Largest Health Insurers Hold Onto Enrollment In Majority Of States


The three largest insurers in at least 30 states held at least 80 percent of the total enrollment in those states for the individual, small group, and large group health insurance markets in each year from 2010 through 2013, according to a recent report from the General Accounting Office (GAO). In accordance with requirements of the Patient Protection and Affordable Care Act (ACA), the GAO studied competition and market concentration in the health insurance market, and it discovered that, in addition to holding at least half of the enrollment in most states from 2010 through 2013, the largest insurers in each state generally remained the top insurers.

Enrollment concentrated among large insurers. In each of the three market segments, the three largest insurers had at least 80 percent of the total enrollment in at least 37 states in 2013. In more than half of those 37 states, a single insurer had more than half of the total enrollees and in 5 of those states there was at least one market segment in which the largest insurer had at least 90 percent of all enrollees. As an example, the GAO says that in Alabama’s small group market, the largest insurer, which was Blue Cross and Blue Shield of Alabama, had 97 percent of the state’s total enrollment.

More insurers participated and the market segments were less concentrated in 12 states’ individual markets, 14 states’ small group markets, and 11 states’ large group markets, and enrollment was spread out among more insurers.

In its report, the GAO points out that the ACA has a number of provisions that could affect market concentration and competition, such as the establishment of the Consumer Operated and Oriented Plan (CO-OP) program and rating rules limiting variance of insurance premiums. The report is the result of an analysis of 2010 data reported by insurance companies to the National Association of Insurance Commissioners (NAIC) and 2011 through 2013 data required to be reported by insurers annually to the Centers for Medicare and Medicaid Services (CMS).

Heavy presence for Blue Cross and Blue Shield. The GAO also reports that, on average in each state, about twice as many insurers participated in the individual market (24) as the small group (12) and large group (11) markets. Blue Cross and Blue Shield was the largest insurer in most states in each market segment, from 2010 through 2013. More specifically, across that time period, a Blue Cross and Blue Shield insurer was consistently the largest insurer in 44 states for the individual market, 38 states for the small group market, and 40 states for the large group market.

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