“States and the federal government will have to work hard to make sure that new insurance exchanges in President Obama’s healthcare law actually create more competition, a new study says… The Health Affairs study says people in those areas generally pay higher out-of-pocket costs than people in more populated areas with greater competition. ‘If experience with the federal benefits program is an indication of how much competition can be expected in the exchanges, then people obtaining coverage from exchanges will not benefit much from competition unless the exchanges are at least modestly assertive in setting conditions of participation for qualifying health plans,’ the authors wrote.”