Most of Iowa’s metro areas are controlled by one or two health insurers, to the detriment of physicians and consumers, according to a study by the American Medical Association (AMA).
 
These findings were derived from “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” The newly released study examined 2008 enrollment in health maintenance organizations (HMOs) and preferred provider organizations (PPOs) from 359 metro areas in 46 states.
 
In 60 percent of those areas, the two largest insurers had a combined market share of 70 percent or greater.
 
“High concentration levels in health insurance markets are largely the result of consolidation, which likely has led to the exercise of market power and, in turn, harm to consumers and providers of care,” according to the study.
 
Market concentration also creates pressure on physicians to “accept unfair contract terms and corporate policies, which undermines the physician role as patient advocate,” said Dr. Cecil Wilson, the AMA’s president, in a press release.
 
In Iowa, the study found that Wellmark Blue Cross and Blue Shield controlled 60 percent or more of the commercial health insurance markets in seven of the eight metro areas studied by the AMA, with the exception of the Quad Cities market. In Greater Des Moines, 79 percent of the combined HMOs and PPO coverage is provided by Wellmark, compared with a 15 percent market share for its next-largest in-state competitor, UnitedHealthcare.
 
Wellmark officials declined to comment on the study. The Des Moines-based health insurance company recently requested an 11 percent increase in premiums for its individual health plans; state officials approved an 8.5 percent increase. In May 2010, Wellmark increased premiums by 18 percent. Wellmark officials cited increasing health-care costs and projections of members’ health-care usage as justification for the increases.