Under the Patient Protection and Affordable Care Act, underwriting will effectively disappear. Enrollee demographics and medical history can no longer be used to calculate premiums. Two exceptions allow for variation in the rate based on age and smoking, although even in these cases the degree of variation is legally limited. Without the ability to use underwriting for risk selection or premium assignment, 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 for competing for a healthy insured population. While medical underwriting can no longer be used for risk selection, the new law will provide some helpful protections for insurance companies. A new program will establish reinsurance for high-risk populations. This reinsurance program will evaluate the rates of insurers with low-risk populations and provide reimbursements to insurers with high-risk populations. If the program works as intended, health plans will no longer be as sensitive to the risk of the insured population. With this program balancing population health risk across different insurers, competition for healthy candidates will no longer provide a market advantage. As the competitive landscape changes, insurers that can adapt effectively will find new opportunities to stand out in the marketplace. Instead of adjusting premiums to risk or competing for the healthiest customers, insurers can compete on the quality and efficiency of their plans. Reforms such as new insurance exchanges, public reporting requirements of quality metrics, and a new health plan rating system will help insurers leverage the merits of their products to attract new applicants... middle of paper... capabilities 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 include identifying providers who consistently deliver high-quality, efficient care and use best practices that are adaptable to other businesses or circumstances. These providers will be used 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 succeed in improving their quality and efficiency. Insurers who are committed to providing excellent quality and efficiency will receive public recognition of their efforts, and this leadership role could prove to be an important competitive advantage.