The most rational response an agent or broker can make to the latest efforts to change the current Affordable Care Act system is probably, "Wow. How about that?"

But some producers, like other people, might want to come up with at least a hazy idea of how the individual major medical coverage market and related markets might work in 2018, given all of the conflict and confusion inside the federal government.

Consumers and employers will be desperate to hear your ideas about how health insurance will really work. The longer the uncertainty persists, the more they will look to you for ideas about what all that talk in Washington means for their ability to pay for their future medical care.

Critics of the Affordable Care Act system dubbed it "ObamaCare," even though, of course, it was former Senate Democratic Leader Harry Reid who disappeared into an office and came out with the tower of paper that changed the U.S. health finance system.

Some have dubbed the current effort to repeal or change the Affordable Care Act system "TrumpCare."

Here are five possible 2018 individual health insurance market NewCare system scenarios.

1. GrudgeCare

Officials in the Trump administration could decide, on the other hand, that they are so angry about the outcome of efforts to change the current system, and so convinced of the need to shock Democrats into getting serious about the need to make changes, that they will use every tool they have to cripple the system.

If so, and if the courts and Congress let administration do that, then the individual market could freeze, with insurers unable to issue any kind of viable, well-understood individual major medical coverage, either inside or outside the Affordable Care Act exchange system.

The disruption in the individual major medical market could be so severe that it could lead to explosive growth and unexpected underwriting problems and claim problems in adjacent markets, such as the short-term health insurance market and the hospital indemnity insurance markets, and force issuers of this products to throw up emergency barriers to keep the walking dead from slipping in.

In that scenario, agents and brokers may just have to turn away from the major medical insurance and focus on selling products in markets that still work.

2. VermaCare

Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, has openly supported Republican efforts to dismantle the current Affordable Care Act system, but she also ran the consulting firm that trained Indiana's HealthCare.gov navigators.

She has designed state Medicaid health reimbursement arrangement programs.

The program in Indiana seems to have worked. The program in Iowa seems to have worked less well.

But, if anyone has concrete, clear-eyed ideas about how to make the current Affordable Care Act System keep staggering forward, it might be Verma.

Maybe the Trump administration will give her the freedom to do the best job she can at keeping the system going, with the resources she has, and it will work pretty well.

In that system, agents and brokers may just have to keep abreast of the usual changes in programs, products and policies.

3. DoomCare

Still another possibility is that Trump administration officials will sigh and lick their wounds.

Then they'll go on to do the best job of overseeing the current Affordable Care Act rules and programs as well as they can, with as much warmth and flexibility as they can, and with reasonably generous financial support from Congress.

It's possible that, in that scenario, in which Seema Verma's team at CMS runs the system at least as enthusiastically as a Democratic president's team would have run it, the system will continue to deteriorate.

In this scenario, the market might end up working almost as poorly as the GrudgeCare market, but agents and brokers might have a real chance to help shape whatever comes next.

In that scenario, maybe policymakers will have a new interest in finding out what really works.

4. BlueStateCare

In a GrudgeCare or DoomCare scenario, states like California and New York state might find ways to keep their systems working at least as well as it worked in 2016, and even to find ways to make programs more efficient and more generous.

In that scenario, producers in some states might do much better than producers in other states.

Internal migration for purposes of seeking health coverage might be a bigger deal than international immigration.

Producers near state borders might find they spend much of the day helping clients figure out how to get insured in the state with the most appealing health coverage.

The headlines might be full of stories about BlueStateCare system managers coming up with ways to shut out sick applicants from states with less appealing health insurance markets.

5. PirateCare

The federal government and most states have tight rules governing how doctors, hospitals and other providers can just charge patients a "fixed amount for providing all the care they need every year."

The problem is that almost any organization that promises to provide X amount of goods or services in a given year for a fixed price is apt to over-promise.

It may sign up many more than customers than it can handle, run at a loss in spite of strong sales, and eventually close down.

This often happens to health clubs, and it has also happened to many subscription-based medical services package providers over the years.

The worse chaos gets in the conventional, well-regulated market for health insurance, health maintenance organizations, and accountable care organizations, however, the more physicians who have cash-only concierge practices will want to work with hospitals in their communities to find ways to make the concept work this time.

Oor at least long enough to keep their practices and their patients going while the individual major medical insurance market recovers.

Instant Insights /

5 possible 2018 health insurance market system scenarios

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