The year in health care: adjusting to change

From the first open enrollment period under the Affordable Care Act to the unveiling of Apple’s HealthWatch, the health care industry has seen some big advancements and major changes in 2014, making it a year of constant adjustment for benefit advisers.

“I’ve been at the helm of our firm for 35 years and we’ve seen more change in the past two years, than in all of my 33 years before that,” says Hyatt Erstad, president of the Boise, Idaho-based insurance company Erstad and Company.

It’s no secret the Affordable Care Act has dramatically changed the health care industry as we’ve known it, and 2014 has seen many of those changes implemented, including the first open enrollment period for individuals to enroll on the exchanges.

“As I look at 2014 from the highest level perspective it will obviously be the first full year of the individual mandate, court opinions around federal subsidies, and minimum value plans,” says Les McPhearson, CEO of United Benefit Advisors.

Benefit advisers and their employer clients have spent much of the year trying to inform themselves about the rules, requirements and looming deadlines of the ACA; a task made more difficult by further deadline delays and rule changes announced by the Obama administration in 2014.

Most notably, President Obama announced in February that employers with fewer than 100 employees will not be required to provide health insurance to their employees until 2016.

See related: Benefits industry mostly thankful for another ACA employer mandate delay

The benefit broker/agent industry is “constantly in a state of change. Every day we’re expected to morph into whatever is necessary to accept the change the alphabet soup of federal agencies and the ACA throws at us,” says Ronnell Nolan, president and CEO of Health Agents for America Inc., adding that she believes brokers and agents are meeting the challenges with gusto and will continue to do so in 2015.

“We must be prepared to work in any box that may be delivered to us, regardless of the change. We must continue to provide the American people with the excellent service they deserve, when purchasing insurance. Change is far from over, but do not give up,” she adds.

See related: Expanded coverage under ACA means extra work for adviser, little extra pay

Joel Wood, senior vice president of Government Affairs for The Council of Insurance Agents & Brokers, agrees, “With all the remaining uncertainty and anxiety about ultimate threats to the employer-provided group health insurance marketplace our members have done damned well and we continue to see tremendous growth on the benefits side. Much of that is because clients are turning more and more to brokers for guidance and for helping manage costs.”

High health care costs

With health care costs trending higher again in 2014, employers continue to look for ways to soften the blow to their bottom lines, including shifting more of the cost burden onto employees. High-deductible plans continue to be popular with employers juggling the need or desire to offer health insurance to their employees without breaking the bank. 

Under some medical plans, an employee’s total out-of-pocket costs for medical care can be as high as 40% — up to an annual maximum of $6,350 for an individual and $12,700 for a family in 2014. 

See related: How to help employees close the widening gap in health insurance coverage

Understanding that high medical claims typically account for the bulk of their high health care costs, many employers are also embracing wellness initiatives targeting the underlying diseases and medical conditions that lead to high-cost claims.

With innovative systems and technologies such as data analytics and Apple’s wearable wellness watch looking to shake up the health care industry even further, 2015 will likely be another year of change.

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