How will the elimination of the individual mandate affect enrollment rates?

The requirement that every American have healthcare coverage or pay a financial penalty was one of the key provisions of the Patient Protection and Affordable Care Act (ACA). Known as the individual mandate, it was one of the most controversial provisions of the ACA. Some questioned its legality and others questioned its effectiveness at driving insureds into the insurance pool.

The U.S. Supreme Court settled the issue of the mandate’s legality in 2012, ruling that attaching a financial penalty to a failure to purchase health insurance did not run afoul of the U.S. Constitution. This decision, though, did not settle the issue of its effectiveness. And in late 2017, Congress enacted the Tax Cut and Jobs Act, which reduced the financial penalty to $0 beginning with the 2019 mandate year, effectively eliminating the individual mandate.

Understanding the impact of this change on the health insurance risk pool is important to both insurers offering ACA-compliant products and state policymakers evaluating alternatives to the individual mandate. Health insurers—now in the process of setting rates for 2019—need to understand how elimination of the individual mandate penalty will affect future enrollment rates, which have a significant impact on rate projections. Some states are considering implementing state-based individual mandates, in some cases in conjunction with a Section 1332 State Innovation waiver.

In this paper, Milliman’s Andrew Bourg, Fritz Busch, and Stacey Muller discuss the significance of the individual mandate and model the impact of eliminating it.

Seven simple steps to a stress-free enrollment

When it comes to open enrollment, communication matters. But is it working? Many employers don’t think so. A recent survey by the International Foundation of Employee Benefit Plans found that 80% of organizations think employees don’t open or read materials. And 49% think employees don’t understand the content. So what’s the solution? Try these tips to get your messages across.

1. Look at last year. Consider the feedback you got on last year’s campaign. Which communication pieces resonated? Which fell flat? Take a look at the questions employees raised and work those into your materials for this year.

2. Define success and then measure it. Determine what a successful campaign looks like. What are your goals? Do you want a certain number of employees to enroll in a medical plan or use the online tools? After enrollment, look at the numbers and gather employee feedback via focus groups or an online survey to guide future campaigns.

3. Cut the clutter. People don’t want to weed through a 50-page brochure to find information. Remember that readers are used to quickly scanning an article for the high points. Break up paragraphs into bullet points, pull important details into callouts, and use infographics in place of long-winded narratives.

4. Know your purpose. Start with what you want your communication piece to do and let that drive the format. For example, if you want to educate, use FAQs and examples. If you want to inspire employees, feature testimonials.

5. Use straight talk. Don’t try to sugarcoat change messages. Clearly explain what’s happening, why it’s happening, and when it’s happening. Change can be hard, but you have to be honest with employees to earn their trust.

6. Start early and communicate often. Give employees a heads-up early on, especially if you’re making major plan design changes. Announce key dates, such as when enrollment will be and when employee meetings will be held. As the deadline approaches, remind employees to take action.

7. Go for variety. Reach your employees with a variety of media to appeal to generational and personal preferences. For example, if you’re explaining a new high-deductible health plan, you might mail employees a print piece to their homes, post a video online, and walk through the new plan at employee meetings.

If you need additional support, be sure to talk with your Milliman communication consultant.

This article first appeared on RetirementTownHall.com.

Considerations for product governance risk management

A key focus of the insurance regulatory authorities around the world has been the protection of policyholder interest. This has resulted in more emphasis on product governance and product life-cycle management. The insurance directive launched under the European Union insurance law has issued guidelines for insurers to embed product oversight and governance into their risk management frameworks.

A robust product governance process can help reduce mis-selling and complaints, and increase policyholder confidence in the market. It can also ensure internal and regulatory compliance for the products offered by the insurer.

The core components of a robust product governance process are:

• Product governance policy
• Product development
• Pricing and value
• Distribution and sales
• Legal, compliance and risk management
• Ongoing assessment of the product

To read more about building a strong product governance policy, read Neha Taneja’s article here.

Critical Point podcast: “Healthcare waste and how to find it”

Milliman’s new podcast, Critical Point, presents unique perspectives from the firm’s professionals. The podcast’s debut episode, “Healthcare waste and how to find it,” features Jackie Sehr, Marcos Dachary, and Dr. David Mirkin from Milliman MedInsight®, a data warehousing and healthcare analytics platform. In this episode, they discuss healthcare waste and approaches to minimize waste and reduce unnecessary costs across the American healthcare system.

To listen to this episode of Critical Point, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

2018 Social Security and Medicare trustees’ reports released
The Social Security and Medicare Boards of Trustees issued their annual financial review of the programs. The projections indicate that income is sufficient to pay full scheduled benefits until 2026 for Medicare’s Hospital Insurance program, 2032 for Social Security’s Disability Insurance program, and until 2034 for Social Security’s Old Age and Survivors Insurance program. The Supplementary Medical Insurance (SMI) Trust Fund remains adequately financed throughout the projection period, but only because SMI has unlimited access to general revenues.

For more information, click here.

The CMS’ RDS Center changes its location for retiree and cost report files
The Centers for Medicare and Medicaid Services’ (CMS) Retiree Drug Subsidy (RDS) Center is changing the location where retiree and cost report files are sent via Connect:Direct. By the end of 2018, all files that are currently sent to the RDS Center via Connect:Direct must be sent to the new location. This change only impacts vendors that submit data to the RDS Center via Connect:Direct and does not affect vendors that submit data using the RDS secure website.

For more information, click here.

Commercial health insurance: Overview of 2016 financial results and emerging enrollment and premium data

In this report, Milliman’s Paul Houchens, Jason Clarkson, and Jason Melek provide a detailed review of the commercial health insurance industry’s financial results in 2016 and evaluate changes in the market’s expense structure and enrollment prior to relative years. They also provide enrollment and Advanced Premium Tax Credits estimates for 2017.