Republicans have been busy claiming that the Affordable Care Act is"failing" and is a "disaster," but a report from the Department of Health and Human Services itself is giving the lie to those claims.
A blog post in the Los Angeles Times points out the falsehoods in Republican claims about the health of the ACA when compared with the report issued by HHS.
The agency's annual report about the ACA's risk-management provisions has found that key ACA programs are "working as intended," not only protecting insurers from unexpectedly large risks but also helping to moderate premiums for consumers.
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In addition, the post cites a Health Affairs article from health economist Timothy Jost that points out yet another contradiction between Republican assertions and reality: Jost writes that the HHS report "would seem to refute the commonly held belief that the marketplace population is becoming sicker," with 2016 figures indicating instead that the ACA's customer base is getting healthier and the risk pools have actually been stabilizing, not collapsing.
He quotes the HHS report saying, "Both the transitional reinsurance program and the permanent risk adjustment program are working as intended."
The report provides information on the ACA's permanent risk adjustment program and its temporary reinsurance program, which ran from 2014 until expiration at the end of 2016.
The risk adjustment program was designed to equalize risk among plans with lower average risks and those with higher average risks by imposing a charge on the lower-risk plans and providing the resulting funds to the higher-risk plans. The aim is to end up with a neutral result in each state.
And, according to the post, "the HHS data show that's exactly what has happened. Among California's 15 eligible insurance carriers, about $392.7 million appears on both sides of the ledger for 2016."
That cuts down on the incentive for insurers to design plans to screen out sicker, more expensive people, since "the more successful such plans are in achieving low-risk enrollment pools, the more they'll get dinged for a payment each year."
And the reinsurance plan, designed to run just for three years on the premise that insurers would be experienced enough, and have a large enough pool of insureds, not to need payouts for individual high-cost patients.
The HHS report says in part, "There were a number of reasons to believe that risk scores would be higher for the 2016 benefit year relative to the 2014 benefit year," including the fact that the average enrollee spent more time on the exchanges in 2016 than earlier. That in turn brings higher claims, thanks to "increased numbers of reported diagnoses, higher risk scores, and greater paid claims amounts per member, even when the risk profile of the membership is held constant…. Despite these factors, risk scores were stable in the individual market and decreased by 4 percent in the small group market."
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