The analysis — which the AMA cited in its opposition to proposed mergers between Anthem-Cigna and Aetna-Humana — found 14 states had a single health insurer with at least 50 percent share of the commercial health insurance market, while 46 states had two insurers with at least 50 percent share of the commercial market.
Here are the states, listed in order of least competitive, with little competition among commercial health insurers. The AMA based rankings on market concentration levels as determined by the Herfindahl–Hirschman Index, a measure used by the U.S. Department of Justice and the Federal Trade Commission.
10 states with least competitive commercial health insurance markets
Commercial insurance refers to the combined HMO, PPO and POS markets
1. Alabama
2. Hawaii
3. Michigan
4. Delaware
5. Alaska
6. South Carolina
7. Louisiana
8. Nebraska
9. Illinois
10. North Dakota
10 states with least competitive HMO markets
1. Alabama
2. Vermont
3. South Carolina
4. Utah
5. Louisiana
6. Nebraska
7. North Dakota
8. Nevada
9. Idaho
10. Colorado
10 states with least competitive PPO markets
1. Alabama
2. South Carolina
3. Michigan
4. Iowa
5. Louisiana
6. North Carolina
7. Delaware
8. Nebraska
9. Tennessee
10. Hawaii
10 states with least competitive POS markets
1. Rhode Island
2. Oklahoma
3. Nebraska
4. Montana
5. New Mexico
6. Iowa
7. Alabama
8. Alaska
9. Mississippi
10. Arizona
10 states with largest drop in competition levels
Reflects biggest decrease in competition among commercial insurers between 2010-2013
1. Louisiana
2. Idaho
3. New Jersey
4. Missouri
5. Montana
6. Illinois
7. Texas
8. West Virginia
9. Iowa
10. Ohio
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