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Risk pool more important than ACA enrollment


AHIP's Karen Ignagni wants to see a new tier in the exchanges to drive consumers into the risk pool

Are the health exchange marketplaces going to meet the often-cited benchmark of 6 million enrollments? Possibly. Does it matter? Probably not.

Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP) appeared on C-SPAN, and noted that insurers are more concerned with the health status of the risk pools than the final enrollment tally in their exchange products.

“There are a number of people who have gotten into the program in January who are using a number of healthcare services,” she said. “That’s to be expected. No one in our industry thought it would be any different.”

Insurers generally forecast that the final days of open enrollment will bring in healthier people to sign up because that was the experience with the Massachusetts individual mandate. Absolute numbers matter less than the distribution of healthy-to-well members, market-by-market.

National data is not as important as state data because risk pools are, by law, balanced at the state level. Premiums are set for even smaller geographic areas.

However, Ignagni also suggested that an additional coverage tier should be created to allow those who previously had insurance-bare-bones types of plans most likely-to transition into the exchanges. Her suggestion would solve two problems: quell the outcry from consumers who want to keep their old, non-compliant plans; and drive those same people into the exchange risk pool.

By allowing the extension of the old 2013-model-year plans into 2016, President Obama essentially allowed millions of potential enrollees to sidestep exchanges. AHIP’s policy would remedy the situation. Ignagni didn’t say whether federal officials are aware of or are considering the idea.

NEXT: Subsidies must be reconciled >>



Ignagni also says it’s going to be months before the exchanges and the insurers will be able to reconcile the financial aspects of the premium subsidies that more than 80% of enrollees currently are cashing in on. Health plans will collect the amounts they are owed in subsidies from the federal government, which could be significantly different than what the exchange platforms calculated.

Ignagni also noted the work insurers are doing as a “support network” for consumers looking for coverage.

“Our plans are doing an extraordinary amount of things to meet people where they live, to meet them in their communities, through social media, through television, through counselors that help explain options to people,” Ignagni said. “These are important decisions.”

In particular, she noted that insurers are providing information on out-of-pocket costs, networks and plan selection.

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