health insurance markets are: 1. Alabama, 2. Hawaii, 3. Michigan, 4. Delaware 5. Alaska, 6. North Dakota, 7. South Carolina, 8. Rhode Island, 9. Wyoming and 10. Nebraska.
- The top 10 states with the least competitive HMO markets are: 1. Rhode Island, 2. Alabama, 3. Arkansas, 4. Wyoming 5. Utah, 6. Nebraska, 7. Idaho, 8. Nevada, 9. North Dakota and 10. Washington.
- The top 10 states with the least competitive PPO markets are: 1. Alabama, 2. Michigan, 3. Hawaii, 4. South Carolina, 5. Delaware, 6. Indiana, 7. Iowa, 8. North Carolina, 9. Nebraska and 10. Rhode Island.
- The top 10 states with the least competitive POS markets are: 1. North Dakota, 2. Rhode Island, 3. Oklahoma, 4. Alabama, 5. Wisconsin, 6. Tennessee, 7. New Mexico, 8. Vermont, 9. Mississippi and 10. Ohio.
"It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power," the study notes, pointing to increased premiums, watered-down benefits and insurers' growing profitability as evidence that highly concentrated markets harm patients and physicians.
The AMA's Competition in Health Insurance: A Comprehensive Study of U.S. Markets is free to members. Non-members can purchase the study for $150. To order the study, please visit the AMA Bookstore online, or call (800) 621-8335 and mention item number OP427112.
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