Tag Archives: ACA exchanges

How to stabilize the ACA marketplace ahead of change

Any upcoming changes to the Patient Protection and Affordable Care Act (ACA) will not likely be fully implemented until 2019 or 2020. The stability of the individual and small group health insurance markets during this period of transition will depend on the regulatory changes that are made in the interim and the transparency of those changes.

A new paper by Milliman’s Lindsy Kotecki and Hans Leida presents five key considerations for promoting market stability for the 2018 and 2019 benefit years under the assumption that they are transitional years with many current ACA rules in effect.

1. Don’t collapse the stool.
2. Extend risk mitigation programs.
3. Extending the transitional policy.
4. Consider interim rule changes carefully.
5. Transparency is key.

New “three Rs” and ACA marketplace considerations

Commercial health issuers should develop contingency plans as legislative proposals designed to modify the Patient Protection and Affordable Care Act (ACA) emerge. While the direction of the ACA marketplace is uncertain now, health plans can proactively evaluate the risks and rewards of various contingency plans to act quickly once the new market environment becomes clear.

Milliman actuaries Amy Giese and Alison Fasching have authored a new paper offering issuers considerations for commercial contingency planning. In the paper, the authors explore the following new “three Rs” to mitigate risk in the current environment:

Remain in the market
Refile in the summer if changes occur after products are initially filed
Remove products from the market

To learn more about the developing healthcare landscape in the U.S., follow Milliman Healthcare reform 2.0.

Actuarial Challenge webinar

The Robert Wood Johnson Foundation and Milliman are cohosting a webinar on Monday, February 27 at 2 p.m. ET to summarize and discuss the results of round one of the Actuarial Challenge. Round two activities will also be noted.

The webinar will look at the various types of proposed reforms in the Round One papers, noting common suggestions as well as proposed changes that are more unique.

On February 15, the Actuarial Challenge issued an announcement of its Round One results. The announcement provided a summary of each of the 14 papers submitted during the Challenge. You can find a copy of the announcement posted on the Actuarial Challenge website.

To participate in the WebEx webinar, use the following information:

Meeting number: 636 329 625

Or join by phone toll-free: 1-866-913-6864 (US)
Conference Code: 262 796 3471

A challenge to move the marketplace forward

RWJF_#ActuarialChallenge1

The Patient Protection and Affordable Care Act (ACA) brought extensive changes to the health insurance market. Accolades as well as concerns have been raised by stakeholders as the marketplace evolves under the new structure. While policy-makers and politicians analyze the strengths and weaknesses of the individual health insurance marketplace, the Robert Wood Johnson Foundation is working with Milliman, among the world’s largest providers of actuarial services, to identify potential improvements to increase its stability.

In partnership with the American Academy of Actuaries and the Society of Actuaries (SOA), the Actuarial Challenge urges health actuaries to propose new ideas and different approaches to increase stability in the individual health insurance market, further moving the market toward universal access to quality, affordable health services. The potential Challenge participants include, but are not necessarily limited to, actuaries employed by:

• Health insurance companies and health maintenance organizations (HMOs)
• Regulators
• Healthcare providers (health systems, hospitals, physician groups)
• Pharmaceutical companies and pharmacy benefit managers (PBMs)
• Actuarial professional organizations
• Health actuarial consultants
• Colleges and universities with actuarial science programs

But before proposals are developed, teams compete, and finalists are
selected for simulations, potential Challenge participants are invited to join the #ActuarialChallenge Twitter chat on Friday, October 21, 1 p.m. ET.

Hosted by @MillimanHealth and @RWJF_Live, several experts will lead the chat:

• Joel Ario, Managing Director, Manatt Health
• Kathy Hempstead (@KHemp64), Senior Advisor, Robert Wood Johnson Foundation
Stacey Muller (@StaceyMullerFSA), Principal and Consulting Actuary, Milliman
Jim O’Connor (@JimOConnorFSA), Principal and Consulting Actuary, Milliman

Despite millions of Americans gaining health insurance coverage in the last several years, healthcare costs have continued to increase, provider choice has become increasingly restricted, and, in some cases, the quality of provider networks have come into question. You can help explore new approaches that can increase stability in the health insurance marketplace during the Twitter chat on October 21. Follow the Twitter hashtag #ActuarialChallenge.

Transitional policies result in higher medical loss ratios

A new Milliman analysis shows that the percentage of transitional policy members in a state’s health exchange market appears to correlate with higher medical loss ratios. In the analysis, Milliman consultants Erik Huth and Jason Karcher quantify the effect that transitional policies had on issuers’ 2014 individual market performances and how it may result in 2017 rate increases for transitional states.

Here’s an excerpt:

The table in Figure 3 shows that issuers in transitional states had higher 2014 loss ratios but appear to not have taken large enough 2015 and 2016 rate increases to achieve profitable 2016 loss ratios (assuming 2014 to 2016 significant cost savings are not realized in other ways). Although issuers’ 2017 rate increases will reflect their 2015 experience and updated projections, there is potential for transitional states to see higher rate increases in 2017.

Figure 3

The graph in Figure 4 shows the 2014 ACA loss ratio and the average 2014 to 2016 statewide QHP base rate change for each state. The gray line represents an illustrative 2014 to 2016 rate increase needed to target an 85% 2016 loss ratio given the 2014 loss ratio and assuming a 5% annual claim trend. For example, a state with an 85% 2014 loss ratio would require a 10.25% 2014 to 2016 rate increase to target an 85% 2016 loss ratio (i.e., 5% annual rate increases to cover the 5% annual claim trend to maintain the 85% loss ratio). States well underneath the line indicate a possible need for higher 2017 increases than states closer to the line. Keep in mind that projected 2016 loss ratios are merely illustrative. There are many factors that will affect a state’s overall 2016 loss ratio and required 2016 and 2017 rate increases, such as, but not limited to, changes in experience and statewide morbidity levels, wear-off of pent-up demand, provider contracting, claim trends, population migration and characteristics, and product and issuer mix. These values also represent a statewide composite, while specific issuers could have materially different results than the average.

Figure 4