There are also issues about how to educate consumers about these changes. Fred Karutz, general manager of health plan solutions at Silverlink Communications, predicted there will be "mass confusion, for employees, members, and providers about how the new rules apply" for insurance over the next few months.
Insurers will need to undertake a "multi-faceted communication approach, providing each constituency a road map of change, and how to access the latest information," Karutz says.
Among the changes for health insurers are rules that could drive smaller insurers out of business, according to conservative commenter Edmund Hasilmaier, senior researcher for the Heritage Foundation's center for health policy. Creation of state-run exchanges in the bill potentially undermines insurers' ability to have flexibility in underwriting and other matters because the government may have final control on types of coverage in a market, such as excluding insurers from some exchanges because of cost, he says.
Hasilmaier adds built-in regulations within the new measures may result in a stranglehold on the industry, as a "regulated utility with a limited rate of return with very few players" in a position to make profits.
Hasilmaier says young people not buying into the health insurance system could "exacerbate everything they are trying to fix."
While some insurers oppose reform and some are mixed, Kaiser Permanente of California has been one of the most enthusiastic supporters.
"Reform will make history and improve lives in some important ways," company spokeswoman Trish Doherty said. "This legislation also would establish a number of important principles that, over time and with continued refinement, should improve the functioning of the health insurance market and healthcare delivery system."