Federal antitrust regulators seem to be dominating thehealth insurance industry headlines this summer.

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Related: Aetna, Humana work to save merger

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Health market watchers are looking to see whether the antitrustregulators will let Indianapolis-based Anthem acquire Bloomfield,Connecticut-based Cigna Corp.

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Regulators are also mulling the effort by Hartford-based Aetnato acquire Louisville, Kentucky-based Humana.

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Many publications have carried stories in the past week, basedon remarks from "sources," that at least two insurers have madeoffers for Aetna Medicare plan assets, to resolve concernsthat an Aetna-Humana deal would create a company with too big of ashare of some states' Medicare plan markets.

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Other major health care-related acquisition proposals havefallen through in the past. Humana, for example, broke off a deal with Minnetonka,Minnesota-based UnitedHealth Group in 1998.

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The Anthem-Cigna deal, the Aetna-Humana deal, or both dealscould fall through this time around. But the general businessand Affordable Care Act forces that drove the insurers to announcethe deals could continue to promote market consolidation, no matterwhat happens to specific deals.

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Policymakers in Washington now have trouble even providingfunding for the Zika virus response.

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Here are some speculative views about how further health insurerconsolidation could shape the insurance industry's role in futureefforts to reform the U.S. health care delivery and health carefinance systems:

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Cash is king
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Federal health insurance exchange managers have given littleattention to health insurance features other than price. (Image:Thinkstock)

1. Insurers may go with the flow and focus even more tightly onlowering premiums, and nothing but lowering premiums.

Regulators at the Centers for Medicare & Medicaid Services(CMS), the arm of the U.S. Department of Health and Human Servicesthat implements Affordable Care Act provisions that affect thecommercial health insurance market, are now working on efforts togive ACA exchange plan enrollees more information about plannetworks. They are also working on a quality rating program.

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But exchange program managers initially focused mostly onhelping consumers hold down premiums. Andy Slavitt, the acting CMS administrator,recently told insurance company representatives that he believesconsumers are interested mainly in the cost of coverage.

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Related: Premiums on popular Obamacare plans may rise in2017

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Typical analyses of health insurer consolidation effects focuson the impact on premiums, not provider networks or servicequality, and ongoing consolidation pressure could increase insurersto focus more on the matters that seem to get the most attentionfrom antitrust regulators.

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That could reduce the likelihood that insurers will uncoverproblems and unmet needs by experimenting with efforts to improveplan quality.

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Listening
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Producers can bring insurers customers, and a uniqueperspective on what customers are saying. (Photo:Thinkstock)

2. Because insurers have less (or think they have less) need touse agents, brokers and consultants to make sales, they may listento producers and consultants less.

Major medical issuers have announced series of individual healthcommission cuts in recent years, and their presence at agentmeetings seems to be shrinking. Issuers may get more informationabout consumers from analyses of online transactions, but less fromproducers who talk to consumers, employers and providers face toface every day.

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Grim, silent corporate suits
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When Assurant gave up its health insurance unit, the healthcare system lost Assurant executives' quarterly comments about thesystem. (Photo: Thinkstock)

3. Insurers may be less inclined to be candid about what'sgoing on in the market.

In 2015, when New York City-based Assurant was a major player inthe Affordable Care Act exchange system, it was one of the firstand only publicly traded insurers with executives who talkedcandidly during quarterly earnings calls with securities analystsabout their views of ACA commercial health insurance rules and theACA exchange system.

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When Assurant shut down its health insurance unit, marketwatchers lost a source of information about the effects of theACA.

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If consolidation continues, and the remaining health insurersget more of their business from government health programs, such asMedicare and Medicaid, that could further limit the remaininginsurers' ability to talk freely about concerns about governmentrules and programs.

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Related: 5 reasons why UnitedHealth wants to quitPPACA

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Elections
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Several large insurers have left America's Health InsurancePlans in recent years. (Photo: Thinkstock)

4. Insurers may give their trade groups fewer resources thosetrade groups can use to be candid.

Aetna and UnitedHealth Group are two large insurers that haveleft America's Health Insurance Plans, a major health insurer tradegroup, since mid-2015.

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If future insurer consolidation reduces the number of insurerswilling and able to pay AHIP dues, that could hurt AHIP's abilityto represent insurers' interests in Washington, and to translatethe views of insurance industry actuaries and claim managers abouthow health insurance really works into language that lawmakers,congressional aides and regulatory agency officials canunderstand.

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Related: Trump, Clinton, and what's next for healthcare

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Corporate office buildings
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In a market with fewer insurers, policymakers might get anarrower range of advice from insurers. (Photo:Thinkstock)

5. The diversity of insurer views might decrease.

Today, health insurers tend to express a wide range of views onissues such as how states should regulate health insurancepremiums, or the proper role of health savings accounts. Furtherindustry consolidation could narrow that range.

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Related: Health exchange advisory panel shuts out commercialinsurers

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U.S. Capitol
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Congressional committees have had trouble getting basicinformation about ACA programs. (Photo: Allison Bell/LHP)

6. Regulatory agencies may feel even less need to disclose whatthey're doing.

Members of Congress are complaining now about problems withgetting basic information about Affordable Care Act operations,such as public information about the number of people insmall-employer exchange plans, from federal agencies.

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Related: ACA in 2016: 10 changes to the Affordable CareAct

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Recently, insurers may have triggered the release of some ACAprogram information by suing the federal government over concernsabout an ACA insurer risk management program, the risk corridorsprogram.

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A drop in the number of health insurers with an interest in therelease of regulatory program information could weaken industrydemands for the release of that kind of information.

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The futureA New Mexico lawmaker revealed throughquestioning Wednesday that a key Obama administration health policyofficial did not understand what has been happening to the supplyof health coverage in Albuquerque. (Photo: Thinkstock)

7. A lack of interest in communication today could lead tomarket gaps tomorrow.

Policymakers in Washington may think they have the informationto make the health care system run smoothly, but, in the past,congressional watchdog agencies have found that communicationproblems even within federal departments have contributed toproblems with launching HealthCare.gov, the Affordable Care Actexchange enrollment system for states that are unable or unwillingto set up their own enrollment systems.

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Related: Health co-ops fallling likedominoes

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Rep. Michelle Lujan Grisham, D-New Mexico, showed Wednesday at aHouse hearing in Washington, when she questioned Kevin Counihan,the head of the HealthCare.gov program, that he did not fullyunderstand how claim cost problems are reducing competition in theindividual health insurance market in Albuquerque.

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Any insurer consolidation trends or other trends that affectconsumers', employers', producers, insurers' and officials' effortsto talk about current problems with the market could let smallerheadaches turn into bigger headaches.

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Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at [email protected] or on Twitter at @Think_Allison.