Strategic Actuarial Issues and Implications for Health Insurance Exchanges

Venue: Internet

Location: modesto, United States

Event Date/Time: May 25, 2011
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This webinar will summarize the top 10 actuarial issues of a health exchange. These issues will include whether the exchange is mandatory vs. voluntary, whether to merge the individual and small group markets, and other issues. We plan to discuss in-depth the Basic Health Program and risk adjusters, a description of which follows:

Basic Health Program: The Affordable Care Act establishes the option for states to create a Basic Health Program to provide healthcare coverage for individuals between 133% of the Federal Poverty Level (FPL) and 200% of the FPL. The federal government will provide subsidies for premium and cost sharing that would otherwise have been provided to consumers to offset the cost of premiums and out-of-pocket expenses in the insurance exchange. This portion of the session will focus on the primary assumptions and considerations of making this program decision. Specifically, we will explore:
The cost of these individuals under a Medicaid type benefit
The cost of these individuals in a Commercial exchange benefit
The federal subsidies offered
Other implications of this program such as access to benefits and continuation of coverage
Risk adjustment methods: Under the ACA, each State must apply risk adjustment to equalize actuarial risk among its healthcare insurers. In this part, we will discuss the important considerations when adopting risk adjustment in an insurance exchange. In particular, we will address:

the key decision points when selecting a risk adjustment system
applicability of existing risk adjustment systems to the uninsured population
state vs. federal considerations
risk adjustment inside and outside the exchanges