Health Affairs March 29, 2017
Paul D. Jacobs, Michael L. Cohen, and Patricia Keenan

Abstract

The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants’ health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before...

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Topics: ACA (Affordable Care Act), CMS, Health System / Hospital, HHS, Market Research, Patient / Consumer, Payer, Physician, Population Health Mgmt, Primary care, Provider, Public Exchange, RCM (Revenue Cycle Mgmt)
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