Interest groups not satisfied with proposed risk adjustment changes
CMS’ proposals to change risk adjustment calculations for exchange plans for 2018 would come too late, according to America’s Health Insurance Plans (AHIP) and Consumers for Health Options, Insurance Coverage in Exchanges in States (CHOICES).
The proposed 2018 Notice of Benefit and Payment Parameters would add partial-year enrollee and prescription drug use data into risk adjustment, along with covering up to 60 percent of high-cost claims in a reinsurance-like program. What worries insurance groups is the timing of the proposal.
“The big issue is that this is for 2018—and not addressing many of the challenges that plans are facing for 2017, which is the more immediate need,” AHIP spokeswoman Clare Krusing said in a statement. “So while there is a clear sign that CMS is looking at solutions, there needs to be action taken now to provide stability for consumers and the health plans.”
The statement from CHOICES was harsher in its critique of the proposal, saying the risk pool in the exchanges is “broken” and CMS isn’t recognizing the urgency of the issues.
“The reality is that the ACA’s premium stabilization programs have not succeeded in their intended effect to stabilize the Individual and Small Group markets—and waiting until 2018 or later to resolve ongoing problems will have detrimental effects on consumers,” the group’s statement said. “The proposed rule readily acknowledges a long standing concern of CHOICES, which is the existence of an estimation bias in the risk adjustment formula that under-predicts the costs for low-risk enrollees and over predicts cost for high-risk enrollees. The result of this bias dissuades carriers from attracting younger and healthier consumers to the extent that some carriers have reduced or all-together stopped offering bronze plans which attract healthier and more price sensitive enrollees.”
CHOICES did support the substance of the proposals, saying including data from prescription drug use and special enrollment period customers would increase the accuracy of risk adjustment.
More detailed responses to the proposal should be coming soon, as the comment period will be open for 30 days beginning Sept. 6.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.