If disproportionately large numbers of sick people enroll in health plans offered in the new insurance marketplaces, insurers could raise premiums quickly and destabilize the exchanges. Anticipating such a scenario, the framers of the Affordable Care Act created premium stabilization mechanisms, including two transitional programs and a permanent risk adjustment program, to protect plans against the potential for “adverse selection.” Focusing on California, researchers will survey adults who have signed up for coverage through the state’s marketplace during the first six months of open enrollment, a first step in gauging whether sicker-than-average enrollees are enrolling in the exchanges. The findings, from a state with a large, diverse population, will provide essential information to officials charged with maintaining marketplace stability during the rollout. If phase 1 is successful, a second phase will be proposed to develop protocols for evaluating the risk-adjustment program’s effectiveness.
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Massachusetts General Hospital
John Hsu, M.D., M.B.A., M.S.C.E.