Almost three-fourths of U.S. metropolitan areas lacked a competitive health insurance market in 2020, with shrinking options among payers harming patients and providers, the American Medical Association concluded in a study published Tuesday.
Seventy-three percent of 384 metropolitan statistical markets were highly concentrated in 2020, up from 71% in 2014, the physicians' society reported in its 20th annual study of health insurance markets. In many cases, competition declined in areas dominated by just a few health insurers. Fifty-four percent of markets that were designated as highly concentrated in 2014 became even less competitive by 2020, and another 26% markets also reached highly concentrated levels, the report says.
Consolidation among insurers leads to lower payments for doctors and higher premiums for policyholders, research has shown. The health insurance lobbying group AHIP did not respond to an interview request about the AMA's findings.
President Joe Biden has pledged that federal regulators will take a more critical stance toward corporate mergers, including between healthcare companies, than did prior administrations.
"As merger rumors involving health insurers swirl, the prospect of future consolidation in the health insurance industry should be more closely scrutinized given the low levels of competition in most health insurance markets," AMA President Dr. Gerald Harmon said in a statement.
A single insurance company held at least half the market share in 46% of metropolitan areas, up from 40% in 2014, the AMA reports. Fourteen states had one health insurer that controlled at least half of their markets. Alabama had the least competitive market, followed by Michigan and Louisiana, according to the study. Wisconsin, Oregon and New York had the most competitive markets.