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10 states with the most concentrated health insurance markets — Alabama is No. 1

Lack of competition is a worsening problem for already-concentrated health insurance markets, according to the American Medical Association's 2020 "Competition in Health Insurance: A Comprehensive Study of U.S. Markets."

The AMA analyzed market concentration in all 384 metropolitan statistical areas, the 50 states, and Washington, D.C., using the Herfindahl-Hirschman Index. Federal guidelines classify markets with an HHI of more than 2,500 points as "highly concentrated."

Ten states with the least competitive commercial health insurance markets:

1. Alabama
2. Hawaii
3. Michigan
4. Delaware
5. South Carolina
6. Kentucky
7. Alaska
8. Louisiana
9. Illinois
10. North Carolina

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