The Affordable Care Act risk-adjustment program is working so poorly that it's pushing individuals and small groups that have alternatives out of the ACA-compliant coverage market, according to Mark Bertolini.
The ACA now requires insurers to sell individual and small-group health coverage on a guaranteed-issue basis, without shutting out sick people or charging them more for coverage. The ACA risk-adjustment program is supposed to help keep the issuers from ending up with more than their fair share of sick people. Program managers are supposed to use cash from carriers with healthier enrollees to help carriers with sicker enrollees.
Bertolini, the chairman of Aetna, said today during a conference call with securities analysts that, because of market design flaws, the average price of ACA-compliant individual and small-group coverage is about 10 percent to 15 percent below where it needs to be for the participating issuers to break even.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
