This is the accessible text file for GAO report number GAO-09-363R entitled 'Private Health Insurance: 2008 Survey Results on Number and Market Share of Carriers in the Small Group Health Insurance Market' which was released on March 24, 2009. This text file was formatted by the U.S. Government Accountability Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to Webmaster@gao.gov. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. GAO-09-363R: United States Government Accountability Office: Washington, DC 20548: February 27, 2009: The Honorable Olympia J. Snowe: Ranking Member: Committee on Small Business and Entrepreneurship: United States Senate: The Honorable Christopher S. Bond: United States Senate: The Honorable Richard J. Durbin: United States Senate: The Honorable Blanche L. Lincoln: United States Senate: Subject: Private Health Insurance: 2008 Survey Results on Number and Market Share of Carriers in the Small Group Health Insurance Market: As a follow-up to our 2005 and 2002 reports on the competitiveness of the small group health insurance market, you requested updated information on each state and the District of Columbia.[Footnote 1] Specifically, this report provides information from states and the District of Columbia (hereafter referred to as a state) on the number of carriers licensed in the small group market, the largest carriers, and their market share.[Footnote 2] To obtain this information, we sent an electronic survey to the office responsible for regulating insurance, health plans, or both in all 51 states. After following up with nonresponding states by e-mail and telephone, all but 1 state completed the survey. Of the 50 states that responded, however, 3 were unable to provide the requested information on small group carriers and their market share. For the remaining 47 states, not all had the information needed to answer all of the questions. For example, 44 states reported the largest carrier and 39 states provided market share data. Also, the 47 states varied in how they defined the size of a small group. Most--33--defined a small group as 2 to 50 employees; 12 defined a small group as 1 to 50 employees; and 2 had another definition. Finally, states generally reported information as of December 2007, though 6 states were able to provide 2008 numbers, and 3 states were limited to data from 2006. We did not independently validate the information provided by the states. However, in the survey, we asked states to describe the source of the information reported and provide clarifying information about the numbers reported. As a result of this information, we excluded some states' responses from certain market share analysis, e.g., if the state had no way of separating data on small group health insurance from data on all group health insurance. We performed our work from December 2008 through February 2009 in accordance with all sections of GAO's Quality Assurance Framework that are relevant to our objectives. The framework requires that we plan and perform the engagement to obtain sufficient and appropriate evidence to meet our stated objectives and to discuss any limitations in our work. We believe that the information and data obtained, and the analysis conducted, provide a reasonable basis for any findings and conclusions. Because we did not evaluate the policies or operations of any federal agency to develop the information presented in this report, we did not seek comments from any agency. The following summarizes the findings from our 2008 survey: * The median number of licensed carriers in the small group market per state was 27. * The median market share of the largest carrier in the small group market was about 47 percent, with a range from about 21 percent in Arizona to about 96 percent in Alabama. In 31 of the 39 states supplying market share information, the top carrier had a market share of a third or more. * The five largest carriers in the small group market, when combined, represented three-quarters or more of the market in 34 of the 39 states supplying this information, and they represented 90 percent or more in 23 of these states. * Thirty-six of the 44 states supplying information on the top carrier identified a Blue Cross and Blue Shield (BCBS) carrier as the largest carrier, and in all but 1 of the remaining 8 states, a BCBS carrier was among the five largest carriers. * The median market share of all the BCBS carriers in the 38 states supplying this information was about 51 percent, with a range of less than 5 percent in Vermont and Wisconsin and more than 90 percent in Alabama and North Dakota. In comparing what states reported in 2008 to what they previously reported to GAO in 2005 and 2002, we found: * The median market share of the largest small group carrier has increased to about 47 percent in 2008 from the 43 percent reported in 2005 and the 33 percent reported in 2002. Twenty-four of the 29 states providing information in both 2002 and 2008 saw increases in the market share of the top carrier that ranged from about 2 to 39 percentage points. In contrast, the top carriers in 5 states lost market share with decreases ranging from about 1 to 16 percentage points. * The number of states with a combined market share of the five largest carriers of 75 percent or more has also increased since our 2002 survey. The combined market share of the five largest small group carriers represented three-quarters or more of the market in 34 of 39 