First, many advisers were waiting for the Affordable Care Act to be repealed, either by actions of the Supreme Court or, indirectly, by the American electorate. Neither came to fruition. Now, the waiting game continues, this time around just how much it will impact health care costs.

In speaking with many of you about your thoughts on President Barack Obama's landmark legislation, I'm hearing nearly unanimous consensus that the ACA is leading us down the road to astronomical rate increases and a spike in the nation's health care spend. You've got the words, "I told you so!" perched at the tip of your tongue, just waiting to be spoken in 2014.

Meanwhile, however, there is some indication that the changes brought on since the ACA became law in March 2010 may be having a positive effect on health care inflation. Or at least, indication that it can't be proved that they aren't.

Stay with me here, folks. According to research from two studies published last month in the journal Health Affairs, about 37% of the slow in medical cost growth from 8.8% in 2003 to 3% from 2009 to 2011 can be attributed to the recession. An additional 8% comes from declining private insurance coverage and cuts in Medicare payments, but the remaining 55% is "unexplained," wrote study co-author David Cutler, a Harvard University health economist.

A former Obama adviser, Cutler told Bloomberg News that, although neither study calculated the effects of the ACA directly, structural changes brought on by its passage mean it is "gathering steam over time."

He continued, "It's not a coincidence that these things are happening at the very same time that policies are starting to penalize readmissions, infections, and things like that."

Do you buy it? I, for one, am hopeful that Cutler is right. For better or worse, we've got the ACA, and I'd like to see something positive come out of it. Cutler's research found that if the current 3% growth rate continues, the U.S. could see $770 billion in savings through 2021.

Such savings would surely provide a reason to bite your tongue. Alas, the realist in me won't be holding her breath.

But, even if the ACA doesn't turn out to be our "unexplained" hero of health cost savings, that doesn't mean there won't be any benefits to it. This issue of EBA, along with our online coverage at, is packed with ways for you to take advantage of the new landscape carved out by health care reform.

Nelson Griswold shares not one but four opportunities for you in "New post-reform roles for brokers," p. 20. "Successful post-reform benefits firms will be consultative and able to solve meaningful business problems," he says.

You know, problems like skyrocketing costs.

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