- The federal government last Friday issued a final rule aimed at strengthening the ACA risk pool for the 2018 plan year.
- CMS says the risk adjustment model will be modified to account for the number of consumers who had an ACA plan for less than a year as well as improve how the risk associated with high-cost consumers is accounted for and will incorporate prescription drug data.
- In addition, the new risk adjustment model will better compensate healthier consumers, the agency stated.
Health insurance companies across the U.S. have continued to request steep increases in premiums. They claim providing coverage for a sicker patient population with the implementation of the ACA has contributed to the substantial financial losses that appear in their earnings reports, as well as a lack of payments under the risk corridor program from the federal government that were intended to address this issue.
Many of them, including insurance giants Aetna and United Health, have significantly scaled back their ACA offerings for the 2017 coverage year, which in turn has caused many communities to face insurer monopolies in the ACA markets.
Data released by HHS in August suggested the risk pools are becoming more stable as more Americans have signed up for ACA coverage and per-person medical care costs in the marketplace did not change much in 2014 and 2015. Last week, the administration said the enrollment deadline had to be extended to Jan. 1, 2017 because of the amount of enrollees has exceeded expectations. In fact, last Thursday marked a record day for ACA enrollment when 670,000 individuals signed up for coverage.
The administration's ultimate goal for a stronger risk pool is to enroll younger adults who are typically healthier. The new changes to last week's final rule includes could be the major steps in the direction that were needed to have this become a reality.