The health insurance industry, reportedly reacting to ObamaCare, is moving toward consolidation at the same time it is requesting premium increases from regulators in most states.

Aetna is planning to spend about $35 billion to buy competitor Humana. Topping that recently announced deal, Anthem, Inc. wants to buy Cigna Corp. for $54.2 billion.

The health insurance companies say they face an increasingly difficult market and need to consolidate to reduce costs and survive.

The Anthem-Cigna deal, if it goes forward, would cover 53 million Americans.

With customers in 14 states, Anthem is a for-profit corporation and the largest of the Blue Cross-Blue Shield groups operating across the country. Pittsburgh-based Highmark is the largest “Blue” in Pennsylvania.

Generally, mergers mean less competition and higher costs for consumers. But in Western Pennsylvania's health care market, it's possible that the Anthem-Cigna merger would mean more competition for Highmark, which historically has had near-monopoly domiance. That dominance has weakened slightly in recent years, but Western Pennsylvania's health insurance market is not as competitive as others.

A truly competitive market makes a difference. In Southern California, a competitive market for health insurance, premiums are increasing just 1.8 percent. In the Los Angeles market, people willing to shop around and change health insurance providers could cut their premiums 10 percent.

Overall, the California marketplace will see rates increase this year by about 4 percent.

The modest increase could be the result of California being a competitive market, with many people able to compare as many as 10 companies. It could also suggest more healthier and younger people signing up for ObamaCare, to help subsidize the older, sicker people.

While many Californians can shop and compare plans between 10 or more insurance companies, people in Western Pennsylvania can compare just two or three companies, with Highmark dominating, UPMC in second position and Aetna ranking third.

An optimistic view sees merged health insurance giants making this region's market more competitive, offering more choices and lower prices.

But the alternative view is that consolidation of the health insurance industry will mean a few big players and less competition, producing higher profits for companies and bigger paychecks for CEOs, but fewer choices and higher prices for consumers. And while ObamaCare puts a limit on the percentage of a health insurance company's revenues going to overhead, including executive salaries, a merger with another big company would instantly increase revenues, allowing multimillion-dollar executive salaries to continue.

Southern California and other parts of the country are expected to see relatively small price increases for health insurance. But other parts of the country are seeing big increases, with some price-hike requests to state regulators in the 20 percent to 30 percent range.

The health insurance companies in those markets say they underestimated the number of people signing up under ObamaCare and how much health care they would need. The health insurers claim they have been losing money on these newly insured people.

The best-case scenario is that increased competition among health insurance companies will help hold down overall health care costs in the United States. If that's what happens, it's a good thing.

But still, Americans should be asking politicians in Washington why people in the United States pay about twice as much for health care, on a per capita basis, as people in most other advanced countries.

That's a question not given enough attention during the health care debate — and one that most pols in Washington continue to ignore.