Description: Recap of Q&A sessions held to discuss the findings and methodology of a SOA study on the cost of the newly insured under the ACA.

Description: Republicans have promised to repeal and replace the Affordable Care Act for years. Now that they have power, what will Republican health care reform look like?

Description: This article provides a detailed description of the unbalanced subsidy provisions in the Affordable Care Act with easy to follow numerical illustrations. An understanding of the illustrative calculations is necessary to understand the subsidy implications. The article highlights some surprising and likely unintended results that will be interest to issuers, employers, consumers, regulators and policymakers. Actuaries can add expertise to their clients and to the public discussion with a proper understanding of the subsidy calculations and the resulting implications.

Description: The Affordable Act's risk corridor program is a temporary feature that applies to individual and small group QHPs from 2014 through 2016. Designed to protect insurers against pricing uncertainty, the program appears straightforward but has many subtle consequences. In this article, we review the need for risk corridors, the calculation itself, and the implications that result.

Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: This article discusses the challenges and unknowns relating to the regulatory inclusion of pediatric dental benefits within the essential benefits list of the Affordable Care Act (ACA).

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: This article summarizes 2012 AAA activities relating to the Affordable Care Act implementation, including work on the Amicus Brief for the Supreme Court Decision, MLR regulations, Actuarial Value, Rate Review, Essential Health Benefits and work with the NAIC.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.