states, compared to 26 of 34 states reported in 2005 and 19 of 34 states reported in 2002. * Finally, the median market share of all the BCBS carriers in 38 states reporting this information in 2008 was about 51 percent, compared to the 44 percent reported in 2005 and the 34 percent reported in 2002 for the 34 states supplying information in each of these years. The enclosure summarizes by state the number of licensed carriers, the largest carrier and its market share, and the market share of the five largest carriers in the small group market. In addition, the enclosure shows the rank of the largest BCBS carrier and the combined market share of all BCBS carriers. As arranged with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution of it until 30 days after its issue date. Copies will then be sent to other interested parties. In addition, the report will be available at no charge on the GAO Web site at [hyperlink, http://www.gao.gov]. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Please call me at (202) 512-7114 if you have any questions. Major contributors to this report were Kristi Peterson, Assistant Director; Susan Barnidge; Grace Materon; and Nelson Olhero. Signed by: John E. Dicken: Director, Health Care: Enclosure: [End of section] Enclosure: Table 1: Results of 2008 Survey on Number of Carriers, Largest Carrier, and Market Share Data for Small Group Health Insurance Carriers, as reported by 47 states: State: Alabama[A]; Number of licensed carriers: 7; Largest carrier: Blue Cross Blue Shield of Alabama; Market share of largest carrier (percentage): 96; Market share of five largest carriers (percentage): 100; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 96. State: Alaska; Number of licensed carriers: 11; Largest carrier: Premera Blue Cross; Market share of largest carrier (percentage): 77; Market share of five largest carriers (percentage): 94; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 77. State: Arizona; Number of licensed carriers: 32[B]; Largest carrier: Pacificare Life Assurance Company; Market share of largest carrier (percentage): 21; Market share of five largest carriers (percentage): 73; Rank of largest BCBS carrier: 2; Market share of all BCBS carriers (percentage): 21. State: California; Number of licensed carriers: 28[C]; Largest carrier: Kaiser Foundation Health Plan, Inc.[D]; Market share of largest carrier (percentage): 37[D]; Market share of five largest carriers (percentage): 96[D]; Rank of largest BCBS carrier: 2[D]; Market share of all BCBS carriers (percentage): 41[D]. State: Colorado; Number of licensed carriers: 21; Largest carrier: Kaiser Permanente; Market share of largest carrier (percentage): 23; Market share of five largest carriers (percentage): 79; Rank of largest BCBS carrier: 3; Market share of all BCBS carriers (percentage): 20. State: Connecticut; Number of licensed carriers: 33[E]; Largest carrier: Anthem Health Plans, Inc.[F]; Market share of largest carrier (percentage): 46[F]; Market share of five largest carriers (percentage): 93[F]; Rank of largest BCBS carrier: 1[F]; Market share of all BCBS carriers (percentage): 46[F]. State: Delaware[A]; Number of licensed carriers: 14; Largest carrier: Blue Cross Blue Shield of Delaware; Market share of largest carrier (percentage): 58; Market share of five largest carriers (percentage): 95; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 58. State: District of Columbia; Number of licensed carriers: 14; Largest carrier: Group Hospitalization & Medical Services, Inc.; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): NA. State: Florida; Number of licensed carriers: 27; Largest carrier: Blue Cross & Blue Shield of Florida, Inc.; Market share of largest carrier (percentage): 30; Market share of five largest carriers (percentage): 87; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 34. State: Georgia; Number of licensed carriers: 211; Largest carrier: Blue Cross Blue Shield Healthcare Plan of Georgia; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): NA. State: Hawaii; Number of licensed carriers: 7; Largest carrier: HMSA; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): NA. State: Idaho; Number of licensed carriers: 18; Largest carrier: Regence Blue Shield of Idaho; Market share of largest carrier (percentage): 49; Market share of five largest carriers (percentage): 98; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 90. State: Illinois; Number of licensed carriers: 53; Largest carrier: Health Care Service Corporation[F]; Market share of largest carrier (percentage): 51[F]; Market share of five largest carriers (percentage): 82[F]; Rank of largest BCBS carrier: 1[F]; Market share of all BCBS carriers (percentage): 51[F]. State: Indiana; Number of licensed carriers: 328; Largest carrier: NA; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: NA; Market share of all BCBS carriers (percentage): NA. State: Iowa[A]; Number of licensed carriers: 28; Largest carrier: Wellmark, Inc.; Market share of largest carrier (percentage): 60; Market share of five largest carriers (percentage): 90; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 60. State: Kansas; Number of licensed carriers: 22; Largest carrier: Blue Cross & Blue Shield of Kansas, Inc.; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): NA. State: Kentucky[A]; Number of licensed carriers: 13; Largest carrier: Anthem Health Plans of KY; Market share of largest carrier (percentage): 47; Market share of five largest carriers (percentage): 96; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 47. State: Louisiana[A]; Number of licensed carriers: 403[G]; Largest carrier: Louisiana Health Service & Indemnity Co.