The disruptive force of health care reform has garnered comparisons to natural disasters since the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010. With potential show-stoppers behind us, there are still more notable milestones to pass before 2014’s seismic shift.

What’s at stake for health care market players

Health care as we know it evolved organically, giving us a market that covers people who are employed full-time but leaves millions un- or under-covered in a system imploding under the strain of its costs. Before the tipping point of 1/1/2014, there’s much to be done:

  • The law continues to shape the market and some key elements for employers are yet to be clarified, such as the final regs on essential health benefits and whether health reimbursement arrangements (HRAs) can be counted as meeting employers’ obligation to provide health care benefits.
  • Insurers are building new plan designs to meet qualified health plan requirements and trying to figure out how they must adapt to serve an enormous new consumer-focused market.
  • Health care providers are partnering with insurers to implement new models of assessment, patient care and remuneration designed stem the pace of cost increases.
  • Employers, who provide health coverage to most of the nation, must determine how to make the most of the law for employees and their businesses.
  • People – the consumers of care – whether they’ve had the benefit of employer-sponsored health benefits or little to no coverage – will be able to get more involved in selecting coverage and managing their needs than ever before.

These diverse players will all meet up in the new private and public insurance marketplaces – health care exchanges.

As much as the news is filled with incremental announcements in the development of public exchanges (the state and the federal marketplaces), 2013 may well be the eye of the storm for employers who are figuring out what it all means for them as the health care insurance market gathers definition.

See the Watch This blog “Insights for 2014 from Today’s Most Successful Exchanges” for insights from Bryce Williams – Extend Health CEO and Towers Watson Managing Director of Exchange Solutions – on what industry and business leaders are facing this year.

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January 30, 2013

Check out the latest blog post from Bryce Williams: Insights for 2014 from Today’s Most Successful Exchanges

Watch This

The genesis of the Medicare exchange market offers some good insights about what things could look like after the seismic shift that’s coming to the rest of the insurance market in 2014.

The law changes. In 2003, the Bush administration enacted the Medicare Prescription Drug, Improvement and Modernization Act (MMA), creating a thriving market for guaranteed-issue medical and prescription drug plans that could finally be compared head-to-head.

Companies and insurers engage. In 2005, one of the Big Three auto manufacturers challenged Extend Health to get better rates on Medicare plans than it could: In the close radius of the company’s headquarters, it had good enough sway, but having to rent networks in retiree destinations from Florida to Nevada meant its group plan was less efficient than the burgeoning individual Medicare market.

Extend Health built a network of national and regional carriers that offered retirees the same or better individual Medicare…

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