Impact on Premiums from Health Care Market Concentration from the Affordable Care Act's Health Insurance Marketplaces

The project team will merge a variety of datasets to measure how healthcare prices and premiums have changed from 2010-2016 and how market concentration across hospitals, physician organizations and insurers has changed during this time. Key data sources include: the Health Insurance Exchange (RWJF-HIX) Compare premium data for 2014-2017, supplemented with Fund grantee Jon Gabel’s premium database; the National Association of Insurance Commissioners’ Health InfoPro data for the 2010-2016 individual and group market; the Health Care Cost Institute’s claims database for 2010-2014; and 2010-2016 healthcare market concentration data from the American Hospital Association’s Annual Hospital Survey, SK&A’s Office Based Physicians Database provided by IMS, and HealthLeadersInterstudy’s Managed Market Surveyor of health insurers.

Findings will inform policymakers about whether consumers are being hurt by increased healthcare market concentration, including whether health insurer concentration offsets hospital and physician concentration to the benefit of insurers or consumers. This research will inform antitrust enforcement actions and whether pending and future mergers and acquisitions should be approved.