Reform

Reform Uncertainties

The recent Florida ruling, siding with 26 states in finding reform unconstitutional, will create more uncertainty and require very close attention by health plan executives. Specific reform regulations, as they develop and/or are refined, could result in up to 32 million more insured lives (and maybe 100 million individuals choosing their own individual benefit package), but will result in dozens of new agencies, grant programs, pilots and demonstration projects, in addition to adjustments to the insurance markets and payments. To the degree that reform goes forward, many unique state and regional market differences, personalized collaboration tools, privacy technologies and social media innovations and adoption will play an increasing role in a health plan’s future or require MLR waivers or other exceptions. If reform is repealed, some current efforts may need to be “sunset.” Uncertainty over whether comprehensive reform repeal takes place or just piecemeal refinement or defunding of some programs, and whether it happens at the Federal level or at the State level, will have a significant impact on health plan strategy, operations and market positioning.