Projecting start-up capital requirements for Health care co-ops and public plans

Summary of House of Representatives Tri-Committee Bill – H.R. 3200.

2010 Health Pricing Boot Camp: Medicare Track, Nov. 8- 9, 2010 - Session # 3. This presentation details an overview of the bid process, discussing separately HMO and SNP, local PPO, regional PO, and Private Fee for Service PFFS.

2010 Health Pricing Boot Camp: Medicare Track, Nov. 8- 9, 2010 - Session # 2. This presentation details the overview of the various product designs in Medicare Part C and the revenue paid to the Medicare Advantage Organizations MAOs both from the government and from member premiums.

2010 Health Pricing Boot Camp: Medicare Track Nov. 8-9, 2010 , Session #10. Medicare Advantage plans are reimbursed by CMS on a risk adjusted basis for both Part C and Part D coverages. Going forward, there will also be adjustment for Quality STARS and new FFS relationships by region. This session will cover the basics of the Medicare risk adjustment models and the impact revenue to the plans. Additionally, we will discuss the impact of STARS and new FFS benchmarks to be gradually introduced in the next several years.

This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

Presented at June 2007 Health Meeting. Discusses the politics, positioning and timing of health policy with regards to children's health initiatives, national health policy and actuaries roles and involvement, and social insurance issues.

2012 SOA Health Meeting Session #79. This session will discuss changes and potential issues raised by the Patient Protection and Affordable Care Act (ACA) and other impending regulatory changes and the impact on claim reserves. This will include the effects on reserves of the Medical Loss Ratio (MLR) rules and rebates, the impact of the exchange risk and risk corridor payments, and other federal/state changes. Presenters will also address premium deficiency reserves under the ACA.

According to the 2012 Medicare Trustees’ Report, in just over a decade, the Medicare HI Trust Fund is projected to have more cost than it does revenue. Many actuaries predict an even earlier eclipse. The amount of the baby boomers enrolling in the program and escalating hospital costs have been a continued stress on the outlook of the program. However, the report's estimated likely time at which the program will become insolvent is based on assumptions according to the current legislation, including one that Congress will allow a significant fee cut to physicians. The Affordable Care Act improved the outlook for Medicare through entering into more innovative programs, reducing payments to Medicare Advantage issuers, and increasing taxes for those with high incomes. This improved solvency outlook is made despite benefit improvements to gradually fill in the Medicare Part D donut hole and add some preventive services. In this session, we will review the major assumptions driving the 2012 Medicare Trustees’ Report, discuss reasonable alternate scenarios, and provide an overview of solvency solutions that the nation’s elected officials must face sooner or sooner.

A discussion of the impact of the June, 2012 U.S. Supreme Court decision on Medicaid expansion and the financial impications for states.