Tag Archives: Healthcare Reform

Consumer transparency issues in an evolving individual health insurance market

Consumers in the individual and small group health insurance markets want to understand the future of their health insurance. This paper by Milliman actuaries Esther Blount and Andrew Bourg highlights the steps the Patient Protection and Affordable Care Act (ACA) has in place to promote consumer knowledge in the individual market and the pros and cons of removing such initiatives.

Summary of individual market enrollment and Affordable Care Act subsidies

The Patient Protection and Affordable Care Act (ACA) introduced many changes to the individual health insurance market beginning in calendar year (CY) 2014, including new rating rules and the introduction of federal financial assistance to purchase health insurance through the insurance marketplaces. It is important for state policymakers to understand the health and stability of the individual health insurance market and how the ACA has affected its health insurance consumers.

Milliman actuaries Paul Houchens, Jason Clarkson, and Zachary Fohl have prepared a profile of the individual health insurance market for each state along with the District of Columbia (DC). The profile summarizes insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2017 open enrollment period.

Pent-up uncertainty may lead to more demand among Americans

While legislation to repeal and replace the Patient Protection and Affordable Care Act (ACA) has halted for now, the future of American healthcare remains in flux. In this article, Milliman’s Kim Hiemenz and Michelle Klein discuss how the uncertainty surrounding healthcare may lead to pent-up demand among many Americans.

Changes to actuarial soundness requirements may or may not accompany changes to Medicaid funding

Proposals to change federal funding for state Medicaid programs using block grants or per capita caps could affect federal actuarial soundness requirements for Medicaid managed care capitation rates. In this article, Milliman’s Michael Cook discusses the following three scenarios that could play out if changes to Medicaid funding happen.

• The continuation of federal actuarial soundness requirements under revised federal funding is a plausible scenario.
• The establishing of individual state requirements if federal requirements are eliminated.
• The continued development of actuarially sound capitation rates by individual states even in the absence of any soundness requirements.

Are essential health benefits here to stay?

With the American Health Care Act scheduled to be up for a vote, and Republicans still negotiating elements of the bill, the fate of essential health benefits (EHBs) is uncertain. Rebekah Bayram and Barbara Dewey’s recent paper “Are essential health benefits here to stay?” explores how consumer choices are affected by mandating benefits, explores the potential effects on premiums, and identifies areas to watch as Congress debates healthcare reform.

The paper has also been referenced in a number of recent media articles. Below is a wrap-up of coverage from the past two days:

• Bloomberg article by Zachary Tracer: Health rules targeted by GOP could upset U.S. insurance market
• Los Angeles Times column by Michael Hiltzik: Eliminating essential health insurance benefits is a lousy idea that won’t save money. Here’s why.
• Business Insider opinion piece by Josh Barro: Republicans may gut an overlooked provision of Obamacare — and disrupt health insurance

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.