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ACA Exchanges Receive Enough Revision to Continue


The changes that have been put forth to help secure the Affordable Care Act (ACA) exchange markets for health insurance consumers should be enough to tide it over for another year but it is likely that more changes will be necessary in the upcoming year.  The change announcement has been released sooner than originally planned and it includes adjustments to plan year 2018 for plan requirements as well as the ACA risk adjustment program.

These revisions were brought on due to the fact that major insurers on the exchanges such as UnitedHealth, Aetna and Humana have all said that they would be scaling back their offerings in plan year 2017 which has created issues.  In fact, these issues coupled with low enrollment in the exchanges has forced some to question whether the exchanges have the ability to continue.

Some have voiced concerns about noteworthy premium increases in certain states, even as the Department of Health and Human Services (HHS) released their findings which pointed out that coverage in these States would still be affordable for those receiving premium subsidies.  

The changes are being met with optimism by those in the health insurance industry and many are pleased that recommendations by the industry are being addressed in those latest changes.  It is likely that smaller, more regional plans having less capital on hand will be most benefitted.  

Changes to risk adjustment have become vital as the insurance industry has pointed out that those enrolling in plans have proven to be sicker and thus more costly to insure than first expected.  A new factor being taken into consideration is prescription drug data for diseases such diabetes, AIDS and HIV or Hepatitis C.

It is a certainty that risk adjustment will be paying close attention to those who enroll through the exchanges outside of the open enrollment window.  Some insurers have stated that consumers have been waiting until they are sick and in need of care to sign up for health insurance.  Restrictions for enrollment outside of the open enrollment period have become stricter in response to industry concerns.

While the Obama administration is working to instill confidence in the health insurance marketplace so as to leave a stabilized market; the next administration along with the Congress are likely to make changes to keep the system in place.  

Other changes that have given a level of hope and encouragement are the fact that healthier and younger people are enrolling which will provide them the option of less coverage for a lower premium each month.  

CMS is also considering a Simple Choice plan that would work as a high deductible plan that can be used in conjunction with a health savings account (HSA).  This would be a bronze level plan and come as a choice in response to the need for high deductible options as they are “valued by many consumers.”

Bronze plans require the consumer to pay for a major service before the deductible kicks in; a service such as an emergency room visit, a doctor’s office visit, or a drug purchase.  Preventative services, however, will still require no out-of-pocket expense from the insured.

While it is extremely important that the younger and healthier group of consumers become a part of the health insurance system, some of the new options are of concern to patient advocacy groups.  They fear that some consumers might not fully understand which services are and which are not covered and thus will not fully understand how a high deductible insurance policy works.

Last modified onWednesday, 07 September 2016 23:01
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