Health claim costs for people with individual major medical coverage written under the new Affordable Care Act rules may have fallen a little between 2014 and 2015, Obama administration officials say.
Administration officials make that case in a new analysis based on reports health insurers filed with the ACA risk-adjustment and reinsurance programs.
The officials look at U.S. claim costs for individual enrollees on a “per member, per month” basis.
For the country as a whole, the average level of claims per-member, per-month costs fell 0.1 percent, the officials say.
For the 10 states with the biggest growth in enrollment in ACA-compliant individual health policies, average costs fell 5 percent, the officials add.
The officials who refer to the ACA public exchange system as “the Marketplace” program, go on to say that there are signs typical individual health enrollees may be getting healthier.
“Nearly all states saw continued growth in Marketplace enrollment in 2016, suggesting continued improvement in their risk pools,” the officials say.
Thanks to new Centers for Medicare & Medicaid Services efforts to tighten enforcement of applicant eligibility rules, “we expect the Marketplace risk pool will continue to grow and improve going forward,” the officials say.
The analysts prepared the report for the Center for Consumer Information and Insurance Oversight, part of the Centers for Medicare & Medicaid Services (CMS).
The CMS insurance oversight office runs the HealthCare.gov exchange enrollment system, and it oversees ACA exchanges in the states that run their own state-based exchange programs.
The insurance oversight office is now struggling to persuade health insurers to sell plans for 2017 through HealthCare.gov and state-based exchange systems.
For a look at two industry reactions to the new CMS analysis, read on:
Marilyn Tavenner (Photo: Centers for Medicare & Medicaid Services)
Marilyn Tavenner is now the president of America’s Health Insurance Plans, a major trade group for health insurers.
She previously was the head of CMS.
Tavenner did not contradict the new CMS individual health market claim numbers, but, in a statement, she called the CMS assessment of the market “overly optimistic.”