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GAO-15-101R 1 (2014-12-01)

handle is hein.gao/gaobaailu0001 and id is 1 raw text is: G A O U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 December 1, 2014 Congressional Addressees Private Health Insurance: Concentration of Enrollees among Individual, Small Group, and Large Group Insurers from 2010 through 2013 Millions of Americans obtain health coverage through private health plans, which include private health insurance sold in the individual and group insurance markets.1 Group health plans provided by both large and small employers are the leading source of health coverage in the United States. Specifically, in 2013, 58 percent of Americans under age 65 had health coverage through employer-sponsored group health plans.2 These employers may offer fully insured plans (by purchasing coverage from an insurance company) or self-funded plans (by setting aside funds to pay for employee health care). Most small employers purchase insured plans, while most large employers self-fund. Americans without access to group health insurance coverage, such as those with employers that do not offer health insurance coverage, may choose to purchase it directly from an insurer through the individual market. About 8 percent of Americans under age 65 had coverage through the individual market in 2013. Historically, there have been indications of high levels of concentration in the individual, small group, and large group markets-that is, markets in which a small number of insurers enroll a significant portion of the total number of beneficiaries. In a survey of the small group market, we previously found that the largest insurers increased their share of enrollment between 2002 and 2008, indicating that the small group market likely became more concentrated over time.3 For 2008, we found that the median share of enrollment for the largest insurer in the small group market across the states surveyed was about 47 percent, with a range of about 21 percent in Arizona to about 96 percent in Alabama.4 More recent research has also identified high levels of market concentration. For example, an analysis based on 2010 data found the median share of enrollment held by the largest insurer in each state was 54 percent and 51 percent, respectively, for the individual and small group market segments.5 1Private health insurance includes individual and group coverage-including small and large group health plans. Insurance offered by small employers is known as small group insurance and insurance offered by large employers is known as large group insurance. 2U.S. Census Bureau, Table HI01, Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2013, Current Population Survey, 2014 Annual Social and Economic Supplement, accessed October 6, 2014, http:iwww.census.gov/hhes/www/cpstables/032014/health/hi0l1 .xis. 3GAO, Private Health Insurance: 2008 Survey Results on Number and Market Share of Carriers in the Small Group Health Insurance Market, GAO-09-363R (Washington, D.C.: Feb. 27, 2009). Also see GAO, Private Health Insurance: Number and Market Share of Carriers in the Small Group Health Insurance Market in 2004, GAO-06-155R (Washington, D.C.: Oct. 13, 2005); and GAO, Private Health Insurance: Number and Market Share of Carriers in the Small Group Health Insurance Market, GAO-02-536R (Washington, D.C.: Mar. 25, 2002). 4These figures are based on data from the 39 states that provided us with market share information. See GAO-09=363R. 5Kaiser Initiative on Health Reform and Private Health Insurance, Focus on Health Reform: How Competitive are State Insurance Markets? (Menlo Park, Calif: Kaiser Family Foundation, October 2011). GAO-15-101R Concentration of Enrollees among Private Insurers Page 1

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