Armed with reports they say document the lack of real health plan choice, several hundred protesters plan to demonstrate their case for a competitive, public plan this week as 1,200 health officials gather for America's Health Insurance Plan convention in San Diego.
"We want the insurance companies to support and allow our government to create a public health insurance option," says Mari Lopez, health policy specialist for the California Partnership, a statewide group that fights poverty. The partnership, several labor union groups, and single payer advocacy organizations plan to join in the demonstrations outside the San Diego Convention Center.
Lopez insists that the group does not oppose health plans per se.
"But we don't want those health plans to obstruct the creation of an affordable public plan. There needs to be something for the public that's similar to Medicare. They need to support this, or get out of the way," she says.
The groups are referring to claims by many health plan industry representatives that the health plan market remains competitive throughout the country.
But a report released late last month by Health Care for America Now! documents that in 12 of 43 states surveyed, one health insurance company controls at least two-thirds of the healthcare market. In another 12 states, one health insurance company has 50% or more of the healthcare market.
In 39 states, two health insurance companies have 50% or more of the health plan market.
According to the American Medical Association, 94% of insurance markets in the U.S. are now highly concentrated, which the report says has "undermined market efficiency. Premiums have skyrocketed, increasing more than 87%, on average, over the past six years."
The report said that insurance company mergers and consolidations have "disproportionately" disadvantaged rural and lower-population states. In Hawaii, Rhode Island, Alaska, Vermont, Alabama, Maine, Montana, Wyoming, Arkansas, and Iowa, the two largest health insurers control at least 80% of the statewide market. In Alabama, the biggest insurer holds 89% of the statewide market."
Both the national report released last week and the newer California report maintain that private health plans should compete side-by-side on a level playing field with public insurance plans "to reward those that deliver better value and do the best job of improving their enrollees' health."
"Public health insurance can offer a benchmark for private plans and a source of stability for enrollees, especially those with the greatest medical needs," the report said.
"A critical element of a functional competitive marketplace is to protect the ability of consumers to choose between genuine alternatives. The highly consolidated health insurance industry we have today, with its unacceptable concentration of market power, does not allow this," the report added.
Representatives of labor groups, including the Service Employees International Union and the California Nurses Association, will be staging several demonstrations against health plans on Thursday.
Lopez points to the downward trend in employer-sponsored health plans. In the early 1990s, she says, 70% of the U.S. workforce was covered. Today, she says, it's down to 54%. That's because health plans have run up premium costs to a level at which they are no longer affordable for many small- and moderate-sized businesses, she adds.
"We want to make the case to those who say we should have a competitive marketplace that having another competitor (a public health care plan) would be a good thing," says Anthony Wright of Health Access California.
Yesterday, Health Care for America Now! released a second report on health plan consolidations affecting just California, which claimed that insurance companies have "built a near-monopoly in the California market, burdening families and businesses with premiums that grew 4.8 times faster than wages from 2000 to 2007."
In California, the report said, the two largest health insurers control 58% of the market, a level that the U.S. Department of Justice classifies as "highly concentrated."
Two companies control at least half of the market in major population centers throughout the state, including Los Angeles, San Diego, Sacramento, Santa Ana, San Francisco, Fresno, Riverside, and Redding. Companies that sell their plans are more highly concentrated in California than they are in Florida or New York, the report added.