Will it still be a poorly-communicated political football? Absolutely.  

Because I receive something like 100 pages of updates, guidance and love from HHS every week, I don't think making cogent predictions on the form of the ACA is very wise. But one past blog post that has come true in a huge way is the one in which I said the success or failure of the marketplaces was going to hinge on the quality and volume of communication done about the ACA.

What I did not anticipate was the total crash of the web portal for most states.  Second-rate vendors, working with third-rate governmental supervision produced fourth-rate quality results. Who knew?

So, beyond the ACA, what will be big issues in the first half of 2014? 

Overall, fewer players, more transparency and more complex strategies.  By players, I mean on all fronts.  Brokers and agencies are growing, merging or selling themselves and leaving the market altogether. The net result is similar to the airlines – fewer but larger carriers and smaller, boutique firms filling the gaps. This will continue, resulting in very few small individual agencies out there, with mid-sized regional and mega-national firms holding the lion's share of the business.  Healthcare providers are merging in several ways, including hospitals buying up multi-physician practices, and smaller regional hospitals selling to their larger metro area neighbors. Carriers are shifting out of unprofitable markets and being very careful about their participation in the marketplaces. So, overall, we'll see fewer choices in many areas.

The winds of transparency are blowing through. Technology is enabling a lot of this, with a bunch of new mobile apps and data-sharing and decision assistance out there to help drive good health care spending decisions. I predict all major carriers will be offering smartphone-based tools designed to help consumers. This will work, but not because people want gizmos, but because consumers are wanting (no, demanding!) transparency in all their transactions. They are getting it in many other areas of their lives; they want it in health care now.  And they're willing to tweet about it.

Other future bit bytes:

• Narrow networks are driving a return to the good old HMO mindset. What's old is new, again.
• Voluntary benefits are stepping up to fill the gaps left by high deductible health plans. Expect to get some sales calls on this topic.
• PEOs are stepping up, rather than disappearing, and are taking smaller employers and pooling their numbers.

Through all of this, the biggest, most important trend is a return to aligning benefits strategy with organizational strategy.  The smart ones (and, you know who you are) will be using a clean sheet of paper and redesigning from the ground up, and blaming the long-overdue redesign on the big, bad ACA.

Now that I've made a few predictions, back to your action-packed life, either getting set for open enrollment or planning Thanksgiving dinner. Or both.