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  • AMA Issues Top 10 Least, Most Competitive States for Insurance

    The American Medical Association's (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.

    The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.

    The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.

    The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.

    Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.

    Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.

    "The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."

    Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.


    • So wonder what the insurers argument for 50 dollar copays with 65 total reimbursement, topped off with a 2000 deductible and a 20 visit limit. Does not sound much like cost sharing to me.

      Posted by dano napoli on 10/17/2014 3:21 PM

    • The CEO of Wellpoint received $17 million in compensation for 2013, Health Care Services Corp CEO had a salary of 1.1 million but received a $14.9 million bonus in 2012 and UHC CEO: $12 million with Aetna at $30 million. (http://www.healthcare-now.org/health-insurance-ceo-pay-skyrockets-in-2013) These are figures from 2012 and 2013. So if the goal is cost sharing someone didn't get the memo...

      Posted by Marsha Lawrence on 10/21/2014 11:21 AM

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