[F]; Market share of largest carrier (percentage): 53[F]; Market share of five largest carriers (percentage): 87[F]; Rank of largest BCBS carrier: 1[F]; Market share of all BCBS carriers (percentage): 53[F]. State: Maine; Number of licensed carriers: 8; Largest carrier: Anthem BC/BS; Market share of largest carrier (percentage): 56; Market share of five largest carriers (percentage): 96; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 56. State: Maryland; Number of licensed carriers: 16; Largest carrier: CareFirst BlueChoice, Inc.; Market share of largest carrier (percentage): 51; Market share of five largest carriers (percentage): 90; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 71. State: Massachusetts; Number of licensed carriers: 28; Largest carrier: Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.; Market share of largest carrier (percentage): 44; Market share of five largest carriers (percentage): 88; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 52. State: Michigan; Number of licensed carriers: 49; Largest carrier: Blue Cross Blue Shield of Michigan; Market share of largest carrier (percentage): 47; Market share of five largest carriers (percentage): 77; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 58. State: Minnesota; Number of licensed carriers: 17; Largest carrier: Blue Cross and Blue Shield of Minnesota; Market share of largest carrier (percentage): 42; Market share of five largest carriers (percentage): 95; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 42. State: Missouri; Number of licensed carriers: 50; Largest carrier: Health Alliance Life Ins. Co.; Market share of largest carrier (percentage): 30; Market share of five largest carriers (percentage): 73; Rank of largest BCBS carrier: 3; Market share of all BCBS carriers (percentage): 17. State: Montana; Number of licensed carriers: 13; Largest carrier: Blue Cross Blue Shield of Montana; Market share of largest carrier (percentage): 38; Market share of five largest carriers (percentage): 91; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 38. State: Nebraska; Number of licensed carriers: 58; Largest carrier: BlueCross/BlueShield of Nebraska; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): NA. State: Nevada; Number of licensed carriers: 28; Largest carrier: Health Plan of Nevada; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: In top 5; Market share of all BCBS carriers (percentage): NA. State: New Hampshire; Number of licensed carriers: 10; Largest carrier: Anthem-NH; Market share of largest carrier (percentage): 50; Market share of five largest carriers (percentage): 99; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 50. State: New Jersey; Number of licensed carriers: 13; Largest carrier: Horizon Health Care Services Inc.; Market share of largest carrier (percentage): 28; Market share of five largest carriers (percentage): 86; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 46. State: New York[A]; Number of licensed carriers: 31; Largest carrier: Oxford Health Insurance and Oxford Health Plans, Inc.; Market share of largest carrier (percentage): 26; Market share of five largest carriers (percentage): 74; Rank of largest BCBS carrier: 2; Market share of all BCBS carriers (percentage): 42. State: North Carolina; Number of licensed carriers: 27; Largest carrier: Blue Cross Blue Shield of North Carolina; Market share of largest carrier (percentage): 65; Market share of five largest carriers (percentage): 94; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 65. State: North Dakota; Number of licensed carriers: 10; Largest carrier: Noridian Mutual Insurance Company dba BlueCross BlueShield of North Dakota; Market share of largest carrier (percentage): 91; Market share of five largest carriers (percentage): 99; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 91. State: Ohio; Number of licensed carriers: 180[H]; Largest carrier: Anthem Insurance Group; Market share of largest carrier (percentage): 35; Market share of five largest carriers (percentage): 85; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 35. State: Oklahoma; Number of licensed carriers: 25; Largest carrier: Healthcare Services Corp., BC/BS of Oklahoma; Market share of largest carrier (percentage): 51; Market share of five largest carriers (percentage): 82; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 53. State: Oregon[A]; Number of licensed carriers: 15; Largest carrier: Regence Blue Cross Blue Shield; Market share of largest carrier (percentage): 44; Market share of five largest carriers (percentage): 79; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 51. State: Rhode Island; Number of licensed carriers: 4; Largest carrier: Blue Cross & Blue Shield of Rhode Island; Market share of largest carrier (percentage): 84; Market share of five largest carriers (percentage): 100; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 84. State: South Carolina; Number of licensed carriers: 27; Largest carrier: Blue Cross Blue Shield of SC; Market share of largest carrier (percentage): 47; Market share of five largest carriers (percentage): 93; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 56. State: South Dakota[A]; Number of licensed carriers: 