The GAO is an arm of Congress that helps lawmakers oversee government programs and spending. A GAO team looked at what happened to the number of insurers operating in states' small-group and large-group markets between 2011 and 2022.
The number of issuers serving large groups in the average state fell to eight in 2022, from 12 in 2011, GAO analysts found.
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The number of states where one issuer hogged at least 80% of the large-group enrollment climbed to 12, from six.
The situation was even worse in the small-group market. There, the average number of issuers serving each state dropped to six, from 13, and the number with just one issuer handling more than 80% of small-group enrollment climbed to 15, from three.
"Highly concentrated insurance markets may indicate less competition, which may affect consumers' choices of issuers and the premiums they pay for insurance," John Dicken, a GAO director, wrote in a summary of the health insurance market competition analysis.
The details: The drafters of the Patient Protection and Affordable Care Act of 2010, one of the two laws in the Affordable Care Act package, predicted that PPACA provisions would increase competition in the private health insurance market.
The GAO team analyzed health insurance market competition because a PPACA provision requires the GAO to send Congress reports on the level of competition in the individual, small-group and large-group markets every two years.
Related: Concentration of insurance carriers a growing concern for many states
The GAO team based the analysis on the reports health insurers send to the Centers for Medicare and Medicaid Services to comply with the PPACA minimum medical loss ration provision. The provision requires insurers to spend at least 80% of individual and small-group revenue and 85% of large-group revenue on health care and care quality improvement efforts.
When the GAO team was counting issuers, it treated separate insurance companies that were owned by the same parent company as being part of one company.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
