69% of metro areas have 'significant' absence of health insurer competition, AMA finds

One health insurer held at least half of the market share in 169 of 389 metropolitan areas, according to an American Medical Association study.

AMA's study, titled "Competition in Health Insurance: A Comprehensive Study of U.S. Markets," comprises commercial enrollment data from 2016 in the fully and self-insured markets as well as the public health exchange. In roughly two years, the percentage of markets with one insurer dominating at least a 50 percent share of the market grew 8 percent.

Competition among payers declines when insurers sport high market concentration. This can lead to premiums rising above competitive levels, the AMA said. For 69 percent of metropolitan areas, a significant absence of payer competition was present.

Of major commercial payers, Indianapolis-based Anthem held the largest geographic footprint in the U.S., representing the insurer with the highest market share in 82 of 389 metropolitan areas. Chicago-based Health Care Service Corp. was second, and Minnetonka, Minn.-based UnitedHealth Group was third. 

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