"To address the unaffordability of insurance premiums in the individual and small-group markets, the ACA established health insurance exchanges that are designed to provide one-stop-shopping platforms in which consumers can compare and purchase insurance online. Offering consumers transparency in insurance pricing and product information should help promote competition and affordability...

As a result of the Supreme Court decision, approximately three million additional individuals—primarily those between 100 and 138 percent of FPL—are now expected to enroll in the insurance exchanges. This influx of people may have a positive impact on the functioning of those exchanges. More consumers create more competition, and a competitive marketplace that makes insurance more affordable is one of the key principles underlying the insurance exchange concept."

"This final rule will implement the new Affordable Insurance Exchanges (‘Exchanges'), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses."

"...[T]he Affordable Care Act will promote transparency, accountability, and competition among health insurance companies through both the new state exchanges and new standards for reviewing how premiums are set by insurers. By promoting greater competition and accountability, the Affordable Care Act will motivate insurance companies to hold down health care costs and premium increases while improving quality of care."

"The law authorizes states to creates a new, competitive marketplace where those without job-based coverage can easily shop for quality, affordable coverage--and receive a tax credit (based on their income) to help make coverage affordable. This new competitive insurance marketplace will allow for real competition among insurers and will finally give people purchasing insurance the kind of quality, high-value and easy-to-compare options that have been out of reach for years."

"The Patient Protection and Affordable Care Act of 2010 (PPACA) does little to address the monopoly problem and may even worsen it. The highly regulated and heavily subsidized regime ahead under the PPACA already has triggered a feverish scramble among health industry firms (insurers, pharmaceutical manufacturers, physician practice groups, and device makers, as well as hospitals) to get bigger market share and also become better connected politically to ensure that they will be among the politically dependent survivor incumbents in the years ahead...

The PPACA poses some additional barriers to more vigorous competition in health services. Its ‘minimum medical loss ratio' rules for insurers may superficially appeal to some insurance purchasers but could further disarm payers in aggressive price negotiations with providers and stifle insurers' investments in innovative monitoring and improvement of health care delivery...

Unless a more effective competition policy can be implemented in the health sector, many millions of additional Americans will soon carry exactly the kind of health coverage that currently serves provider and supplier monopolists so well."

" the ACA will further consolidate control of health care into fewer and even more powerful health insurance companies,...

Also, health insurance companies are NOT REQUIRED to sell health insurance policies within the Health Insurance Exchange... This invalidates the premise of the ‘Exchange,' which is to standardize policies and create a competitive market by allowing consumers to compare prices, benefits, and quality thereby forcing insurers to compete. For decades just the opposite has occurred– monopoly– and more of the same is expected under the ACA."

"Insurers are... pulling out of the individual insurance market because of new regulations that fix their profit margins and impose mandates on how they have to spend their revenues…

The vertical integration among insurers will leave many markets with little or perhaps no choice among health plans...

Insurers and providers are making these defensive business decisions largely because better competitive options are foreclosed to them by the Obama plan."

"Health-care plans that existed before the new law are 'grandfathered' with regard to some of its provisions...

Health plans would no longer be grandfathered if a business changes insurance companies, raises deductibles more than 5%, drops any existing benefits, or even increases co-pays by as little as $5...

Complying with these new rules would raise costs for companies who provide coverage [and] reduce competition among health insurance companies."