'Cries for Help' in Deciphering Regulatory Changes

Christopher Cheney, March 19, 2014

Payer and provider executives alike are grappling with a nearly crippling level of uncertainty on how regulations and rules will change their business.

"Risk comes from not knowing what you're doing."
—Warren Buffett

How do you run a business in a highly regulated market where the rules are seemingly in a constant state of flux? Health plans across the country are facing this quandary on deadlines that are often measured in days and weeks, not the months and years it takes for most businesses to react effectively to a changing market.

While health plan executives are reluctant to go on the record, I have been inundated with a flood of hushed complaints over the past two months from insurance industry insiders who say they are grappling with a nearly crippling level of uncertainty.

You do not have to look hard to find examples of what they are talking about.

On the new public exchanges for individual health insurance policies, carriers have faced a bewildering maze of business challenges from quarters that are largely beyond their control. Just in the past two months, federal regulators have changed or considered changing key ground rules for the new public exchanges, including the decision to allow individuals to keep insurance policies that do not comply with the Patient Protection and Affordable Care Act until fall 2016. For its part, the Centers for Medicare and Medicaid Services released a 148-page document that included details about proposed Medicare payment rate changes in the fiscal year starting in October.

Christopher Cheney

Christopher Cheney is the senior finance editor at HealthLeaders Media.


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