The health benefits community has been waiting for some force — a shift in employer preferences, a shift in insurer strategies, an upheaval in Washington or state capitals — to drop a hammer and smash everything to bits for decades.
People have been watching for the hammer ever since managed care organizations came along and smashed Indemnity Plan World.
1. For some people, PPACA World will be heaven.
If the PPACA exchange plans really start to operate in 2014, and the PPACA rules that govern the individual and small-group markets really take effect in the coming year, at least for some new plans sold to some people, then the rules will hurt some and help some.
Many reasonably healthy people with what has been decent coverage will pay more for coverage and have a harder time getting care in-network.
3. In states that have relatively low exchange plan enrollment because of exchange enrollment system problems, doctors, hospital executives, insurers and insurance regulators will send thank-you notes and bouquets to the information technology companies that caused the system problems that held down enrollment.
The Congressional Budget Office (CBO) predicted that the QHPs would enroll about 7 million people by the end of 2014.
Opponents of the Democrats are hailing any sign that the exchanges will fail to meet the CBO QHP enrollment goal as a wonderful sign that the exchanges, PPACA and the Obama administration are failing.
4. The insurers, agents and brokers that sell hospital indemnity insurance, accident insurance, critical illness insurance and other products that are exempt from PPACA underwriting and pricing rules will flourish.
Even if PPACA World ends up working fine, insurers, employers and consumers are entering 2014 facing so much uncertainty that they will have a hard time making any decisions. They will just sit there, staring at computer screens, wishing someone else would call the shots.
Meanwhile, whether PPACA World really arrives or not, consumers will have higher deductibles, and they will face higher co-payment amounts, higher coinsurance levels and tighter limits on coverage for out-of-network care.
5. Health policymakers will start thinking about what PPACA World 1.5, Son of PPACA, or Anti-PPACA World might look like.
After watching consumers flail around trying to figure out how to pay $11,500 in out-of-pocket health care costs each year, they might start thinking about either lowering annual maximum out-of-pocket spending limits or encouraging the sale of gap fillers.
After getting reports about consumers struggling to make timely appointments with the rare doctors who happen to be in the new, narrow “high-performance provider networks,” the policymakers might start to think about updating network adequacy standards.