Analysis of HHS Proposed Rules On Reinsurance, Risk Corridors and Risk Adjustment
Wakely Consulting Group - Ross Winkelman, Julie Pepper, Patrick Holland, Syed Mehmud and James Woolman
Under the Affordable Care Act (ACA) much of the expanded coverage will be provided through health insurers offering products on the new health insurance exchanges. To ensure robust markets, exchanges must have in place processes for mitigating the financial risk to insurers associated with enrolling individuals with diverse health care needs. The intention is for issuers to compete for customers based on cost and quality, rather than attracting the healthiest, lowest-cost enrollees. The U.S. Department of Health and Human Services released its initial proposed rules on Standards Related to Reinsurance, Risk Corridors and Risk Adjustment on July 11, 2011. This issue brief prepared by Wakely Consulting Group summarizes the proposed rules and provides perspective on the implications for states as they integrate risk mitigation into the exchange implementation process. The brief highlights the application of the different risk mitigation programs (risk adjustment, reinsurance and risk corridors) to the various insurance marketplaces (individual and small group, both inside and outside the exchange) and includes next steps for states and insurers. The summary of these rules, as well as the authors’ analysis of their implications, is meant for policy-makers and state officials familiar with these complex issues.
Building on this proposed rules analysis, Wakely Consulting Group also prepared a Work Plan that serves as an outline for state officials on the decisions and actions necessary to implement the risk adjustment and reinsurance provisions of the ACA.
In February, Galen Benshoof underscored the importance of agents and brokers in ensuring robust enrollment and exchange sustainability. Recognizing this, the State Network funded programs in Illinois and Minnesota, led by Wakely Consulting Group (Wakely), to enhance in-person agent and broker engagement while expanding their capability to assist anyone who walks through their doors, even if they are eligible for Medicaid or other state coverage programs. These Lead Broker Agency programs were a success, and the states are planning to continue or expand the programs next year!
A new issue brief, prepared by Kathie Mazza at Wakely, describes the concept of these pilots and outlines how other states interested in partnering with insurance brokers can implement similar initiatives for future open enrollment periods.
Student health plans have long been a source of coverage for college students who do not have other options available. In 2012, the U.S. Department of Health and Human Services redefined student health plans under the Affordable Care Act (ACA), requiring that they be treated like individual health insurance. This means that students buying these plans through their college or university now have the same protections available to them as if they bought a plan in the individual market. It also means that states and the federal government have a new role in oversight of these plans.
The State Network team mourns the recent passing of our dear friend and colleague, Andy Hyman. Andy was the father of the State Network, seeing the value in connecting states with the expertise they need to achieve the vision of coverage that drove him every day.