Regardless of the recent Supreme Court ruling on the Patient Protection and Affordable Care Act (PPACA) (available here in its full 193-page judicial glory), or how the election plays out November 6, healthcare reform will continue to exert many pressures on the health insurance marketplace. These pressures may fundamentally change the way millions of Americans receive their coverage in the future. This is particularly true for Medicaid and other types of insurance that will be delivered at the state level.
First, let’s talk about Medicaid. The PPACA contains rules and regulations that will increase the Medicaid population. CMS estimates that the number of Medicaid enrollees will grow by 14.9 million in 2014, and by 25.9 million in 2020. Healthcare providers, payers, states, and pharmaceutical manufacturers will be impacted significantly by this growth. Pharmaceutical, medical device, and diagnostics sales professionals will need to understand how this growth will affect a variety of stakeholders in the marketplace, including their own company.
And, as if the expansion of Medicaid wasn’t enough to keep track of, here come state-based health insurance exchanges (HIXs). Starting in 2014, these exchanges will introduce an entirely new process, and options, for selecting and purchasing commercial health insurance policies. The introduction of HIXs has the potential to shift the market from predominantly large-group policies to a significant number of individual and small-group policies. Industry sales professionals and organizations will need to understand how these changes will affect their customers.
Now, here is the kicker: The expansion of Medicaid and the introduction of HIXs are going to happen at the same time. This means that states will have a choice: They can cover more lives through their Medicaid programs or take advantage of subsidies offered through state-based exchanges. Whatever they decide, their decisions will change the environment in which your sales professionals do business. When planning for your managed markets training in 2013, don’t overlook Medicaid and what’s happening at the state level, no matter what happens with healthcare reform.