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Escape from PPACA

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Many actuaries see growing small employer interest in self-insurance, and some think small employers will consider other, less familiar options.

Analysts at Munich Health North America summarize those views in a paper based on survey responses from about 90 U.S. health insurance or health care actuaries.

The reinsurance firm conducted the survey to find out what the actuaries are thinking about the Patient Protection and Affordable Care Act.

About 56 percent of the actuaries said they expect to see PPACA increasing commercial health insurance costs in 2015, and 5.2 percent expect to see a big PPACA-related increase.

Only 1.3 percent thinks carriers now have enough claims experience data to come up with well-supported 2015 rate proposals.

About 56 percent said they see a significant movement of fully insured employers to self-insurance, and 74 percent said they expect to see a number of states imitate California’s efforts to curb small employer use of stop-loss insurance – or insurance for health plans – to back up self-insured health plans.

About 19 percent said they’re already seeing small employers use another, more exotic coverage option: Forming employer-owned captive health insurance companies. Forty-seven percent said employee benefits captives could be a viable growth area, and only 14 percent rejected the idea that benefits captives could be a growth area.

About 77 percent agreed that employers will use “additional alternative risk structures” to respond to the effects of PPACA.

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