In a white paper on how the final MLR regulation creates challenges for high deductible plans, Roy Ramthun, president of HSA Consulting Services, writes that the MLR regulations create several challenges for fully-insured high-deductible health plans since they are designed to pay out fewer claims due to upfront deductibles while they still have all of the administrative costs associated with adjudicating and tracking these claims.

Ramthun wonders if insurance companies will still be selling insured high deductible plans in 2014. “Insurance companies (especially the current market leaders) may be encouraged to sell more expensive plan designs with more first-dollar coverage (e.g., HMOs and traditional PPOs) because it will be easier to meet the MLR requirements,” he said.

The pace of health care reform change will slow somewhat in 2012 with only 11 new provisions set to become effective, and with the exception of Uniform Coverage Summaries for Consumers, most of them impact Medicare.

However, 2012 will deal two wild cards that have the biggest potential yet to change both health care reform and the future of CDHPs: The Supreme Court challenge and the presidential election. All of the declared candidates opposing President Obama have said they would push to repeal PPACA and replace it with a more CDHP-friendly law if elected.

Where does that leave CDHPs? Regardless of what happens in the courts or at the polls, it appears employers have already decided that they are going to continue to shift their health benefit programs to CDHPs. This trend has shown up in the latest data from the Employee Benefit Research Institute which indicates the number of Americans enrolled in CDHPs increased again last year and now include 21 million individuals covered by private insurance representing about 12 percent of the market.