If regulators stick with the current ICHRA rules, the ICHRA program "has the potential to lower individual market premiums by improving the risk profile," the actuaries write.

But, if "employers limit ICHRA offerings to workers with high health care costs, the risk profile could worsen, potentially increasing individual market premiums," the actuaries warn.

Similarly, if regulators let workers use ICHRA cash to buy other types of products, such as short-term health insurance, that "could increase individual market premiums by skewing the risk pool," the actuaries say.

If healthier employees flock to the cheaper, skimpier plans, and sicker employees stay with traditional major medical insurance policies, that will kill the traditional policy issuers, the actuaries predict.

What it means: Actuaries who are in their 50s or older have seen many health insurance market waves come and go.

Now, they are looking at the current individual market with the knowledge that it too could fall down.

The actuaries: The actuaries who developed the new individual health market commentary are members of the individual and small group markets committee at the American Academy of Actuaries.

Members of the academy have taken tests that show that they understand the math needed to analyze pension and insurance risk.

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The academy offers federal and state policymakers help with risk analysis.

Health market stabilizers: The actuaries who wrote the new commentary say policymakers can use many strategies to stabilize a health insurance market.

Some of the strategies the actuaries discussed are:

◆ Careful state regulatory oversight.

◆ Price transparency rules, premium subsidies and consumer protection rules that encourage younger, healthier people to pay for coverage.

◆ Uniform rules for all insurers in the individual market.

◆ Mechanisms such as risk-adjustment programs that can protect insurers that end up with more than their fair share of sick enrollees.

If policymakers can persuade healthy people and insurers to stay in the individual market, that can lead to more predictable, stable premiums and a stronger individual market, the actuaries write.

The actuaries contend that any rules or programs that help younger, healthier people separate from older, sicker people could hurt the individual market.

In addition to poorly designed ICHRA programs, items on the actuaries' list of potential threats include:

◆ Affordable Care Act premium tax credit cuts.

◆ Efforts to expand access to health insurance products that fall outside ACA major medical insurance requirements, such as short-term health insurance.

◆ Efforts to let consumers buy coverage written in states with looser regulations.

"When considering policy initiatives that would change the rules applying to the individual market, it is important for policymakers to consider how the changes would affect the market's effectiveness in achieving the goals of access, affordability, choice, and competition," the actuaries write.

Poor choices "would likely lead to a deteriorated risk pool, higher premiums, and reduced insurer competition and consumer choice," the actuaries conclude.