Description: Health care reform will require health insurers to change the way they make decisions on what to sell while remaining financially sound. The new regulatory reality of expanded access to coverage leaves insurers with fewer options for managing costs and business risk. With the introduction of risk adjustment mechanisms in the exchanges, the most profitable members will not necessarily be the lowest cost ones, but rather, the members which the health plan is relatively more effective at servicing. While Patient Protection and Affordable Care Act 'PPACA' prohibits underwriting and using any health status information for denying coverage or varying the premium rates, this article describes how the use of consumer data will affect the way health insurers make decisions on what products to sell.

Description: An economics professor and a health care consumer advocate weigh in on the Patient Protection and Affordable Care Act, including implementation issues, directions for the future and what role actuaries shoudl take.

Description: This Letter to the Editor is a response by the author of the article 'Predictive Modeling with Consumer Data' to two previously published Letters to the Editor. From The Actuary, February 2012, Volume 9, Issue 1.