Plenty of U.S. health insurance market stories could be the biggest health insurance story of 2014 — but most haven’t really changed anything all that drastically.
Health insurance agents and brokers have been anticipating drastic changes in the market since around the 1970s, when doctors got a reputation for owning yachts. “The other shoe” was always about to drop, but never quite dropped.
The health maintenance organization movement roared in, then ran into the trial lawyers.
The health savings accounts gave insured patients incentives to be better health care shoppers, but it did nothing to help uninsured patients.
Now the Patient Protection and Affordable Care Act (PPACA) has started to take full effect — but not really.
Many of the changes that PPACA was supposed to make in 2014, such as requiring large employers to provide a minimum level of health benefits or face the possibility of having to pay a fine, won’t apply until 2015, at the earliest.
In 2015, the Republicans will control the Senate as well as the House.
It’s not clear what they can do about PPACA, or what they will actually want to do, if and when they have the ability to do more than talk, but the results of the elections make making confident statements about “how PPACA has changed the health insurance market” almost as risky as trying to predict “how PPACA will change the market” in 2015.
Maybe the Republicans will rescind PPACA entirely, and blot it out as if it had never existed in the first place.
Or maybe they will change the PPACA “three R’s” risk-management programs — the programs that are supposed to help major medical insurers adjust for PPACA-related swings in medical claim risk — in a way that will put the satisfactory results health insurers have reported this year in a depressing new light.
But here are our early thoughts about what seemed to be the biggest health insurance story of 2014, and about the four runners-up.
For a few weeks in October, the Ebola story seemed as if it might be the only 2014 news story that really mattered.
Ebola was certainly the news story of the year in West Africa, where, as of Nov. 28, public health authorities had recorded about 16,000 known Ebola infections and about 5,700 Ebola deaths.
Ebola, and the fear of Ebola, led U.S. public health authorities to impose controversial quarantine and isolation orders, and to organize major contact tracing efforts. The Ebola outbreak threat may have sparked the first wave of quarantine benefits news articles to come along since insurance companies developed modern medical insurance and disability insurance policies.
At press time, however, Ebola had caused just four infections in the United States and two deaths.
This is a story that could fade from the U.S. health insurance market forever, or return and turn everything upside down.
4. The private exchange movement.
Brokers, insurers, technology firms, and established Web-based insurance brokers and quote services firms have been starting and expanding dozens of what are now called “private exchanges.” As opposed to “Web-based insurance shopping sites.” Or “Web-based insurance stores.” Or Martha.
The private exchange programs have many advantages over the PPACA public exchange programs, including a chance to escape from crippling bureaucracy and utopian expectations.
But it’s still not clear how big they really are, how they are performing, or what exactly they’re doing. Analysts at the Henry J. Kaiser Family Foundation have suggested that the private exchanges may be serving about 1.7 million group plan enrollees, and 2.5 million enrollees of all kinds. Accenture suggested in June that the number could be closer to 3 million.
The current total could be higher yet; two large private exchange organizers, Mercer and Aon, say their exchanges now serve a total of about 1.5 million people, up from 800,000 a year earlier.
3. The PPACA public exchange system.
Some 2014 health insurance stories could reasonably be compared with shoes, flying in the air, that eventually will drop.