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October 28, 2016 at 01:00 PM
Executives at Molina Healthcare, a government plan issuer that still likes the Affordable Care Act, say the current ACA risk-adjustment program formula is terrible for issuers that sell coverage at a low price and do a good job of managing risk.
Because of the way the ACA risk-adjustment formula now works, the system took about 25 percent of the Long Beach, California-based carrier’s ACA exchange plan premium revenue and shifted the money to competitors, the company said when it announced its third-quarter earnings.
The ACA risk-adjustment program is supposed to help protect an individual or small-group major medical coverage issuer from absorbing more than its fair share of the risk in a market. The program uses health risk scores for the enrollees to move cash from plans with relatively low-risk enrollees to competitors with higher-risk enrollees.
Related: How sick is everyone? A vast PPACA tracking system takes shape
Molina Healthcare paid $254 million into the program for 2015 and estimates it may pay $372 million into the program this year.
The company as a whole, which focuses mainly on the Medicaid and Children’s Health Insurance Program markets, is reporting $42 million in net income for the third quarter on $4.5 billion in revenue, compared with $46 million in net income on $3.6 billion in revenue for the third quarter of 2015.
The company ended the quarter providing or administering medical coverage for 4.2 million people, up from 3.5 million people a year earlier.
Bad math
Dr. Joseph Mario Molina, the company’s chief executive officer, said he believes participating in the ACA exchange system, or “marketplace” system, is important to his company’s mission to help people receiving government assistance get health care.
“The marketplaces are generally performing well,” Molina said during a conference call with securities analysts.
Molina Healthcare now has about 550,000 exchange plan enrollees, up from 170,000 at the end of the third quarter of 2015, and the exchange system has helped the company diversify, Molina said.
Because the ACA risk-adjustment system is just starting up, “we should not be surprised that it needs fine-tuning,” Molina said.
