Four out of five metropolitan areas in the United States lack a competitive commercial health insurance market, according to analysis from the American Medical Association.

“New data presented by the AMA demonstrates the degree of anti-competitive market clout that some health insurers have gained through mergers and acquisitions,” AMA President Peter Carmel said in a news release.

There are several markets where mergers among health insurers may cause “competitive harm to patients, physicians and employers,” Carmel said. The state with the least competitive commercial health insurance market is Alabama, followed by Alaska, Delaware, Michigan and Hawaii.

According to the AMA, a significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the group. These markets rated “highly concentrated,” based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission. And in about half of metropolitan markets, at least one health insurer had a commercial market share of 50 percent or more, the group said.

Researchers used 2009 enrollment data from health maintenance organizations and preferred provider organizations from 368 metropolitan markets in 48 states. In 24 states, the two largest health insurers had a combined market share of more than 70 percent.

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Health insurance competition is lacking

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