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Robert B. Vogel, MD, JD
Retinal Ophthalmologist at Piedmont Eye Center, Lynchburg VA;
Attorney, Overbey Hawkins & Wright, PLLS, Lynchburg, VA;
Adjunct Professor, Humanities and Bioethics, Liberty University School of Medicine, Lynchburg, VA.
In response to insurance companies pulling out of Affordable Care Act (ACA) exchanges, CMS published policy changes to support the insurance companies who have concerns about high-cost enrollees and risk adjustment.
The policy changes are part of an effort to strengthen the risk pool, ACA Marketplace CEO Ken Counihan wrote in a CMS blog post. Proposed changes in the policy statement that are meant to help insurers deal with high-cost enrollees and risk adjustment include the following:
Among the proposed changes meant to strength the Marketplace Risk Pool are the following:
There is still uncertainty as to whether these proposals are strong enough to keep insurers in the marketplace or draw them back in. Next year, Aetna will offer individual insurance products in only four states, claiming it lost $200 million on its ACA exchange plans in the second quarter of 2016 with total losses of $430 billion since 2014. UnitedHealthcare will offer ACA plans in just three states next year.