Actuary Sizes Up 2018 Individual Health Picture

That could lead to an overall typical increase of somewhere between 10% to 20%, along with an adjustment for each carrier’s own experience, Dillon said.

The Congress are now deciding how the ACA will work in 2018, and the courts are deciding whether the U.S. government has to pay insurers cash owed by the ACA risk corridors program, a troubled ACA program that was supposed to help smooth over insurers’ ACA-related financial problems, and payments owed by the ACA cost-sharing reduction subsidy program. The program helps low-income ACA exchange plan users handle their deductibles, co-payments and coinsurance bills.

The New York Times reported Wednesday that President Donald Trump met with health insurance executives on Tuesday and left them unclear about what will really happen to the subsidy program.

The effect of the elimination of the cost-sharing reduction program could be enough to chase some carriers from the market, Dillon said.

3. Regulators seem to be behaving in a rational fashion.

Many state insurance regulators have pushed 2018 product filing deadlines back as far as the federal government will let them, and the Centers for Medicare & Medicaid Services, the arm of the U.S. Department of Health and Human Services in charge of ACA commercial health insurance rules and programs, has posted what appear to be helpful regulations and guidelines.

Dillon likened the CMS efforts to “tightening the lugnuts” of a train in danger of running off the tracks, but he said he thinks the efforts have been positive. 

4. Insurers could create emergency backup products quickly, if regulators let them.

Dillon said there is room for hope if policymakers fail to resolve the ACA problems but do give insurers room to come up with substitutes for the current individual major medical products.

ACA rules transformed the products in January 2014 and imposed many benefits requirements and operating limits, such as a ban on almost all forms of medical underwriting.

“The pre-ACA world was not that long ago,” Dillon said.

Many carriers still have employees who know how the pre-ACA products worked, and many sell products such as hospital indemnity insurance, accident insurance or critical illness insurance that could be tweaked to fill a void in the individual major medical market, Dillon said.

Some insurers might offer stripped-down products, rather than full major medical products, and some might try to control the costs of offering true major medical coverage by returning to medical underwriting, if they were allowed to do so, Dillon said.

Many medical insurers offer non-ACA products, such as critical illness insurance, that still rely on traditional medical underwriting, and even the newer insurers that have never used medical underwriting for sales purposes have had to go through a detailed enrollee health status analysis process internally, Dillon said.

The carriers go through that analysis process to participate in the ACA risk-adjustment program, Dillon said.

The ACA risk-adjustment program is supposed to shift cash from individual and small-group issuers with low-risk enrollees to issuers with high-risk enrollees.

— Read Senate Confirms Seema Verma as CMS Administrator on ThinkAdvisor.