Florida Blue dominates in 22 metropolitan statistical areas across Florida, according to an analysis by the American Medical Association, although Florida is not on the list of least-competitive markets for such things as insurance and preferred provider organization, or PPO, coverage.

The company's strength in the state puts Jacksonville-based Florida Blue on a short list of the nation’s top dominant companies, ranking it No. 4.on a list of companies with the highest insured market shares in the most metropolitan statistical areas.

Nationally, the commercial health-insurance market has less competition than it did five years ago, according to the AMA analysis.

The report noted that the less competitive an insurance market, the higher the costs of insurance premiums for people wanting coverage. Non-competitive markets also reduce the payments to health care providers participating in the insurers’ networks.

“In short,” the report said, “the exercise of market power adversely affects health insurance coverage and health care.”