Brokers, carriers and politicians have written and spokenvolumes about the status of health care benefits in 2017. As the yearwinds down, is it possible to sum up the 12-month roller-coaster in just one word?

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“Uncertain,” says Liz Gallops, individual insurance specialistfor Allegacy Benefit Solutions in Winston-Salem, NorthCarolina.

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“Chaotic,” offers Arthur Tacchino, J.D., principal and chiefinnovation officer for SyncStream Solutions in Baton Rouge,Louisiana.

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Not surprisingly, the failure of the U.S. Senate to repeal and replace the Affordable CareAct (ACA) was both the major story and the leading cause of ulcersamong insurance professionals this year.

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“The congressional efforts to repeal and replace the ACA havecreated a state of confusion for employers,” Tacchino says.“They’re unsure whether they need to offer coverage or continue tocomply with the ACA's complex tracking and reporting requirements.Employers see premiums rise while simultaneously hearing thatpoliticians will take action to drive premiums down, but thennothing is done. In fact, the opposite is happening. This yearseemed as hectic and confusing as it did in 2010, the inauguralyear of implementing the ACA.”

Back to the status quo

Despite campaign promises, passing repeal and replace was alwaysa longshot, says Craig Paulson, president of Altura Benefits inSalt Lake City and president of Utah Association of HealthUnderwriters.

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“It was never politically feasible for a full repeal and replaceto occur,” he says. “The short-term impact of no ACA revisions willbe continued instability in the personal plan market. In the longrun, the market will remain unstable unless politicians can reachbipartisan solutions to making the ACA better.”

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Chris Byrd, executive vice president of Wex Health in Hartford,Connecticut, agrees.

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“We reached the end of the road on the ACA and now are returningto normalcy,” he says. “Many employers were watching and waiting tosee if there would be a wholesale change in the framework andwanted to hold off on making big strategic decisions. The ACAremains the law of the land. They had dealt with it before and knowit will stay in place for now.”

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What does this return to the status quo mean for brokers andtheir clients?

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“The short-term impact is definitely continued confusion,”Tacchino says. “In many ways, the failure of the Senate to repealand replace Obamacare may also drive non-compliance. There werecertainly employers who believed the ACA was going away and didn'tthink they’d need to comply this year. Now they’re scrambling toretroactively comply.

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“The long-term impact is hard to tell. However, it will beinteresting to see if repeal and replace gets revisited in early2018. Another failed attempt by Republicans, just before the 2018midterm elections, could significantly impact their control of theHouse and Senate, and they may decide that, strategically, they’renot willing to take that risk. This would only prolong the ACA andembed it even further into society.”

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Individual consumers face the same challenges.

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“It creates more immediate attention on the ACA and confusionfor the average consumer as to the existence and viability of theprogram,” Gallops says. “Long term, it sets up the possibility forbipartisan reforms to improve the ACA. But it also opens the windowfor the executive branch to push through regulatory changes toundermine the ACA reforms and create more instability in themarket.”

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However, not all of the regulatory developments were bleak.

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“Seventy-one percent of small businesses don't offer grouphealth insurance to their employees,” Byrd says. “At the end of2016, many of them were able to offer health reimbursementarrangements (HRAs) that employees can use to purchase individualhealth insurance or pay out-of-pocket expenses. A recent executiveorder directed agencies to look at other ways to expand HRAs to gobeyond the 21st Century Cures Act.”

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There also was good news for an often-maligned governmentprogram.

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“We saw many positive things happen for Medicare Advantage,”says Kristine Grow, senior vice president, communications, forAmerica's Health Insurance Plans in Washington, D.C. “Nearly athird of beneficiaries now choose a Medicare Advantage plan.Ninety-nine percent of Medicare beneficiaries will have access toat least one Medicare Advantage plan in 2018. Over half of Medicarebeneficiaries live in a county that has at least two additionalMedicare MA-PD plans from 2017. In addition, all beneficiaries willhave access to at least one standalone Part D plan.”

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In addition, the cost of these plans continues to fall.

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“According to CMS, the average Medicare Advantage premium isprojected to fall 6 percent to $30 per month in 2018,” she says.“For Part D, the average monthly premium next year is estimated tobe $1.20 less than 2017. Moreover, most seniors who choose an MA-PDplan don't pay any premium. And more than half of MedicareAdvantage enrollees are in plans that will continue to have a zeropremium next year.

