Following last week's State of the Union (SOTU) address, President Obama met with House Republicans for a brief interchange in which he emphasized bipartisanship. Both the speech and the meeting signaled the Obama administration's change in emphasis away from healthcare reform and in the direction of the economy. However, a de-emphasis on healthcare reform does not mean that health insurance reform is off the table, as suggested by an Insurance & Technology report last week and reinforced by a conversation with Paul Keckley, executive director of Deloitte's Center for Health Solutions.Keckley notes that healthcare reform wasn't even mentioned until about 25 minutes into the SOTU, a postponement which he believes was carefully calculated. "I think the intent of the [SOTU] speech was to reset the domestic agenda around jobs and the economy, and set that as the primary expectation in 2010," Keckley comments. "The other things mentioned in the speech become secondary to jobs and the economy - that was the bottom line."

Keckley was surprised that President Obama decided not to link healthcare costs to the overall economic picture. "Healthcare expenditures represent 36 percent of the federal budget, and it is the fastest growing expense," he notes. "With a prime-time audience and the world media watching, not connecting a third of spending is a missed opportunity."

However healthcare reform may have fallen among the President's priorities for the time being, a strong appetite for reform prevails, including health insurance reform specifically, Keckley believes. "I think commercial [health] insurance plans will have to make midcourse adjustments around product configuration, premium structures and and relationships with providers," he says. "I think they're all aware of that but they are waiting for some clear understanding of what the regulations will be."

Reform may come in a series of bills rather than a single, big game-changer, Keckley suggests. "I would not be surprised that health insurance plans will face regulatory changes addressing things like pre-existing conditions, guaranteed issue, lifetime limits and even interstate competition," he comments. "If that's the case, you can imagine what it will do to premiums, and that's what operators have to consider. It could alter premium structure, and you would have to expect premiums to rise dramatically."Reform may come in a series of bills rather than a single, big game-changer, suggests Paul Keckley of Deloitte. "I would not be surprised that health insurance plans will face regulatory changes addressing things like pre-existing conditions, guaranteed issue, lifetime limits and even interstate competition," he comments.