Almost two months ago, we noted that the "risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score"
The point being: even when it works (for certain values of "works") it's a giant time bomb ticking away.
And now we learn, thanks to FoIB Allison Bell, that it's about to go off:
"For Congress, putting a health insurance risk-adjustment program in the legislation that created the Patient Protection and Affordable Care Act of 2010 was a no-brainer."
Which is quite apt, don't you think?
The result of mindless tinkering is that "[w]hen insurers are dealing with the ACA risk-adjustment program, the amount of cash they get may ultimately depend on whether competitors make good on risk-adjustment obligations."
That is, they're trusting ion the old adage about honor among thieves, and relying on not just the willingness, but the ability of other carriers to pony up their share. Which, given the current state of the market, is, well, problematic. For example, Meritus Health Partners, Arizona's Co-OP, owes almost $50 million.
The problem?
"Reminder: Meritus has been placed under supervision by the Arizona Department of Insurance."
And that's just the 10th place finisher. Top billing [ed: ISWYDT] goes to Molina Healthcare of Florida, with an estimated tab of almost $219 million. That's a substantial hit, no matter how big you are.
All told, those Top 10 account for some $5.6 billion in risk adjustment fees.
"Bending the cost curve down," indeed.
The point being: even when it works (for certain values of "works") it's a giant time bomb ticking away.
And now we learn, thanks to FoIB Allison Bell, that it's about to go off:
"For Congress, putting a health insurance risk-adjustment program in the legislation that created the Patient Protection and Affordable Care Act of 2010 was a no-brainer."
Which is quite apt, don't you think?
The result of mindless tinkering is that "[w]hen insurers are dealing with the ACA risk-adjustment program, the amount of cash they get may ultimately depend on whether competitors make good on risk-adjustment obligations."
That is, they're trusting ion the old adage about honor among thieves, and relying on not just the willingness, but the ability of other carriers to pony up their share. Which, given the current state of the market, is, well, problematic. For example, Meritus Health Partners, Arizona's Co-OP, owes almost $50 million.
The problem?
"Reminder: Meritus has been placed under supervision by the Arizona Department of Insurance."
And that's just the 10th place finisher. Top billing [ed: ISWYDT] goes to Molina Healthcare of Florida, with an estimated tab of almost $219 million. That's a substantial hit, no matter how big you are.
All told, those Top 10 account for some $5.6 billion in risk adjustment fees.
"Bending the cost curve down," indeed.
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