Former Aetna CEO suggests separating special enrollment customers on exchanges

A separate risk pool for customers who purchase insurance from the Affordable Care Act (ACA) exchanges during the special enrollment period could help stabilize the market, argued former Aetna CEO and chairman Ronald Williams.

Williams, writing in an op-ed published by the Wall Street Journal, said while CMS has made adjustments to the marketplace, insurers could be lured back in by changes which prevent customers from buying coverage when they need health care services, then cancelling it once they don’t.

“We could place consumers enrolling during the Special Enrollment Period (SEP) into special risk pools separate from the federal health exchanges,” Williams wrote. “These risk pools could be made available for this specific purpose, and be monitored and managed by insurers. Risk pools existed in many states prior to the [ACA] and some states are considering reinstating them. Another option would be refundable tax credits, which are similar to paying for health insurance through taxes.”

If special enrollment periods will remain, Williams said health agencies should require customers to prove they’re eligible—the same standard included in a proposed rule from HHS released in June.

For more on Williams’ thoughts on ways to attract insurers back to the exchanges, click on the link below: 

""
John Gregory, Senior Writer

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.

Around the web

California-based Acutus Medical has said its ongoing agreement to manufacture and distribute left-heart access devices for Medtronic is the company's only source of revenue. 

The scam took place over a period of seven years, resulting in Medicare being billed for more than $70 million in fraudulent claims for unnecessary scans. 

Compensation for heart specialists continues to climb. What does this say about cardiology as a whole? Could private equity's rising influence bring about change? We spoke to MedAxiom CEO Jerry Blackwell, MD, MBA, a veteran cardiologist himself, to learn more.