HHS says ACA individual risk pool is improving: 4 findings


CMS released data indicating per-enrollee medicals costs in the individual market remained almost unchanged between 2014 and 2015, suggesting a year-over-year improvement of the Affordable Care Act's individual risk pool.

The government predicted risk pools on the individual market would improve over time as enrollment increased and healthier, lower-cost consumers entered the market. HHS said the new data suggests this prediction actualized in 2015.

Here are four findings from the report:

1. Per-member per-month medical costs in the ACA individual market fell 0.1 percent from 2014 to 2015, while per-member costs in the broader insurance market rose between 3 percent and 6 percent in 2015.

2. States with higher-than-average 2015 enrollment saw greater-than-average reductions in per-enrollee medical costs. In the 10 states with the most enrollment growth, per-member per-month claims costs dropped an average of 5 percent.

3. Premium increases in 2015 — which averaged 2 percent — would generally have been enough to keep up with claims cost, due to the slow growth in per-enrollee claims. However, the premium increases would not have made up for 2014 gaps between prices and costs or the partial phasedown of the ACA's transitional reinsurance program. 

4. Almost all states showed enrollment growth in 2016.

CMS' analysis is based on data from all enrollees in the ACA's individual market risk pool, most of whom purchase coverage through the Health Insurance Marketplace. 

More articles about payer issues:
Maine health insurance co-op sues feds over $23M of missing ACA payments
Receivership order issued against failed Arizona health insurance co-op
3 Important statistics about provider referrals

Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars