Although pricing actuaries are trained to project future
costs in environments of heightened risk, COVID-19 has introduced unprecedented
disruption and uncertainty. The pandemic has affected all aspects of the
healthcare industry and the American economy, altering the landscape in ways
that may both increase and decrease expected costs. This volatile and uncertain
environment also presents an extraordinary challenge for health plans
developing rates for 2021 commercial coverage.
This paper by Milliman’s Jeff Milton-Hall, Tom Murawski, and Doug Norris is intended to help commercial health plans navigate this evolving environment. They authors discuss key considerations for how the pandemic and its aftermath could affect the cost of health insurance coverage in 2021.
Congress continues to introduce tweaks to the Patient Protection and Affordable Care Act (ACA). One such bill, “H.R. 6311 – Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018,” could have major consequences for ACA plans if made into law, including exposing plans to significant rating risk if rates are not adjusted accordingly. This paper by Milliman’s Jason Karcher and Jeffrey Milton-Hall considers six features and potential outcomes of the bill that every individual ACA health plan should know.
If the cost-sharing reduction (CSR) subsidies of the Patient Protection and Affordable Care Act (ACA) were eliminated, it could expose insurance carriers to a substantial increase in selection risk related to their particular mixes of business. In August, the Centers for Medicare and Medicaid Services (CMS) announced its intention to propose a set of risk adjustment modifications for states in which insurance carriers raise silver premiums in response to potential CSR subsidy termination.
In this paper, Milliman’s Jeffrey Milton-Hall, Doug Norris, and Jason Karcher explore the CMS proposal along with the current ACA risk adjustment program and three other potential alternative modifications to risk adjustment in response to the possible elimination of CSR funding.