The Health Plan Strategy Puzzle—10 Years Later

Outside of The Centers for Medicare & Medicaid Services policies and regulation, there is probably no market factor that affects how health care is delivered more than the presence and practices of health plans. In 2010, 77.9% of Americans had their health benefits managed by health plans; in 2020, that proportion rose to 90.1% (see Number Of People With Health Insurance In The United States From 1990 To 2020).

The concentration of this enrollment among health insuring organizations is striking. The top five health insuring organizations by enrollment in 2020 have 54% of the market. They are UnitedHealth . . .