We are more than halfway through 2016, and the Affordable Care Act's (ACA) initial implementation is almost complete. As we finish out 2016, there are many health insurance challenges and possible changes that could be headed our way.

Much of what happened in 2015 continues to impact our industry in 2016, and there are a few events that continue to shape and mold the health insurance industry:

• Mergers among large health insurance carriers

• Focus on the repeal or extension of the ACA's most contentious provisions, like small group expansion, 30 hours considered full-time, medical loss ratios and the Cadillac Tax

• Employer preparation for new reporting requirements 

The implementation of the ACA majorly impacted the role of insurance brokers, largely because their clients' needs shifted. Clients who previously cared more about price negotiations, now need brokers in a more consultative role: negotiating prices, insurance policy packaging, and providing guidance regarding regulatory act compliance. 

Even though the ACA has significantly changed the insurance industry, the popularity of the law is still split.  Some of the effects, both positive and negative have been: 

• The uninsured rate is now around 10 percent, down 3 percent since the implementation of the ACA. However, more than 9 percent of Americans are still without coverage.

• Federal and state exchanges attracted more than 10 million enrollees in the 2016 open enrollment period.

• $1.7 billion in tax credits per month are going to more than 85 percent of exchange participants.

• Cost sharing in the form of high deductibles and co-pays often keeps participants, who are now insured for the first time, from seeking care. 

The ACA has reduced the share of uninsured Americans to less than 10 percent through a combination of private insurance and Medicaid expansion. At this point, Medicaid expansion has largely come to a standstill.  But premiums increased by a higher amount in 2016 than in previous years, further exacerbating the cost concerns. Many young adults, who have not put a high priority on obtaining health insurance, now make up the majority of the uninsured ­- arguably due to cost. Deductibles and co-insurance among subsidized plans far exceed the premiums that many participants pay. While health care premium increases have slowed in the past few years, we saw more than 10 percent increases in many markets during this past OEP, with higher increases predicted for 2017.