National elections this fall may wind up being as much of a factor behind managed care stock performance as issues like the cost of medical care, according to a Citi analyst.

The biggest long-term concern hanging over health insurance stocks is the uncertainty of what will happen to companies after 2014, when major provisions of President Barack Obama's health care overhaul begin, analyst Carl McDonald said in a research note.

Public exchanges are scheduled to start that year, on which people will be able to buy health insurance coverage with help from government subsidies. The overhaul, passed in 2010, aims to provide coverage for millions of uninsured people, but it also imposes new regulations and fees on managed care companies.

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