Aspects of the ACA Marketplace

Kurt J. Wrobel
For the full complement of ACA Exchange Initiatives Program articles, check out the web-exclusive series.

Tim Jost’s article introduces the web-exclusive series on various topics surrounding the Affordable Care Act (ACA). The articles dive deeper and highlight several viewpoints from actuaries and other policy experts on the most important aspects of the ACA marketplace. These opinions are particularly unique because the authors come from many different organizations and have had many different experiences with the ACA, including those with co-ops, blues plans, consulting firms, smaller health plans and large national payers.

Authors and topics include:

To provide an analytical grounding for the articles, Rebecca Owen, FSA, MAAA, health research actuary for the Society of Actuaries, begins by offering a general background on the most important emerging risk adjustment information released by the Centers for Medicare & Medicaid Services (CMS). This information is particularly important because it starts to highlight the successes, as well as the most important challenges, in ensuring the long-term sustainability of the program.

With Owen’s research report—“An Examination of Relative Risk in the ACA Individual Market” as background—several of the authors highlight the long-term challenges with the program, including the stability of the risk pool, the magnitude and timing of the risk adjustment payment, and the problem of member turnover. While each author approaches these issues with a different perspective, each article has themes with a similar underlying current that tie back to the program’s high-level challenges.

In addition, several authors detail specific technical facets of the risk adjustment program. The technical aspects of the program are very important, particularly because risk adjustment will be the sole remaining risk protection in the program beginning in 2017. Many authors see opportunities to improve the program—including better accounting for partial year enrollees, the inclusion of pharmacy data adjusting for premium differences for lower-cost plans and using credibility for smaller insurance companies.

Overall, the authors highlight the many challenges we face as we continue to make improvements in the program. These improvements are an important part of ensuring that we have a sustainable program that provides stable premiums for the members of the ACA marketplace.

Kurt J. Wrobel, FSA, MAAA, is chief financial officer at the Geisinger Health Plan.