Revealing Invisible Risk Pools in Small Group Markets
Delve into the intricate world of industry-funded reinsurance pools and their impact on small group markets. Explore insightful data, projections, and assessments to understand the dynamics of risk pooling and its implications for healthcare coverage. Uncover key findings from various studies and reports, shedding light on the complexities of managing risk in the insurance landscape.
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Presentation Transcript
Unveiling Invisible Risk Pools Mark A. Hall Wake Forest University Brookings Institution, with Nick Bagley
Industry-Funded Reinsurance Pools For The Small Group Market State Year Enacted Enrollment mid-2006 Alaska 1993 Repealed Connecticut 1990 >3,000 Idaho 1993 ~ 120 Massachusetts 1991 Repealed Missouri 1992 Repealed Nebraska 1994 20 New Hampshire 2005 >600 North Dakota 1993 Repealed Vermont 1991 Never Implemented Wyoming 1992 ~ 30
Milliman White Paper The Federal Invisible High Risk Pool Effect on premium rates, individual marketplace enrollment and use of federal funds
2 Birds, One Stone? Does Risk Adjust + Retro Reins = Prospec. Reins?
Maine Health Assessment Form 4. Medical Conditions and Treatment. A. Have you or any person to be covered been diagnosed or received treatment in the last two (2) years for any of the following conditions? 1. Cancer Brain andNervous System D Yes D No 15. Cirrhosis of the Liver D Yes D No 29. MyastheniaGravis D Yes D No 2. Cancer Breast D Yes D No 16. CoagulationDefect (Hemophilia) D Yes D No 30. Myotonia D Yes D No 3. Cancer Colon/Rectum D Yes D No 17. CoronaryArtery Disease D Yes D No 31. Parkinson'sDisease D Yes D No 4. Cancer Esophagus D Yes D No 18. CoronaryOcclusion D Yes D No 32. Polycystic Kidney Disease D Yes D No 5. Cancer Lung, Bronchi, Pleura D Yes D No 19. Crohn sDisease(Inflammatorybowel disease) D Yes D No 33. Psychotic Disorders D Yes D No 6. Cancer MultipleMyeloma D Yes D No 20. CysticFibrosis D Yes D No 34. Quadriplegia/Paraplegia D Yes D No 7. Cancer Myeloid Leukemia D Yes D No 21. Friedreich's Ataxia D Yes D No 35. Scleroderma D Yes D No 8. Cancer Ovary D Yes D No 22. HeartDiseaseRequiringOpen Heart Surgery D Yes D No 36. Stroke D Yes D No 9. Cancer Pancreas D Yes D No 23. Hepatitis D Yes D No 37. Syringomyelia D Yes D No 10. Cancer UrinaryBladder D Yes D No 24. Hodgkin'sDisease(Lymphoma) D Yes D No 38. Thrombosis D Yes D No 11. Celiac Disease D Yes D No 25. Huntington'sChoreaor Huntington sDisease D Yes D No 39. VentricularSeptal Defect D Yes D No 12. Cerebral Palsy D Yes D No 26. Hypertension D Yes D No 40. Wilson's Disease D Yes D No 13. ChronicKidneyDisease D Yes D No 27. Insulin DependentDiabetes D Yes D No 14. ChronicSeizureDisorders D Yes D No 28. Lupus D Yes D No
Subsidy Efficiency $10-$15 billion required to reduce uninsured by ~ 1 million That equals $10,000 - $15,000 per newly insured
Bifurcated Risk Pools ACA transitional grand-mothered plans 2015 ACA Compliant Noncompliant Difference Premiums $355 $231 54% Claims $350 $190 84% MLR 99% 82% 17 points
Premiums for Selected HIPPA Nongroup Plans in 3 States GAO 1998 Premium as a percentage of Carrier standard rate -------------------------------------- ------------------ A 140 B 150 C 185 D 200 E 200 F 225 G 300 H 300 I 400 ----------------------------------------------------------
