According to the AMA report, large health insurance companies control the market in nearly three-quarters of the US.

In 2020, nearly three-quarters of US metropolitan areas lacked a competitive health insurance market, and payer opportunities were dwindling, damaging patients and health care providers. The American Medical Association concluded in a study released Tuesday.

73% of the 384 metropolitan statistical markets were heavily concentrated in 2020, up from 71% in 2014, the physician community reported in its 20th annual survey of health insurance markets. In many cases, competition has decreased in areas where only a few health insurance companies dominate. The report says that 54% of markets that were identified as highly concentrated in 2014 have become even less competitive by 2020, and another 26% of markets have also reached highly concentrated levels.

The study found that pooling insurers leads to lower payments to doctors and an increase in insurance premiums. The AHIP Health Insurance Lobbying Group did not respond to an interview request regarding the AMA’s findings.

President Joe Biden has pledged that federal regulators will take a more critical stance on corporate mergers, including between medical companies, than previous administrations.

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“As rumors of a merger involving insurance companies circulate, the prospects for future consolidation in the health insurance industry need to be scrutinized more closely, given the low level of competition in most health insurance markets,” AMA President Dr. Gerald Harmon said in a statement.

One insurance company held at least half of the market share in 46% of metropolitan areas, up from 40% in 2014, according to the AMA. Fourteen states had one health insurance company that controlled at least half of their markets. According to the study, the least competitive market was in Alabama, followed by Michigan and Louisiana. Wisconsin, Oregon and New York had the most competitive markets.

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