Operational and economic consequences of extending non-grandfathered plans must be considered.
Extending non-grandfathered plans, as President Obama is now encouraging, might be a political move that soothes some Americans today but it has immediate and long-term economic fallout. William Kerr, MD, CEO of Avalon Healthcare Solutions, a pediatrician and former managed-care leader, believes the operational and economic consequences must be considered.
"One thing that would concern me would be the integrity of the risk pool," he says. "What happens as we fairly rapidly consider taking one risk pool and allowing it to break apart into multiple risk pools?"
The biggest question for insurers is how to manage the exchange products now that the risk pool will likely be different than expected when the exchange plans were designed earlier this year. Also, the population that remains in the extended plans will face higher premiums and leaner coverage.
"I don't know how, near the Thanksgiving holiday, one is expected to go through a process that normally takes nine months, to go through actuarial assessment, through filing with the insurance commissioner, to marketing and enrollment," Dr. Kerr says.
He's uncertain of how the industry should best move forward when the Affordable Care Act is the law of the land, but the president is asking states and insurance carriers to roll out a new strategy not addressed in ACA.
"You wonder what executives are supposed to react to: the dialog or the existing law of the land," he says.
But Jan Berger, MD, president of Health Intelligence Partners, a consulting firm, believes health plans can take a long-term view and turn the market disruption into an opportunity if they act quickly.
"It's an opportunity for health plans to engage the consumer in a better understanding of what health insurance is, what coverage is and how to best purchase the plan that really meets not only their needs for today but their ongoing needs," Dr. Berger says.
Today consumers are purchasing plans, but many don't understand what their policies would cover if they do have significant healthcare needs.
"The skinny plans were maybe the only thing people could afford in the past, and they didn't understand what they were purchasing," she says. "Now it allows us to have a very different conversation with them. It's actually an opportune time because health plans have the capability and the access to members to start the conversation."
The administration is pushing back the start of the 2015 enrollment period to November 15.
Updated 11-24 to reflect new enrollment period
In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
Listen
Inflation Reduction Act: Reforms to Patient Cost-Sharing
September 18th 2023Lower out-of-pocket costs for patients might put upward pressure on drug prices, as manufacturers face less price sensitivity, note Matthew Majewski and Rhett Johnson of Charles River Associates. But they also note that upward pressure on price is likely to be limited to the inflation rate as any additional price increase would need to be paid back to CMS in the form of inflation rebates.
Read More
Spending climbed by 2.7% in 2021. In 2020, it soared by 10.3%, fueled by federal government spending in response to the pandemic. The blizzard of calculations of 2021 healthcare spending by CMS’ actuaries also provides further evidence that utilization of healthcare services bounced back in 2021.
Read More
Talking PIE, the Act, Before Thanksgiving
November 23rd 2022AMCP CEO Susan A. Cantrell spoke with Managed Healthcare Executive® about Preapproval Information Exchange (PIE) Act of 2022, which would allow drug manufacturers to share information about a drug with payers before the drug is approved. Cantrell says passage of the PIE Act would speed up patient access to new medications.
Read More
Inflation Reduction Act and the Impact on Pharmaceutical Pricing and Investment Decisions
November 21st 2022The reference to “maximum fair price” in the act bodes poorly for manufacturers and suggests more of a take-it-or-leave-it situation rather than a negotiation where clinical evidence would be the prevailing factor in determining price.
Read More