A hand holds a dollar risk-adjustment program sicker-than-average Related: 5 reasons the ACA risk-adjustment storm might blow over

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Noteworthy Preliminary 2017 ACA Risk-Adjustment Subtotals

(in millions)
Anthem $ 260
Health Care Service Corp. $ 573
Other Blues $ 1,425
BLUES $ 2,258
Centene $ (621)
Kaiser $ (554)
Molina $ (853)
BIG NON-BLUES $ (2,028)
Source: Appendix C to 2017 Benefit Year Risk Adjustment Summary Report - Table 3: Issuer-Specific Information for Individual and Small Group Markets (CMS)

available here available here |

Doubts

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ACA risk-adjustment program basics

  • Worries about what happens when issuers fail, or simply refuse to pay their risk-adjustment program bills.
  • Whether the risk scores adequately reflect the relative risk of enrollees.
  • Whether the issuer-level scoring approach is fair to new and rapidly growing plans, which may have little information about enrollees' health.
  • Whether the issuer-level scoring formula is fair to plans with low average premiums.

Other report highlights

  • The average monthly premium for all non-grandfathered, non-catastrophic individual major medical coverage increased 20 percent, to $472.
  • The number of issuers in the ACA risk-adjustment program fell 7.8 percent, to 654.
  • The number of issuers of non-grandfathered, non-catastrophic individual major medical coverage fell 20 percent, to 373.
  • The number of issuers of non-grandfathered small-group major medical coverage fell 6.7 percent, to 515.
  • About 21 percent of enrollees in the 2017 non-grandfathered, non-catastrophic individual major medical risk pool had at least one worrisome health condition included in the risk-scoring process, and 3.2 percent had three or more worrisome health conditions.

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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.