Including: Making insurers help pay the costs of other insurers' high-cost policyholders
Dan Calabrese , Bio and Archives--August 30, 2016
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ObamaCare is a huge and glorious success, and it's the shining jewel in Barack Obama's legacy. That's what the Democrats have been telling us for several years, and for the most part the media have dutifully parrotted this talking point. But in recent months, it's gotten harder for Obama's media protectors to keep pretending everything is OK. Exchanges are in dire fiscal straits. Insurers are dropping out. Premiums are soaring. Provider networks are narrowing.
The left keep reaching back for what it thinks is the one saving grace of ObamaCare - that more people are "covered" than before. And that's true, but the vast majority of these are just sopping off Medicaid, which is exploding both state and federal budgets, while just about everyone is spending more for the glorious privilege of being "covered," not to mention paying higher taxes to pay for all the subsidies ObamaCare promises.These proposals would bring more certainty into the Marketplace, as they would enable issuers to account for the risk of all enrollees in their bottom line, while continuing to ensure that all Americans have access to the care they need.
- Beginning with the 2017 benefit year, the rule proposes a modification to risk adjustment regarding the cost of enrollees who do not stay with an issuer for the full plan year.
- In order to help reflect enrollees with serious conditions like Hepatitis C, HIV, or others, the rule proposes to use prescription drug utilization data as a source of information about enrollee’s health and the severity of their conditions beginning with the 2018 benefit year.
- The rule also proposes to modify risk adjustment as to costs associated with the most expensive enrollees. Under this proposal, a portion of costs exceeding $2 million for an individual would be shared among issuers. This type of risk sharing would reduce uncertainty for issuers who are not yet able to reliably predict the prevalence and nature of high-cost cases.
- The proposed rule also asks for comment on a number of approaches for addressing the costs of healthier enrollees. Our goal is to update risk adjustment for all types of enrollees, to ensure that issuers can have confidence in the program as they design products to attract all types of consumers.
- Lastly, separate from the risk adjustment program, we are seeking comment on whether and how to further support the successful transition of former Pre-Existing Condition Insurance Plan (PCIP) Program enrollees into the Marketplace to ensure that they do not experience a lapse in coverage.
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