Now that PPACA directives are reality and health insurance exchanges are in place, just what impact will health care reform really have on the number of uninsured Americans?
How do you price a service when you have no idea what it will cost you to deliver? That’s the challenge actuaries faced as they tried to predict medical costs for the thousands of new enrollees participating in health care exchanges across the country.
Actuaries thrive on data – specifically, demographics on age, sex, location and health care history. Under Obamacare, insurers must accept all comers with no health information on enrollees. Additionally, they were asked to establish premium rates for an unknown population as participants rushed to meet the sign-up deadlines. Last minute regulatory changes provided further complication – forcing unexpected revisions to calculations that had been worked on for years in preparation for exchange deadlines.
Waiting for Claims Data
Many fully-insured organizations, negatively impacted by PPACA and hearing more and more about the benefits of self-funding, are looking to their advisors for information on self-funding. Often, these companies are told that they can easily move to a partially self-funded plan with their same carrier and there’s no need to involve a TPA. This is a disservice to the employer. Continue reading
For organizations that are determined to be “large” employers under PPACA, it will be necessary to determine if the coverage being offered is “affordable.” Coverage is affordable if the required employee contribution does not exceed 9.5% of their annual household income. Continue reading
Please don’t be confused by the title of this article. Although I spent many long days in DC trying to get PPACA stopped, or at least restructured, how can anyone complain about providing medical care to over 30 million of the uninsured and less fortunate? However, PPACA does not guarantee medical care to anyone, and clearly all of the uninsured do not fall into the category of the less fortunate. What PPACA provides is the individual right to be insured, or pay a penalty, but even once insured, it cannot “force” you to receive medical care or even to live a healthy lifestyle. Continue reading
According to consultants Towers Watson, enrollment has nearly doubled in the last two years alone for account-based health plans when paired with a tax-preferred HSA or HRA account having individual deductibles of $1,000 or more. Data from 2012 indicates that nearly 30 percent of Americans have one of these options in place and more than two-thirds of employers have implemented these plans. Surveys even show that more than 10 percent of employers have made account-based plans their only offering, which is an increase from just over 7 percent in 2010. Continue reading
Even though we still hear political rumblings of repeal, the smart money seems to be on finding ways to boost accountability and engagement as full implementation of the law nears. While a strong majority of employers remain committed to maintaining their health benefit programs, there is plenty of concern about all the new regulations coming their way. Continue reading
Under PPACA, the Department of Health and Human Services (HHS) has issued two sets of proposed regulations that will impact the design and availability of health care plans. Some of the highlights include: Continue reading
Designed to extend health care protection to millions of Americans who lack coverage, the individual mandate is a central part of the Patient Protection and Affordable Care Act recently debated in oral arguments before the U.S. Supreme Court. While no one can predict the outcome, we thought it might be appropriate to consider a few possible scenarios that could arise. Continue reading
Cost containment, medical management, voluntary wellness programs, higher deductibles, increased participant contributions, marketing your health coverage each year to find the “best” carrier rate, are all employer strategies that have been tried over the past ten years with the sole purpose of controlling the rapidly increasing cost of health insurance. However, according to the Kaiser/HRET Study, during the same period, health insurance premiums have increased four times as fast as general inflation and 3.5 times as fast as worker’s earnings. Perhaps it’s time to consider a different strategy? Continue reading