[Congressional Record (Bound Edition), Volume 156 (2010), Part 4]
[Extensions of Remarks]
[Page 5366]
[From the U.S. Government Publishing Office, www.gpo.gov]




           ENHANCING COMPETITION IN HEALTH INSURANCE MARKETS

                                 ______
                                 

                            HON. GWEN MOORE

                              of wisconsin

                    in the house of representatives

                        Tuesday, April 13, 2010

  Ms. MOORE of Wisconsin. Madam Speaker, with a large number of 
concentrated health insurance markets across the country, it is 
imperative that health care reform initiatives focus on enhancing 
competition among insurers and providing American consumers with 
affordable health care coverage. Many health insurance markets in the 
United States appear to have one dominant insurer, and in many other 
markets, the top two insurers serve most enrollees. According to the 
American Medical Association, in 2007, at least one insurer had a 
combined HMO/PPO market share of 50 percent or greater in 64 percent 
(200) of the local markets (or Metropolitan Statistical Areas) of the 
United States. And the two top insurers accounted for at least 60 
percent of enrollment in almost 75 percent of these markets.
  Moreover, it can be extremely difficult for new firms, even large 
national health insurance firms, to enter these markets. A new health 
insurer in an area will have difficulty attracting customers until a 
large number of health care providers have signed up. But providers may 
be reluctant to sign up at competitive rates without assurance that the 
plan can offer a volume of patients. And both consumers and providers 
may be skeptical of a new health plan with which they have little 
experience.
  As a recent Congressional Research Service report states: ``The 
health insurance market has many features that can hinder markets, lead 
to concentrated markets, and produce inefficient outcomes.'' Dominant 
insurers may raise premiums or reduce quality of service. They may also 
reduce or prevent innovations that could benefit consumers or engage in 
exclusionary practices to make entry more difficult.
  HHS or the Exchange Controller, therefore, must take steps to 
encourage the entry of new, credible insurance companies and prevent 
dominant insurers from hampering competition. This includes seeking the 
advice and counsel of the U.S. Department of Justice, Antitrust 
Division, regarding practices that may cause or continue undue market 
concentration. This will be achieved in part by ensuring that the 
antitrust laws remain intact through a savings clause, which was 
included in both the House-passed and Senate-passed bills. However, 
improving competition in health insurance markets requires a one-two 
punch. It also must include seeking the advice and counsel of the U.S. 
Department of Justice, Antitrust Division, regarding practices that may 
cause or continue undue market concentration. More competitive health 
insurance markets will generate significant benefits for American 
consumers. It is the best way to ensure that all consumers, including 
individuals who will now be required to purchase health insurance, will 
be able to obtain quality care at affordable prices.

                          ____________________