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5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.
from Spencer’s Benefits Reports: Consolidation in the health insurance market over the last five years threatens competition and the stability of the health care system, the American Medical Association (AMA) indicates in a recent report, Competition in the Health Insurance Market—A Comprehensive Study of U.S. Markets—2007 Update. Of the 313 metropolitan statistical areas (MSAs) in 44 states that the AMA study reviewed, 96% had at least one insurer with at least a 30% share of the combined HMO/preferred provider organization market. The Department of Justice has determined that when a health care plan represents more than 30% of a physician’s practice revenue, the health insurer can have “monopsony power (where only one buyer seeks to buy the services of several providers) to the detriment of patients,” the AMA report notes.
Through acquisitions in the past couple of years, WellPoint, Inc., has become the largest insurer, followed by United Health Group. These two companies each have acquired 11 other firms since 2000, and they now control 36% of the health insurance market. WellPoint now has 34 million members and United has 33 million. In 2000, Aetna and United were the two largest insurers. In 2004 and 2005, there were 28 health insurer mergers valued at $53.8 billion. Furthermore, United intends to acquire Sierra Health Services, the largest health care plan in Nevada, a merger that the AMA opposes as it would give United 56% of the market in that state, compared with its current 11%.
“The AMA is concerned that the United States is heading toward a system dominated by a few publicly traded companies that operate in the interest of shareholders and not primarily in the interest of patients,” the group’s report states. “It is time for lawmakers and regulators to take a serious look at the long-term negative impact of consolidated health insurance markets on the nation’s health care system.”
As a consequence, “the physician’s role is being systematically undermined as dominant insurers are able to impose take-it-or-leave-it contracts that directly affect the provision of patient care and the patient-physician relationship,” the report continues. “Those physicians whose practices depend most heavily on patients covered by a particular health insurer are most vulnerable to unreasonable contracting terms and anticompetitive reimbursement rates.”
The following details the market concentration in MSAs where one insurer has a significant share of the market:
“The AMA believes it is time to reexamine the legal landscape that has resulted in unfettered consolidation of health insurance markets,” the organization concluded. “If not corrected, the imbalances in the marketplace will have serious negative long-term consequences for the health care system.”
For more information, visit http://www.ama-assn.org/ama1/pub/upload/mm/368/compstudy_52006.pdf.
For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.
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