CMS: ACA reinsurance, risk adjustment ‘working as intended’
CMS’ internal review of the reinsurance and risk adjustment programs for the Affordable Care Act exchanges found the initiatives were succeeding stabilizing risk on the marketplace, going against claims of ACA opponents that the market has entered a “death spiral.”
As summarized of Timothy Jost of Health Affairs, the report said risk scores remained stable in the individual market and decreased in the small group market. It also found risk scores didn’t go up from 2014 to 2016, even though an increase had been expected as insurers became more experienced in the underlying data which could raise scores.
“The data also would seem to refute the commonly held belief that the marketplace population is becoming sicker,” Jost wrote. “Risk adjustment transfers (calculated using the absolute value of net transfers for each issuer in the risk pool) amounted to 11 percent of enrollment-weighted monthly premiums in the individual market, 6 percent in the small group market, and 18 percent in the catastrophic market, for a national average of 8 percent.”
Some large insurers are due to receive nine-figure payments from both programs. Blue Cross Blue Shield of Florida, for example, will get $127 million in reinsurance and $464 million in risk adjustment payments in the individual market.
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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.