Description: There have been a variety of proposals related to expanding eligibility for Medicare, ranging from a publicly funded program to a full buy-in option. This session will explore the actuarial implications of various buy-in proposals and the potential impact that such policy changes could have on the health care market landscape. In particular, we will discuss the ways in which program eligibility requirements, plan designs, provider reimbursement arrangements, network design, rating rules, and subsidies could affect premium levels and membership volume in a Medicare buy-in market, as well as the potential side effects on providers and existing health care markets.

Description: Stakeholders in a specific state (Minnesota) were interviewed about the potential value -- and obstacles -- of a catastrophic backstop program to handle long term care (LTC) financing needs. The design would entail a payroll deduction which would produce a fund to pay LTC expenses once a deductible period (of 1 to 4 years, depending on income) was reached. This design was believed to encourage enrollees to cover the front end better than done today, whether by private insurance or other means.

Description: Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event. Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event.

Description: The big event of 2023 is the launch of multiple Humira biosimilars, which began in January with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing the specialty drug marketplace in the United States. The expectation of the full impact of this big event is very hopeful, but there is still uncertainty several months after its beginning. Humira is the highest-selling drug in the world and has been since 2013 (Figure 1)—except for when COVID-19 projects temporarily surpassed it. The world is eagerly awaiting the launch of multiple biosimilar drugs to compete with Humira and hopefully bring more competitive pricing to the benefit of payers and patients everywhere.

Description: The Health Section Council Chairperson looks back at a historic year for the health care industry, and what it means for health actuaries.

Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.

Description: Announcement of changes to the LTC Section, and a preview of the articles in the December 2009 issue of Long Term Care News, with topics including Health care reform and LTC vs. Medicaid.

Description: This is a discussion of the medical loss ratio, the confusion and debate over the calculation method under the new MLR requirement, and the opportunities it presents to consulting actuaries.

Description: Update on Health Section research projects and topics, including health care reform, complexity science, and strategic planning.

Description: Discussion of various alternatives for financing health care.: It discussed providers,the uninsured employers of uninsured workers, employers through taxes , assessment on health insurance and general revenues.