Many local commercial and exchange markets are largely controlled by one payer, according to the American Medical Association.
The AMA's 2022 "Competition in Health Insurance" report, published Nov. 1, found that 75 percent of metropolitan areas have "highly concentrated" health insurance markets.
According to the report, in 91 percent of metropolitan areas, one payer has at least a 30 percent market share in combined HMO, PPO, point-of-sale and exchange markets.
These are the cities where the largest payer controls less than 30 percent of the market:
Fort Smith, Ark.-Okla.
Blue Cross Blue Shield Arkansas, 29 percent market share
Boulder, Colo.
Anthem, 27 percent market share
Colorado Springs, Colo.
Anthem, 27 percent market share
Denver-Aurora-Lakewood, Colo.
UnitedHealthcare, 25 percent market share
Washington-Arlington-Alexandria, D.C.-Va.-Md.-W.Va.
CareFirst, 26 percent market share
Miami-Fort Lauderdale-Pompano Beach, Fla.
Blue Cross Blue Shield Florida, 26 percent market share
Palm Bay-Melbourne-Titusville, Fla.
Blue Cross Blue Shield Florida, 28 percent market share
Hagerstown-Martinsburg, Md.-W.Va.
CareFirst, 22 percent market share
Springfield, Mass.
Baystate, 28 percent market share
Carson City, Nev.
Anthem, 26 percent market share
Glens Falls, N.Y.
Anthem, 29 percent market share
Kingston, N.Y.
UnitedHealthcare, 29 percent market share
New York-Newark-Jersey City, N.Y.-N.J.-Pa.
UnitedHealthcare, 26 percent market share
Poughkeepsie-Newburgh-Middletown, N.Y.
UnitedHealthcare, 28 percent market share
Columbus, Ohio
Anthem, 28 percent market share
Weirton-Steubenville, W.Va.-Ohio
Highmark, 29 percent market share
Youngstown-Warren-Boardman, Ohio-Pa.
Anthem, 29 percent market share
Albany-Lebanon, Ore.
Cambia, 29 percent market share
Eugene-Springfield, Ore.
PacificSource, 29 percent market share
Portland-Vancouver-Hillsboro, Ore.-Wash.
Kaiser Permanente, 29 percent market share
Allentown-Bethlehem-Easton, Pa.-N.J.
Highmark, 27 percent market share
Reading, Pa.
Capital Blue Cross, 29 percent market share
Providence-Warwick, R.I.-Mass.
Blue Cross Blue Shield Rhode Island, 22 percent market share
Blue Cross Blue Shield Massachusetts, 22 percent market share (tie)
Bremerton-Silverdale-Port Orchard, Wash.
Kaiser Permanente, 28 percent market share
Seattle-Tacoma-Bellevue, Wash.
Premera, 23 percent market share
Walla Walla, Wash.
Premera, 29 percent market share
Kaiser Permanente, 29 percent market share (tie)
Yakima, Wash.
Kaiser Permanente, 29 percent market share
Wheeling, W.Va.-Ohio
Anthem, 28 percent market share
Fond du Lac, Wisc.
UnitedHealthcare, 28 percent market share
Green Bay, Wis.
UnitedHealthcare, 27 percent market share
Janesville-Beloit, Wis.
Quartz, 25 percent market share
SSM Health, 25 percent market share (tie)
Wausau-Weston, Wis.
UnitedHealthcare, 25 percent market share
Anthem, 25 percent market share (tie)