CHICAGO – The American Medical Association (AMA) today released the latest annual edition of Competition in health insurance: an in-depth study of the US markets (PDF) with results demonstrating the rise of highly concentrated markets for health insurance.
The updated study analyzed market concentration and health insurer market shares for 384 metropolitan statistical areas (MSAs), the 50 states, and the District of Columbia. For the first time, the study also presents the national market shares of the 10 largest health insurers in the United States.
“As rumors of mergers involving health insurers swirl around, the prospect of future consolidation in the health insurance industry should be examined more closely given the low levels of competition in most markets in the world. ‘Medicare, ”said AMA President Gerald E. Harmon, MD. identify markets where consolidation involving health insurers can hurt competition for consumers and providers.
WADA’s latest study on competition in commercial health insurance markets shows:
- Seventy-three percent (280) of MSA-level markets were highly concentrated according to federal guidelines.
- Forty-six percent (178) of MSA-level markets had an insurer with a 50% or greater share.
- Between 2014 and 2020, the share of highly concentrated markets increased from 71% to 73%.
- Fifty-four percent of markets that were already highly concentrated in 2014 have become even more so in 2020.
- The health insurers with the highest market share in the most MSA-level markets were: 1. Anthem (80 MSA), 2. Health Care Service Corp. (44 MSA), 3. UnitedHealth Group and Blue Cross Blue Shield of Florida (each with 22 MSA each), and 4. Highmark and Kaiser (each with 20 MSA each).
- The 10 states (PDF) with the least competitive commercial health insurance markets were: 1. Alabama, 2. Michigan, 3. Louisiana, 4. South Carolina, 5. Hawaii, 6. Kentucky, 7. Alaska, 8 Illinois, 9 North Dakota and 10. Oklahoma. See the 10 States with the Least Competitive PPO or Exchange (PDF) (PDF) markets.
- Fourteen states (PDF) had a health insurer with a 50% or more share of the commercial health insurance market.
- The 10 largest health insurers in the United States nationally by market share were: 1. UnitedHealth Group (15%), 2. Anthem (12%), 3. Aetna (11%), 4. Cigna (10 %), 5. Kaiser (7%), 6. Health Care Service Corp. (6%), 7. Michigan Blue Cross Blue Shield (2%), 8. Florida Blue Cross Blue Shield (2%), 9. California Blue Shield (2%) and 10. Centene (2%).
Competition in health insurance: an in-depth study of the US markets is a critical part of AMA’s ongoing antitrust advocacy to protect patients and physicians from competitive harm. The concentration of the medicare market will continue to be a vital public policy issue for WADA, the federation of medicine, as well as for physicians and patients nationwide. The content of the updated 2021 study is available for download on WADA’s website on Competition in Health Insurance Research.