15; Largest carrier: Wellmark Blue Cross Blue Shield of SD; Market share of largest carrier (percentage): 62; Market share of five largest carriers (percentage): 94; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 62. State: Tennessee; Number of licensed carriers: 33; Largest carrier: Blue Cross Blue Shield of Tennessee; Market share of largest carrier (percentage): 68; Market share of five largest carriers (percentage): 94; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 68. State: Texas; Number of licensed carriers: 46; Largest carrier: Blue Cross & Blue Shield of Texas; Market share of largest carrier (percentage): 27; Market share of five largest carriers (percentage): 68; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 28. State: Utah; Number of licensed carriers: 31; Largest carrier: NA; Market share of largest carrier (percentage): 39; Market share of five largest carriers (percentage): 97; Rank of largest BCBS carrier: NA; Market share of all BCBS carriers (percentage): NA. State: Vermont; Number of licensed carriers: 5; Largest carrier: MVP Health Plan, Inc.; Market share of largest carrier (percentage): 45; Market share of five largest carriers (percentage): 100; Rank of largest BCBS carrier: 5; Market share of all BCBS carriers (percentage): 1. State: Virginia; Number of licensed carriers: 36; Largest carrier: NA; Market share of largest carrier (percentage): NA; Market share of five largest carriers (percentage): NA; Rank of largest BCBS carrier: NA; Market share of all BCBS carriers (percentage): NA. State: Washington[I]; Number of licensed carriers: 10; Largest carrier: Regence BlueShield; Market share of largest carrier (percentage): 45; Market share of five largest carriers (percentage): 94; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 79. State: West Virginia; Number of licensed carriers: 27[J]; Largest carrier: Mountain State BlueCross BlueShield (Highmark); Market share of largest carrier (percentage): 52; Market share of five largest carriers (percentage): 86; Rank of largest BCBS carrier: 1; Market share of all BCBS carriers (percentage): 52. State: Wisconsin; Number of licensed carriers: 41; Largest carrier: United HealthCare Insurance Co.; Market share of largest carrier (percentage): 32; Market share of five largest carriers (percentage): 56; Rank of largest BCBS carrier: Not in top 5; Market share of all BCBS carriers (percentage): 4. State: Wyoming; Number of licensed carriers: 12; Largest carrier: Blue Cross Blue Shield of Wyoming[K]; Market share of largest carrier (percentage): 51[K]; Market share of five largest carriers (percentage): 94[K]; Rank of largest BCBS carrier: 1[K]; Market share of all BCBS carriers (percentage): 51[K]. Source: GAO 2008 survey of state insurance regulators. Legend: NA = Not available. Notes: Reported data are for December 2007 unless otherwise noted. Ranking and market share data are based on the number of covered lives unless otherwise noted. One state did not respond to the survey: Mississippi. In addition, 3 states responding to the survey were unable to provide data on small group carriers and on market share: Arkansas, New Mexico, and Pennsylvania. [A] Data are as of the following dates: Delaware, December 2008; Alabama, New York, Oregon, South Dakota, and Virginia, June 2008; and Iowa, Kentucky, and Louisiana, December, 2006. [B] Arizona's data are limited to licensed carriers that had more than $100,000 in annual premiums. [C] Number represents licensed insurers and licensed managed care plans. [D] Data reported represent managed health care plans only. California does not have market share data for insurance companies selling small group health insurance. [E] State clarified that though 33 carriers were licensed, only 19 carriers were marketing small group products. [F] Ranking and market share data for these states are based on gross premiums. [G] State clarified that though 403 carriers were licensed to sell small group health insurance, only 28 carriers collected premiums in 2006. [H] State clarified that though 180 carriers were licensed to sell small group health insurance, 27 carriers were collecting premiums and/ or marketing small group products. [I] Data do not include disability carriers renewing or issuing small group plans. The state, however, reported that the market share of disability carriers is not significant. [J] State clarified that of the 27 licensed carriers, 25 were renewing existing small group policies and 23 were selling new small group policies. [K] Ranking and market share data are based on number of covered employees. [End of table] [End of section] Footnotes: [1] GAO, Private Health Insurance: Number and Market Share of Carriers in the Small Group Health Insurance Market in 2004, [hyperlink, http://www.gao.gov/products/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, [hyperlink, http://www.gao.gov/products/GAO-02-536R] (Washington, D.C.: Mar. 25, 2002). [2] A carrier is generally an entity (either an insurer or managed health care plan) that bears the risk for and administers a range of health benefit offerings. [End of section] GAO's Mission: The Government Accountability Office, the audit, evaluation and investigative arm of Congress, exists to support Congress in meeting its constitutional responsibilities and to help improve the performance and accountability of the federal government for the American people. 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