Description: Read the December 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Health insurance company assets and liabilities have evolved since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010. The ACA fundamentally rearranged how commercial health insurance is funded by integrating federal premium subsidies and pass-throughs together with a marketplace interwoven with transfer payments among stakeholders. The impacts of these programs can be seen in specific accounting items on the balance sheets of health insurance companies over the past 10 years. Their emergence follows three primary trends: (1) balance sheet items tend to be larger and take longer to settle, (2) there are more interactions among items, and (3) the final settlement amounts are more uncertain.

Description: Any prudent organization that is obligated to cover health claims will consider the risk that those medical claims vastly exceed expectations. This is true for an employer self-funding employee health benefits, a health system contracted with two-way risk (e.g., Accountable Care Organizations ACOs), and a small or mid-sized health insurance company. Without protection, these risk bearers can incur ruinous losses. Interestingly, the forms of insurance sold to cover such large medical claims, although quite similar, sometimes go by different names depending upon the buyer. • Employer Stop-loss (ESL): self-funded employers who want protection against large unanticipated claims • Provider Excess (PXS): at-risk health systems who have taken delegated risk from a public or private payer and desire protection against large unanticipated claims • Medical Excess/HMO Reinsurance (HMO Re): health insurers (including HMOs) who desire protection against large unanticipated claims The concepts we discuss in this article apply to all three categories of large claim risk.

Description: Lower costs doesn't necessarily help ACA markets. It often makes things worse.

Description: This report is a discussion of the significant challenges involved in attempting to research with robust analysis the impact of disparities in health care access, cost and quality of care on financial wellness across racial, ethnic, socioeconomic and other demographic groups in the U.S. for reasons other than or in addition to income, wealth or employment status.

Description: The SOA Research Institute along with the International Section, and the Social Insurance and Public Finance Section are pleased to make available a research report that compares international and domestic mandated paid family and medical leave programs. Special thanks to both Sections for their sponsorship of this effort.

Description: This study evaluates how integrating social determinants of health (SDOH) into Medicaid risk adjustment models impacts financial outcomes for ACOs/MCOs, offering foundational insights for policymakers and actuaries.

Description: This report outlines a framework for interpretable machine learning algorithms for detecting fraud in health insurance. It discusses the challenges of using black-box machine learning models in the insurance industry and proposes various interpretable methods to enhance transparency and understanding.

Description: This report examines the demographic, medical, and pharmaceutical profiles of HIV-positive individuals in Medicare and how their needs differ from the general Medicare population.

Description: A multi-author collection exploring how catastrophe modeling can be adapted to life and health insurance, particularly in response to the 2025 Los Angeles wildfires.