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Remembering an Eventful Year in Healthcare

Les Masterson, for HealthLeaders Media, December 30, 2009

This time of year, journalists, writers, and editors try their hands at playing Nostradamus.

We think back on the current year, and predict what the next year will bring. Usually we offer these predictions at the start of the year and never look back at them. But this year I decided to look back to see how right—and how wrong—I was about 2009.

The year 2009 brought great hope—and fear. A new president and Congress looked to make changes to healthcare. This talk was celebrated by some in healthcare, while others—namely health insurers—were concerned about how these changes would affect them.

So, let's look back at 2009 and see how I did:

Healthcare reforms: Think incremental
On this one, I was correct in one aspect. I predicted health reform would be slow, but I also suggested that any health reform would not be meaningful." That's hard to gauge. As part of that prediction, I also suggested that states would not wait for the feds and would implement their own reforms. That has not been the case as states have stood pat while waiting for reform to make its way through Washington.

More children will get insurance in 2009
This one was a home run. I predicted that Congress would renew the State Children's Health Insurance Program (SCHIP) within President Barack Obama's first 100 days and lower income thresholds that would allow states to provide coverage to more children. Obama signed a new law that expanded SCHIP by roughly $35 billion over five years in February after a partisan vote on Capitol Hill.

I was right, but you didn't need to a crystal ball for this one—or my third prediction.

Medicare Advantage fight begins
Anyone who followed the 2008 presidential campaign should have seen this coming. Then-candidate Obama made it clear he did not like Medicare Advantage, saw it as a Republican giveaway to private insurance companies, and bristled at Medicare Advantage services costing the federal government 14% more than traditional Medicare.

Within three months of the new president taking office, the Obama administration implemented more regulations for health insurers that offer Medicare Advantage and the Centers for Medicare and Medicaid Services lowered Medicare Advantage reimbursements to health insurers.

Cutting Medicare Advantage payments are also seen as a way to help fund health reform and a source to help balance the federal budget.

In response, some insurers have dropped out of the Medicare Advantage program and more could follow with the payment cuts being eyed in health reform.

What will be interesting is to see if there is any political backlash from seniors when the impact of lost Medicare Advantage programs is felt in 2010.

More employers will turn to CDHPs
The percentage of employers with consumer-driven health plans did not spike as much as I expected in 2009, but the growth of CDHPs has been gradual since they became an option in the early-2000s. America's Health Insurance Plans said CDHPs increased by 2.5 million members between 2008 and 2009, but CDHPs are still not anywhere near as popular as PPOs and HMOs.

However, these plans are affecting other types of benefit design—both negatively and positively. First, on the negative side CDHPs have inspired employers to create high-deductible plans, which in many ways are just a means to pass health costs onto the consumer. What's often lacking in those plans is the education component. On the plus side, forward-thinking employers and health plans are learning from consumer plans and spreading that education to other plans. So, some insurers are now offering the same healthcare educational opportunities to members regardless of their benefit design.

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