Under the Patient Protection and Affordable Care Act, underwriting will effectively disappear. Enrollees’ demographic data and medical history can no longer be used to calculate premiums. Two exceptions allow for variation in rates based on age and smoking, although even in these cases the degree of variation is legally capped. Without the ability to use underwriting to select risks or allocate premiums, insurers will have to find new ways to compete. Premiums will no longer reflect underlying risks and rate variation will cease to be a meaningful tool in the fight for a healthy insured population. Although medical underwriting can no longer be used for risk selection, the new law will provide useful protections for insurance companies. . A new program will establish reinsurance for high-risk populations. This reinsurance program will assess costs for insurers with low-risk populations and reimburse insurers with high-risk populations. If the program works as intended, health plans will no longer be as sensitive to the risk of their insured population. With this program balancing population health risks across different insurers, competition to attract healthy applicants will no longer provide a market advantage. As the competitive landscape evolves, insurers that can adapt effectively will find new opportunities to stand out in the market. Instead of tailoring premiums to risk or competing to attract the healthiest customers, insurers can compete on the quality and effectiveness of their plans. Reforms such as new insurance exchanges, public reporting requirements on quality measures, and a new health plan rating system will help insurers use the merits of their products to attract new applicants.... .. middle of paper ...... capacity to support the national strategy. This center will be responsible for developing, disseminating and providing training on quality improvement strategies. Part of this role will be to identify providers who consistently provide high-quality, effective care and who use best practices adaptable to other businesses or circumstances. These providers will serve as a model for what can be achieved by other providers, and the new center will make recommendations for how other providers can implement some of the same practices. This program could provide a tremendous leadership opportunity for health plans that are successful in improving their quality and efficiency. Insurers who are committed to excellent quality and efficiency will be publicly recognized for their efforts, and this leadership role could prove to be an important competitive advantage...