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AHIP Statement On The ACA Exchange Market

posted by Clare Krusing

on August 11, 2016

Washington, D.C. – Following today’s announcement from CMS regarding medical cost trend in the ACA Exchange market, AHIP President and CEO Marilyn Tavenner issued the following statement:

“This is an overly optimistic assessment of a market that continues to undergo significant changes for both consumers and health plans,” Tavenner said. “The reality is that the risk pool has not significantly improved. That is a serious concern.”

“This analysis also overlooks the current challenges that are driving up premiums for consumers, including the state of the risk pool at the local level and the lack of pre-enrollment verification for special enrollment periods. We need policy solutions that will address the affordability concerns facing consumers, and that starts by tackling these issues directly.”

Policy Solutions for the ACA Exchange Market

  • Strengthening the risk adjustment program to promote greater payment accuracy. Additional targeted changes to improve the accuracy and effectiveness of the model—such as better accounting for the effects of partial year enrollment and including prescription drug data in the model—can help strengthen the risk adjustment program so it can better fulfill its goals of promoting affordability and stability in the market.
  • Improving verification of special enrollment periods (SEPs). Additional policy steps include further streamlining of and a reduction in the number of SEPs and implementing pre-enrollment verification for high-priority SEPs (such as permanent move and loss of minimum essential coverage).
  • Enhancing the effectiveness of outreach and enrollment strategies to build on coverage gains. Expanding participation in the market—including through more targeted educational and outreach efforts to subsidy-eligible individuals—can not only build on the progress made in reducing the number of uninsured but can also help stabilize the risk pool and promote more affordable coverage.
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