Assessing Health Insurers Using Premium Rate and Medical Loss Ratio Data, Round 5


As the Affordable Care Act approaches its fourth open enrollment period, there is continued uncertainty in the policy community about the stability of the health insurance marketplaces. This ongoing project is assessing what the drivers of premium growth are in the individual market, both on and off the exchanges; year-to-year changes in medical claims by carriers in this market; and the degree to which insurers are profitable or losing money. Mark Hall and Michael McCue will analyze insurers’ rate-setting practices and the justifications they make for them, the impact of market reforms on insurers’ financial performance, and the flow of reinsurance payments. They will draw from data reported to the Center for Consumer Information and Insurance Oversight on premium rates and medical loss ratios, as well as data on market composition and insurers’ characteristics from the National Association of Insurance Commissioners. Insurers’ rate filings for 2017 will furnish particularly important information about the post-reform markets on and off the exchanges, since these documents contain detailed information on insurers’ actual expenses in 2015. Findings will inform regulators, policymakers, and the media about dynamics in the individual and small-group markets and whether the law’s reforms are working to restrain premium growth. By looking at the primary drivers of medical claims and the ability of the ACA’s reinsurance program to offset increased claims, the study will also provide context for evaluating insurers’ financial performance and inform policy options to stabilize the marketplaces.

Grant Details

Grantee Organization:
Wake Forest University Health Sciences
Principal Investigator:
Mark Hall, J.D.
Award Amount:
Approval Date:
July 13, 2016

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