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Increasing merger and acquisition activity in the health insurance industry continues to decrease market competition which benefit experts fear will lead to increased premiums for employers and individuals. Recent research from the American Medical Association identified the 10 states with the least competitive health insurance market based on market concentration levels as determined by the Herfindahl–Hirschman Index or HHI—a measure used by the U.S. Department of Justice and the Federal Trade Commission.

“Commercial health insurance market” means the combined HMO+PPO+POS market. Ranked in ascending order of least competitive, the ten states are: