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On the Third Hand: 2014 clairvoyance grades

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A year ago, I tried to imagine how the start of major Patient Protection and Affordable Care Act (PPACA) coverage expansion programs and health insurance rules would change the health insurance community. I compared the new PPACA World to a hammer that was about to fall on the old U.S. health insurance world.

“PPACA might come and smash Managed Care World as we know it to bits Jan. 1, or a few weeks or months later, or it might just blow away, or something else,” I wrote.

I now think the best description of what PPACA World did is “something else.” The hammer still…seems…to…be…falling.  Ever so slowly toward our heads. Someone else has a PPACA public exchange plan. Someone else has doctors struggling with the new narrow provider networks. But many people, including me, are still in some kind of grandfathered plan, grandmothered plan, or other non-PPACA plan that’s operating pretty much the same old way it always has.

This is getting to be the time of year when reporters like me write our forecasts for 2015. Before I do that column, here’s a self-evaluation of how I did with the predictions I made for 2014.

1. For some, PPACA World will be heaven.


This is not the case for most of the people reading this.

PPACA World has not been easy on health insurance brokers, benefits compliance specialists, or the many conscientious people who are now paying more for less coverage.

PPACA has been great for the sick people who were shut out of the commercial health insurance system for years.

Their coverage may not work all that well, but at least they have coverage to complain about.

2. Exchange managers will get into brutal court fights with the vendors that designed, built and integrated balky exchange enrollment systems.


This seems to be happening, or on the verge of happening, in a number of states.

3. In states that have relatively low exchange plan enrollment because of exchange enrollment system problems, doctors, hospital executives, insurers and insurance regulators will send thank-you notes and bouquets to the information technology companies that caused the system problems that held down enrollment.

I can’t yet tell.

At this point, few providers seem to be complaining all that much about exchange plan payment problems, but it’s hard to tell whether that’s because there are no problems, or because the problems are so serious the providers don’t yet grasp how big the problems are.

4. The insurers, agents and brokers that sell hospital indemnity insurance, accident insurance, critical illness insurance and other products that are exempt from PPACA underwriting and pricing rules will flourish.

As far as I can tell, yes, at least in terms of sales.

We won’t really know how the underwriting went until the statutory annual reports come out in 2015.

Insurance regulators tend to view rapid growth as a risk factor for an insurer as well as a blessing, and that might be as true for the issuers in the gap-filler market in PPACA World as for issuers in any other hot market.

5. Health policymakers will start thinking about what PPACA World 1.5, Son of PPACA, or Anti-PPACA World might look like.


The answer here depends on whether you regard the various House PPACA repeal and change proposals as efforts to create the Anti-PPACA World or simply efforts to rattle the Democrats.

6. The people directly involved with the dental, vision and disability insurance markets will be looking for someone — anyone — to talk to.


It’s hard to express how guilty I feel about some of the dental, vision and disability stories I have failed to cover this year because of PPACA Mania.

7. The flexible spending account (FSA) carryover rule will bite employers and their human resources’ staffers and vendors in the hind parts.

See my self-evaluation for the sixth question.

I suspect that this is the case, but it’s hard to get myself to move from thinking about PPACA to thinking about… something else.

On the one hand: I think I did pretty well on these. On the other hand, time is the true grader. On the third hand, we may never really come to a Red-Blue agreement on some of these. Maybe I’ll always have to give myself a Red grade and a Blue grade.


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