The income umbrella (AP photo/Charles Dharapak)

I’m skeptical of anyone who expresses firm conclusions about how great or horrible PPACA World will be, or how well or badly the new health insurance exchanges are working.

I firmly believe that I feel as if I’m typing words into a computer. Everything else is wild speculation, and especially when anything else is any opinion about anything to do with the Patient Protection and Affordable Care Act (PPACA) exchange program.

On the one hand, the HealthCare.gov enrollment system and many of the state-based systems are still rickety; the individual and small-group plan enrollee out-of-pocket cost-sharing rules seem to have been written by junior trust fund baby analysts who still get their health coverage from Daddy’s corporation; and the PPACA 3R’s risk management program rules seem to be part of a pitch for a new version of Game of Thrones that will replace the various empires in that series with fictionalized versions of WellPoint, UnitedHealth and Aetna.

But, on the other hand, in spite of all of the technical glitches and shortcomings in marketing and enroller programs, the exchanges seem, apparently, to have taken in completed applications for 3.7 million people between Oct. 1 and Nov. 30.

That’s a lot of people.

I think the moral for people trying to sell individual and group disability insurance in PPACA World (or post-PPACA World, if PPACA World suddenly goes away) is that almost anything could happen.

But one trend seems likely to continue no matter what: More insurers will use short directories of low-cost providers to try to hold down costs, and they may offer little or no access to out-of-network providers.

Maybe disability insurers should be figuring out how to build basic access of medical plan providers into their underwriting models now, and working with actuaries to figure out how ease or difficulty of access affects absence, the incidence of disability claims, and return-to-work rates.

If, for example, an employer’s plan network is so small that workers with diabetes will be much more likely to lose their feet due to neglected infections, maybe an insurer should think carefully before selling that employer attractively priced coverage.

Maybe, in the long run, disability insurers could develop their own access-related performance measures and performance improvement programs.

If, say, an insurer is selling an absence management program, maybe the absence management team will want to find some way to let employers know if the medical plan provider networks are so small they are wiping out major medical plan savings by leading to dramatic increases in costs related to unplanned absence.

Even if disability underwriters simply graded employer plan provider access on a pass-fail basis, that could give employers with failing grades information they could use to fine-tune their health benefits programs.

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