Karen Ignagni, president and CEO of America's Health Insurance Plans arrived about 10 minutes late to the opening session of her organization's annual meeting in Salt Lake City. Even with that short delay, there was already mumbling that maybe her tardiness was related to a ruling by the Supreme Court on healthcare reform.

The first words out of her mouth? ?We don?t know.? And, of course, everyone knew exactly what she meant.

But within five minutes, an aide slipped her a note ? there wouldn?t be a court ruling today on the Affordable Care Act. That set the tone for the rest of the premier meeting for the nation's health insurance plans ? plenty of drama even without the groundbreaking ruling reveal.

Ignagni and every speaker afterwards spent part of their time stressing that the ruling ? while a huge deal and quite possibly a major disruption to the market ? is only one part of the disruption in the healthcare landscape. Their message was that things are changing with or without the ACA.

Jay Gellert, CEO and president of Health Net, says we?ve maybe gone back to the future a couple of times. Twenty-five years ago, reforms were in the future, 10 to 15 years ago, they were in the past, and now they?re the future again. ?But unlike in the past, we have a very short runway,? he said, adding that unless the system can slow down medical cost growth and improve population health, we may face price controls or an all-out explosion.

Several folks mentioned the failed reforms of the 1990s ? everything from Hillary-Care to Kentucky's failed experiment to reshape its market. What's different this time? Better data. The recognition that providers are crucial partners with health plans.

And perhaps an imperative that there really is not unlimited money, or time to get it right.

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