The U.S.'s four largest health insurance carriers expect to participate in fewer than one-third of the state exchanges mandated by the Affordable Care Act and are hesitant to sell policies in states where they aren't already doing business. The lower participation could lead to lower-than-expected competition, experts say. The insurers cited confusion about the plans and prices they will be permitted to offer, as well as concerns that first-year traffic will be low and that some of the exchanges may not be ready by the Oct. 1 opening date.

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