“There is no question but that consolidations of this magnitude would raise considerable concern for the simple reason that cost control in health care depends on competitive markets at both the payor and provider levels. Incidentally, robust payor competition is not only vital to the success of the Affordable Care Act (ACA), but also to voucher programs proposed by conservatives…To be sure, there is substantial evidence that a large share of health care cost increases is caused by dominant providers charging high prices. There are a number of reasons to be skeptical of the idea that consolidated insurers will bargain down prices with providers. There is no compelling economic evidence that “bilateral” monopoly produces better results for consumers; and even if a dominant payor succeeds in bargaining successfully with providers it has little incentive to pass along the savings to its policyholders.”

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