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GAO-25-107194 1 (2024-11-14)

handle is hein.gao/gaoray0001 and id is 1 raw text is: G. AOU.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 November 14, 2024 Congressional Committees Private Health Insurance: Market Concentration Generally Increased from 2011 through 2022 Private health insurance is the most common source of health insurance coverage in the United States-covering approximately two-thirds of the United States population in 2022, according to the United States Census Bureau. The market for private health insurance in the United States historically has been concentrated, meaning a small number of issuers of insurance plans enrolled most of the people in a given market.1 In our 2022 report on health insurance market concentration, we considered a market concentrated in a state if three or fewer issuers held at least 80 percent of the market share of enrollment among consumers.2 We found that each of the three types of health insurance markets were concentrated from 2011 through 2020-the large-group market (coverage offered by large employers), the small-group market (coverage offered by small employers), and the individual market (coverage primarily sold directly to individual consumers who lack access to group coverage).3 Within the individual market, we reported a similar pattern in concentration starting in 2015 for those issuers participating in the individual insurance exchanges-marketplaces operated by either the state or federal government that were required to be established in each state by the Patient Protection and Affordable Care Act (PPACA).4 Highly concentrated insurance markets may 1We use the term issuer when referring to the entities that are licensed by a state to engage in the business of health insurance in that specific state. 2See GAO, Private Health Insurance: Markets Remained Concentrated through 2020, with Increases in the Individual and Small Group Markets, GAO-23-105672 (Washington D.C.: November 7, 2022). 3Federal law defines a small employer as having an average of 1 to 50 employees during the preceding calendar year; however, states may apply this definition based on an average of 1 to 100 employees. See 42 U.S.C. §§ 300gg- 91(e)(4),(7), 18024(b)(2)-(3). 4Pub. L. No. 111-148, § 1321, 124 Stat. 119, 186 (2010). Health insurance exchanges are markets that operate within each state's overall individual and small-group market where eligible individuals and small employers can compare and select among qualified insurance plans offered by participating issuers. In this report, the term state includes the District of Columbia. States may choose to operate their own exchanges, or this responsibility can be carried out by the federal government. In this report, we refer to exchanges in the individual health insurance market as individual exchanges. GAO-25-107194 Health Insurance Market Concentration Page 1

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