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10 health insurance stories to watch in 2016


It looks as though change will continue to be a constant in the health insurance industry in 2016.

After all, this is the age of the Affordable Care Act, a massively disruptive force that continues to shape the healthcare sector in unexpected ways, even as the law itself evolves. Then there's the specter of a certain election coming up in the fall.

But even beyond policy-mandated shifts, market forces and the rise of consumerism have forced health insurers to rethink how their businesses work and how they engage with members and providers. And in 2016, those trends will continue.

For a reporter like myself--and healthcare consumer who recognizes the industry still has much to improve--this is all good news. Change can be unnerving, though, and I find the best way to deal with it is to get a sense of what's coming, even if predictions can be problematic.

With that in mind, here are 10 of the biggest stories that the editors of FierceHealthPayer believe will shape the health insurance industry in the coming year:

1. Outcome of the mega-mergers. If the mere announcement that Aetna and Humana as well as Anthem and Cigna planned to merge was enough to captivate the industry in 2015, these deals are only going to rise in prominence in 2016. The Department of Justice and state authorities have the final say on whether the mergers are allowed to proceed, but providers, consumer groups, politicians and even shareholders are sure to continue to weigh in, as well. And if the deals do get the green light, the stakes will be high for companies to properly execute consolidation. Both pairs of insurers have said they expect a decision from regulators in the second half of the year.

2. The 2016 election. Politics' influence on the health insurance industry will loom larger than ever this year as Democrats and Republicans vie to replace the ACA's chief architect, President Barack Obama. Healthcare policy has already made its way into early campaigning, with GOP candidates sharing how they'd repeal and replace the ACA. Democratic candidate Bernie Sanders has touted a single-payer system, while Hillary Clinton has criticized the ACA's Cadillac tax, the pending insurer mergers and the rising cost of prescription drugs. And while the campaign rages on, congressional Republicans plan to move forward with a bill to repeal large swaths of the ACA, even as the recent budget deal has postponed some of its key taxes.

3. UnitedHealth's role on the ACA exchanges. The nation's largest insurer made waves in late November when it adjusted its earnings outlook to account for losses in ACA plans, leading many to wonder if its view that the individual marketplace is unsustainable has merit. While other insurers have made it clear they're willing to wait until the marketplace stabilizes, UnitedHealth's decision about whether to offer exchange plans in 2017 could serve as a major turning point. In the meantime, expect each major insurer's quarterly earnings updates to be closely watched for more signs of trouble.

4. The fate of consumer operated and oriented plans. With a variety of factors working against them, many CO-OPs began a downward spiral in 2015. Only 11 of the original 23 remain, and 10 of those have lost more than $21 million. With risk corridor payments expected to continue to fall short for the 2015 benefit year and policymakers unclear about what to do about the CO-OPs' struggles, the future of the small nonprofit insurers looks grim even as some CO-OP leaders have formed a coalition to advocate for policy changes. It also remains to be seem how continuing CO-OP failures will impact the still-volatile ACA exchanges.