One year after the passage of healthcare reform—embodied in the blockbuster Patient Protection and Affordable Care Act (ACA)—it’s still difficult to see just what form it will take and, more important, what kind of impact it will have on the marketplace.

The jury is still out on what promise to be the law’s most disruptive aspects: the shape, form, and function of the exchanges; the effect of MLR floors on broker compensation; and employers’ inclinations related to defined contribution and exchanges. And the biggest issue facing US healthcare—healthcare value and affordability—seems to have taken a backseat to access, at least in much of the popular press.

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