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“Overall, in 2018, 84 percent of beneficiaries will have accessto a zero-premium MA-PD plan, up from 79 percent in 2017. Surveysshow 90 percent of Medicare Advantage enrollees are satisfied withtheir plan, preventive care coverage, benefits and choice ofprovider.”

Away from Washington

Not all of the news in 2017 came out of Washington. Leadinginsurance carriers made their presence felt from Wall Street toMain Street.

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“If you leave politics aside, two things brush up against eachother,” Byrd says. “First is the collapse of the two bigmergers—Aetna and Humana, and Anthem and Cigna. Massiveconsolidation of carriers has been halted. However, there has beenmore consolidation on the provider side, with several turningthemselves into powerhouses. There has always been a power strugglebetween insurers and providers, and to the extent that providerscontinue to conglomerate and insurers do not, it could have animpact on the industry.”

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Carriers also continued to refine their product offerings in thenever-ending quest to balance features and price. “There has not been a hugeamount of innovation product-wise because of the constraints of theACA,” Byrd says, “but we see continued penetration ofhigher-deductible plans by employers.”

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Consumers increasingly are driving the changes.

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“We continue to see a strong movement toward consumer-centricofferings,” Grow says. “Health plans continue to find new ways toserve their members. Some are offering cost- andquality-transparency tools to help members make better informeddecisions about where to go for care.

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“Some are offering more personalized support through a member'shealth care journey—to help ensure a healthy baby, for example, orto help manage a chronic condition like diabetes or a heartcondition. Some are offering access through more robust mobiletools for greater convenience. Others are offering online trackingtools to help members achieve a health goal. There is a strongdrive to make health care more convenient, more accessible and morepersonal.”

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More employers are turning to wellness programs to both improveoutcomes and hold the line on expenses.

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“Many employers are now utilizing wellness plans and seeing thesignificant benefits of offering these types of programs to theiremployees,” Tacchino says. “Also, we continue to see the healthcare industry utilize and leverage technology in myriad ways. I seethis is as a tremendous benefit to all parties involved and I thinkthe industry will continue to find efficiencies by leveragingtechnology.”

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Grow points to several emerging trends among productofferings.

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“Employers are increasingly demanding value for the care theypurchase for their employees,” she says. “We have also seen growthin high-deductible plans and in health savings accounts. And let'snot overlook non-major medical coverage. Coverage for dental,vision, disability and long-term care all play an important role inensuring that you can get the care you need without jeopardizingyour financial security.”

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The most ubiquitous—and predictable—trend comes as littlesurprise to brokers.

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“Premiums continued to rise,” Tacchino says. “That was theobvious trend. Carriers remained compliant with the ACA andcontinued to offer more comprehensive coverage, but with stricterunderwriting rules.”

Looking ahead by looking back

If 2017 has taught brokers anything, it's that the future isimpossible to predict. However, this year's trends can provide avaluable roadmap as they look ahead to 2018. What do experts see onthe horizon?

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“The biggest 2017 development that impacted benefit brokers wasfailure of the repeal and replace efforts,” Tacchino says.“Brokers, like employers, had to wait to see the fate of the ACA,and this created a lot of uncertainty. It had, and continues tohave, a major impact on brokers and how they advise theirclients.

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“As brokers look toward 2018, they should continue to guideclients with ACA compliance in mind and reaffirm with their clientsthat the ACA is still the law of the land. Brokers need to makesure their clients are taking steps toward compliance, whilecontinuing to document all decisions.”

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Grow expects a continued focus on putting consumers first.

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“We will continue to see health plans push to ensure that we getthe greatest value out of every dollar spent on premiums and care,”she says. “And health plans and providers will continue to worktogether to ensure that patients get the right care in the rightsetting and that patients achieve their best health. Health planswill continue to be strong partners at the federal and state levelsto advocate for improvements to health care for everyAmerican.”

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Forward-thinking brokers can turn this uncertain environmentinto an opportunity for success.

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“Employers are hungry for guidance, so brokers will have to bemore than just a distributor of products,” Byrd says. “They have tobe consultative about products and to some degree, laws andregulations.”

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That's why he believes that the best way to succeed in 2018 isto tune out the noise and listen closely to clients. “I like totell people that what goes on in the market is a lot more importantthan what goes on in Washington.”

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