Both Obamacare and the AHCA bet on the concept that competition among insurers will control health insurance premiums. Why they believe that is a mystery to me.
Only a relatively small portion of any premium is even subject to competition, less than 10%. The bulk of any premium is health care spending. In addition, as the graphic below shows, nearly all states have a process to review and approve premium change requests by insurers.
Betting on competition among insurers to lower premiums is a losing bet.
Source: http://www.ncsl.org/research/health/health-insurance-rate-approval-disapproval.aspx
QUINNSCOMMENTARY 
As suggested by your post, neither D’s nor R’s believe competition is the answer – as all know health insurance is regulated as if it were a utility – where you may have a choice when it comes to heating, but also need electricity. It is the difference between going without a land line and Ma Bell.
To have competition, it must be at the provider/patient lever, where differentiation is both quality and price.
It can be done – see lasix and cosmetic surgery.
So, yes, insurance, as regulated and delivered today, is an impediment to getting competition in place to deliver better cost/benefit results.
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