Federal programs designed to equalize payments for health insurance companies’ costs were “relatively well targeted” in the two years following introduction of the Affordable Care Act’s (ACA) marketplaces, according to an AHRQ study in the April issue of Health Affairs. Because the ACA prevents insurers from varying coverage based on applicants’ health status, the law includes two mechanisms to equalize the impact of differences in enrollees’ health risks. A risk-adjustment program was designed to transfer funds from plans with lower risk enrollees to plans with higher risk enrollees. In addition, the ACA’s temporary reinsurance program, in place from 2014 to 2016, partially compensated insurance plans for higher cost enrollees to provide a cushion for plans in the early years of the marketplaces. AHRQ researchers found that prior to these payments, claims (not including administrative expenses) exceeded premium revenues by $90 to $397 per enrollee per month for the 30 percent of insurers with the highest claims costs. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0 to $49 per month for the same category of insurers. The findings may shed light on how risk-sharing programs can address risk selection among insurers, the authors concluded. Access the abstract.
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