In 2013, we will go from wondering when the unsustainable U.S. health insurance market will collapse to watching it start to shimmy and shake like a gelatin skyscraper. The market isn’t supposed to fall apart in the coming year – but watch out for globs that ooze out early.
1. Fighting tooth and nail for market share.
Companies will be bidding viciously for Patient Protection and Affordable Care Act (PPACA) exchange building contracts, and crying bloody murder and suing when they lose out to other bidders. On the upside, though, this much competition is bound to be a truth machine for the industry, with the really sharp firms coming out on top, both in terms of service provided to the customer, and in results for themselves.
Image: Gov. Bill Haslam speaks to reporters after announcing in Nashville, Tenn., on Monday, Dec. 10 that that he had decided against creating a state-run health insurance exchange. The Republican governor said he will leave it to the federal government to run the marketplace required under President Barack Obama's health care overhaul. (AP Photo/Erik Schelzig)
2. Still more legal wrangling.
The Supreme Court will take up some case or another that will give everyone with a stake in the birth of the exchanges palpitations. Back in June, the court did not “uphold the Patient Protection and Affordable Care Act.” It simply upheld one key provision of PPACA, the provision calling for PPACA to impose a tax on people who fail to buy health coverage. There’s plenty of PPACA left to challenge. And not all of it is guaranteed to survive.
Image: People wait for the U.S. Supreme Court to rule on the constitutionality of PPACA. (AP Photo/Alex Brandon)
3. The price of procrastination.
Canny individuals will put off coverage decisions late in the year, or make strange coverage decisions, in anticipation of being able to get better deals in 2013. This will be especially true of older consumers with health problems in states that still allow full medical underwriting.
Image: Kathleen Watson, a cancer patient who also runs a medical transport company, waits for calls to pick up patients outside a hospital May 14 in Lake City, Fla. She is one of about 60,000 “uninsurable” patients who have gotten coverage through the PPACA Pre-existing Condition Insurance Plan. . (AP Photo/David Goldman)
4. Growth in group disability.
Maybe group disability insurers will start to report growing group disability case sizes, rather than ongoing in-group attrition. Employers have to get bored with shrinking sooner or later. Providing the economy doesn’t go off the fiscal cliff in 2013, the prospects seem good for some kind of economic recovery, even if only a modest one.
Image: Pedestrians huddle under their umbrellas in Times Square Oct. 29 in New York. The umbrella is the national symbol fo disability insurance. (AP Photo/ John Minchillo)
5. Finally, climbing out of the trench.
Interest rates will start to spike up at the end of the year, and the companies that held on to their long-term disability and long-term care insurance operations will suddenly look as if they’re run by rocket scientists.
Image: In this Dec. 14 photo, trader Robert Vella, right, works on the floor of the New York Stock Exchange. Stocks edged higher on Wall Street amid optimism that the lawmakers in Washington were closing in on a budget deal that would stop the U.S. going over the “fiscal cliff.” (AP Photo/Richard Drew)