These are unsettling times. Confronted with unsustainable costs and tens of millions without health insurance, our national debate over healthcare reform continues despite the passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010. While virtually all stakeholders agree with the overall objective of reform — achieving better health outcomes at lower cost — there are many different views (and agendas) regarding how to best achieve it.
In particular, insurers must comply with new regulations regarding medical loss ratios designed to reduce spending on health plan administrative costs and promote spending on preventive and wellness programs. The Essential Healthcare Benefits package that becomes mandatory in 2014 will reduce competition based on coverage levels. And insurance exchanges present a new market mechanism that will pose additional challenges.