AMA Study Finds WellPoint to be the Largest Health Insurer in Many Local Markets



Oct. 9, 2014

CHICAGO - WellPoint Inc. (WLP) has a bigger geographic footprint than any other private health insurer in the United States, according to the new annual study of health insurer competition by the American Medical Association (AMA). The study found that WellPoint, soon to be renamed Anthem Inc., was the largest health insurer by market share in 82 of 388 metropolitan areas examined by the AMA.

WellPoint's commanding position in more than one in five metropolitan areas gave it a market share advantage in more than double the number of metropolitan areas as the next two insurers. Health Care Service Corp. was second with a market share lead in 37 metropolitan areas, followed by UnitedHealth Group (UNH) with a market share lead in 35 metropolitan areas.

"The AMA is greatly concerned that in 41 percent of metropolitan areas, a single health insurer had at least a 50 percent share of the commercial health insurance market," said AMA President Robert M. Wah, M.D. "The dominant market power of big health insurers increases the risk of anti-competitive behavior that harms patients and physicians, and presents a significant barrier to the market success of smaller insurance rivals."

The findings come from the newest edition of AMA's Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which offers the largest and most complete picture of competition in health insurance markets for 388 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2012 data captured from commercial enrollment in fully and self-insured plans, and includes participation in consumer-driven health plans.

The AMA's latest findings regarding competition in the health insurance industry include:

  • A significant absence of health insurer competition was found in 72 percent of the metropolitan areas studied. These markets are rated "highly concentrated," based on the guidelines used by the U.S. Department of Justice and Federal Trade Commission to assess the degree of competition in a given market.
  • Seventeen states had a single health insurer with a commercial market share of 50 percent or more.
  • Forty-five states had two health insurers with a combined commercial market share of 50 percent or more.
  • The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Hawaii, 3. Michigan, 4. Delaware, 5. Louisiana, 6. South Carolina, 7. Alaska, 8. Illinois, 9. Nebraska and 10. North Dakota. Illinois has made its first appearance in the annual AMA list, displacing Rhode Island from last year's list. Louisiana entered the top 5, moving from 9th on last year's list. See the 10 states with the least competitive HMO, PPO or POS markets.
  • The 10 states that experienced the biggest drop in competition levels between 2011 and 2012 were: 1. Illinois, 2. Louisiana, 3. Indiana, 4. New Jersey, 5. New Hampshire, 6. Vermont, 7. Montana, 8. Wyoming, 9. Idaho and 10. Tennessee.

The new AMA report is intended to help researchers, lawmakers, policymakers and regulators identify markets where mergers and acquisitions among health insurers may cause competitive harm to patients, physicians and employers.

Competition in Health Insurance: A Comprehensive Study of U.S. Markets is free to AMA members. The study is also available to non-members. To order a copy, visit the online AMA StoreExternal Link, or call (800) 621-8335 and mention item number OP427113.

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