Claims Costs Report Puts Actuaries in Political Hot Seat

Jacqueline Fellows, for HealthLeaders Media , April 3, 2013

"A lot of these states have already tried to tackle what the Affordable Care Act tackles. So they already tried reducing the uninsured rate and now they get these valuable subsidies to people, so those states stand to benefit," she says.

As to how premiums will be affected by medical claims costs, it's unclear. Only Vermont has released its health insurance premiums for the exchanges. Vermont is running its own state-based exchange, called Vermont Health Connect.

So far, it has two insurers–Blue Cross Blue Shield of Vermont and MVP Health Care. The plans have proposed rates for individual plans that range from nearly $400 to more than $600. Another insurer, the Vermont Health Co-op, is waiting for its license application to be approved so it, too, can sell insurance on the exchange.

The proposed HIX rates are generally thought to be reasonable, but then, Vermont is also one of the only states expected to realize a cost-savings in medical claims over the long-term.

Bohn says actuaries are busy working to come up with rates for insurers that will be accurate. It's another reason she says she's surprised that the report became a political issue.

"Health actuaries, they're busy on all these topics because they have to come up with rates this week or within the next two months, basically. And this is one of the big risks of their decision, and it's also risk for the government because if the actuaries mess up, the government also has this risk corridor program to make up differences when markets are mispriced and so, for us it was not only an exercise to help actuaries, but it was an exercise to help the government, as well."

Jacqueline Fellows is an editor for HealthLeaders Media.
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