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Karen Ignagni agrees. The CEO of the trade association America’s MEDICAL HEALTH INSURANCE Programs, which represents insurers, stated competition between insurers means little if way too many sick people join insurance coverage on the exchanges. Insurers need a stability between sick and healthful visitors to avoid big state hits that result in future rate hikes. Laszewski expects some programs to get either big high quality decreases or boosts in 2015, but he says that says nothing at all about the long-term implications of the overhaul.