Obama administration officials spent eight years shaping the health insurance regulatory landscape to their liking.
Now, Republicans are moving in with their own ideas of what to plant and what to prune.
Rep. Tom Price, an orthopedic surgeon from Georgia who was picked to be Donald Trump’s nominee for Health and Human Services secretary, described his vision for the health policy garden this way: “a health care system that works for patients, families, and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovative spirit.”
Any existing laws, programs or products that survive their shears should be hardy enough to bloom for years to come.
Here’s a list of 10 products and services that might bloom in 2017, based on the changes in Washington, and the underlying demographic and health trends.
1. Federal health official conversations
This has been a tough eight years for agents and brokers who want to know what’s really going on in Washington.
Obama administration officials did not talk to them much, and what they said seemed to come from scripts written by happy robots.
Mike Pence, in contrast, has spoken at events set up by the Indiana State Association of Health Underwriters and the National Association of Insurance and Financial Advisors chapter in Richmond, Indiana. Tom Price appeared in February at a National Association of Health Underwriters conference in Washington.
Chances are federal health agency officials will talk to agent and broker groups more often in 2017, and talk about what’s on their mind, as opposed to what C3PO told them to say.
2. Senior market nibbler products
During the general election campaign season, Trump said he would protect Medicare benefits. But neither he nor Clinton talked about creating big, new health programs for seniors. The clash between the urge to help and the fear of new spending could breed senior market program proposals that are flash but cheap.
Seniors might need the government to create a public reinsurance program for private long-term care insurers, to help nurse that industry back to life. What seniors might actually get could be cheaper consolation prize options, such as a new tax break for long-term care insurance premiums that is narrower than it sounds, or Medicare mobile health device benefits.
3. Gap-fillers and support tools
Given all the uncertainty surrounding individual major medical rules in 2017, and rigid pricing rules, selling individual major medical insurance is dangerous. Agent commissions for selling individual major medical are scarce for the same reason commissions for hitting people in the head with bricks are scarce.
Agents hoping to get paid may have to look for sellers of products outside the individual market uncertainty zone, such as dental insurance, vision insurance, indemnity health insurance, wellness programs, wellness analytics services, and consumer and employee communication services.
The new administration could boost sales of gap-filler products that help pay for medical care, such as hospital indemnity insurance, by clearing away Obama administration- related efforts to shield issuers of ACA-compliant major medical coverage against competition from skimpier, cheaper alternatives.
4. Health accounts
Republicans wedged a new type of health account, a “qualified small employer health reimbursement arrange,” into the newly-signed 21st Century Cures Act. The QSE HRA revives small employers’ ability to give workers cash for individual health insurance premiums. Some moderate Democrats like health accounts, and Trump frequently mentioned expanding health account programs as a tool for replacing ACA coverage expansion programs.
If Republicans can get any new health measures at all through Congress in 2017, they’ll probably pass big health account measures.
5. More elastic ‘minimum essential coverage’
The Obama administration protected the long list of ACA requirements for solid major medical coverage, or “minimum essential coverage” — which is also known as “MEC,” which is pronounced “meck” — partly by not giving anyone clear information about how much ACA provisions such as the ban on annual benefits limits and the drug addiction treatment benefits parity requirements really cost. In 2017, federal agencies might give the public information better information about what each mandate costs, and that could lead to more variation in what plans cover. If plans vary more, consumers might need more help from agents and brokers to compare plans.
6. Voluntary risk pool programs
Some Republicans and insurers have talked about a return to use of risk programs, or special, tightly managed, subsidized insurance programs for people with serious health problems, to stabilize the individual health insurance market. Critics have recalled that many of the risk pools that existed before 2014 provided skimpy benefits, were underfunded, and had long waiting lists. One way insurers could get around the objections would be to create efficient but attractive risk pool programs and simply market the programs as a coverage option, rather than the government forcing some or many people with health problems into the programs. If signing up for the new risk pools was voluntary, insurers might need help from agents and brokers to find and enroll the program participants.
7. Private exchanges 2.0
Louisville, Kentucky-based Humana Inc. gave private exchanges a boost in November, when it reported that the loss of one large group Medicare Advantage account to a private account exchange program had cost it about 120,000 group Medicare Advantage enrollees.
But, for the most part, private exchange programs have been quiet this year, leading to questions about how successful they are.
The new players in Washington could boost private exchange programs in 2017, by killing the ACA public exchange system or helping private exchanges compete with the public system on an even footing. But the private exchanges benefit from some ACA provisions. Private individual exchanges, for example, benefit from ACA restrictions on medical underwriting. For private exchange programs in the individual and small-group markets, efforts to reform the ACA, or replace it with something that, in many ways, is similar, might be more helpful than a return to something like the rules that were in place in 2009.
8. Paperwork burden estimates
Federal agencies are supposed to estimate how much time filling out their forms and meeting other reporting requirements really takes. Obama administration paperwork burden estimators seemed to publish very low estimates and not give competing estimates much attention. The ACA was supposed to simplify benefits administration but ended up forcing employers to study up on counting full-time equivalents.
If the new administration takes efforts to measure and streamline paperwork more seriously, consulting firms that can help agents, brokers, plan administrators and employers measure the paperwork burdens, and propose ideas for burden reduction, might spring up and find many eager clients.
9. Health data protection ninja subscriptions
One frightening new source of compliance pressure is the effort by the U.S. Department of Health and Human Services Office for Civil Rights to audit how well health insurers and their agents are protecting sensitive health information against hackers, thieves and spies.
The companies affected by the audits might be able to get agencies to make the audits go more slowly, but they are unlikely to have much luck with easing requirements, given all the attention hacking has been getting, and ongoing hacker terror could continue to expand the market for health data protection services in 2017.
10. Mosquito netting
Mosquitoes began spreading the dreaded Zika virus locally in Florida this past summer. Aggressive mosquito control programs — and winter — helped control that outbreak.
In mid-December, the U.S. Centers for Disease Control and Prevention reported that mosquitoes had started spreading Zika locally in Brownsville, Texas, one of the poorest communities in the United States.
If cold weather and the CDC stop Zika in Brownsville, Zika will follow Ebola and the swine flu into the annals of diseases that looked as if they could cause serious epidemics but never did.
If Zika spreads rapidly in the mainland United States in 2017, and it causes the kind of brain damage in babies and paralysis in adults that it has caused in other parts of the world, then it might become the only health topic on this list that anyone really wants to talk about. The agent who can get a “foot in the door” in that situation might be the one who has ideas about how to keep Aedes aegypti mosquitoes from coming in the door.
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