Over the years, state lawmakers have groused about the paucity of health insurance carriers in Washington state, saying that the lack of competition has driven up prices. Some have blamed statutory requirements and heavy-handed regulators for the flight of insurers.

But a study by the American Medical Association shows that many of these insurance companies didn’t flee to friendlier business climates. Instead, they were swallowed up in a frenzy of mergers. Between 1995 and 2004 more than 400 such deals were consummated between insurers and managed-care companies.

The analysis of 294 metropolitan insurance markets revealed that in 95 percent of them there is little competition. In 56 percent of the markets a single insurer had more than 50 percent of the business.

When comparing market shares to an index used by the U.S. Justice Department’s antitrust division, Washington state’s market for health plans was deemed “highly concentrated,” as was Coeur d’Alene’s.

Rather than meet the various regulatory guidelines of each state, large insurance companies have found it easier to let smaller companies clear those hurdles and then buy them.

That would be good news for consumers, businesses and health care providers if the economies-of-scale savings from such deals were used to lower prices, but that hasn’t happened. Insurance rates have climbed rapidly and purchasers have little choice but to pay up.

The AMA wants the Department of Justice to look into whether the insurance industry is violating antitrust laws. But that only addresses part of the insurance equation. State mandates on what carriers must include in health care packages make it nearly impossible to offer bare bones, low-cost plans. Plus, the rise in health care costs in general have also forced up premiums.

One intriguing solution is letting health plan purchasers shop across state lines. While that wouldn’t stop insurance company mergers, it might lead to fewer health care mandates, which would help keep down costs.

If the AMA study does nothing else, it shows the futility of trying to regulate the complex issues surrounding access to care and ever-increasing costs at the state level.

States can’t be blamed for trying. Their own budgets are increasing being devoured by health care costs, and national leaders have shown little interest in stepping up since the Clinton administration’s failed attempt to provide universal coverage.

But the problem is bigger – much bigger – than state regulations and insurance company practices.