UnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable. Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider. For example, in 2016 30 percent of counties throughout the US had only two insurers participating in state marketplaces (10 percent of counties had one). Beyond consumer choice, the absence of marketplace competitors threatens premium affordability. Creating new and stable insurance marketplaces, that is by definition challenging to accomplish, has been made additionally difficult by Congressional Republican opposition to the ACA's risk corridor program, that along with risk adjustment and reinsurance, is designed to mitigate unavoidable plan financial losses in trying to appropriately price premiums for a population with an unknown health history.
During this 25 minute conversation Professor Hoadley discusses contributing factors to state marketplace instability and
moreover four methods by which the insurance marketplaces can be stabilized: a "fall back plan;" state participation requirements; extending risk corridors and reinsurance; and, methods to improve marketplace enrollment.
Dr. Jack Hoadley is a Research Professor at Georgetown University's Health Policy Institute where he studies health financing topics including drug pricing, out-of-pocket costs and the dynamics of insurance making decisions. In 2015 Professor Hoadley was reappointed to a second, three-year term as a Medicare Payment Advisory Commissioner (MedPAC) member. Prior to his work at Georgetown, Dr. Hoadley held staff positions at DHHS, i.e., within the Assistant Secretary for Planning and Evaluation (ASPE) office, at MedPAC, the Physician Payment Review Commission and at the National Health Policy Forum. Professor Hoadley has published widely on health care financing and pharmaco-economics topics and has provided testimony to numerous federal Congressional and other government panels. He earned his Ph.D. in political science.
Jack Hoadley and Sabrina Corlette's August 2016 paper, "Strategies to Stabalize the Affordable Care Act Marketplaces: Lessons from Medicare," is at: http://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html.