Description: This session will review the latest developments in the Affordable Care Act (ACA) marketplace, including a discussion of hot topics, challenges, and opportunities on the horizon. Specific topics will include cost-sharing reductions (CSR) loading and the impact on subsidized rates across states (e.g., mandated loading in NM), the interaction of American Rescue Plan (ARP) subsidy expansion, and the impact once ARP-enhanced subsidies end.

Description: Inspired by Seinfeld's Festivus celebration, our panel will conduct a lighthearted but technically robust airing of grievances related to the Medicare Star Rating program. Over the past decade, the Medicare Star Rating program has undergone an array of methodological changes.

Description: The health insurance industry has historically used several factors to develop premium rates. Many of these, e.g. gender rating, have been largely eliminated from health insurance rating practices by regulations as the Patient Protection and Affordable Care Act (ACA) because they were determined as inequitable. However, several other factors still remain as differentiators in premium rates charged to individuals and groups. In conjunction with the SOA, researchers studied whether there could be ‘ghost’ rating factors, like race, ethnicity, or socioeconomic status, that are inherently included in some of these remaining allowable factors. Review results and opportunities for future research. By attending this session, you will be challenged to think about traditional rating factors in a different way. Rather than focusing on whether certain factors are sound based on the underlying claims cost, this session will focus on whether or not these factors are impacting certain socioeconomic or racial/ethnic groups disparately.

Description: At the conclusion of the session, attendees will be able to understand the potential for using global population health mortality and morbidity data in actuarial contexts. Using the Global Burden of Disease project as a resource, this session will discuss how novel population health research can be used to complement and fill in the gaps of existing input data sources for actuarial analysis and modeling. Presenters will share the latest academic research on the topics of demography, life expectancy, health-adjusted life expectancy, causes of death and disability, comprehensive disease incidence and prevalence metric, measures of disease burden for patients and populations, modifiable risk factors where there are opportunities to make interventions and improve health outcomes, and disparities between and within populations. This research is globally comprehensive and comparable between different markets and disease areas. The session will cover the motivation and purpose of GBD, a brief description of the models used, and dive deep on some selected use cases in actuarial contexts. Audiences will leave with: 1. Understanding challenges and opportunities in measuring disease burden comprehensively and consistently 2. Understanding relevant health metrics, including the drivers of future mortality and morbidity 3. Ideas for applications of epidemiological research in your work

Description: Prescription drug markets are undergoing rapid change - significant policy changes implemented through the Inflation Reduction Act, Congressional interest in long-awaited 340b reform, and a growing direct-to-consumer market have already changed the landscape significantly. The ongoing effects of these changes will continue to evolve for many years. Hear from leading prescription drug actuaries and pharmacy policy experts on what these changes mean for prescription drug markets and US healthcare more broadly.

Description: This session will review the latest developments in the Affordable Care Act (ACA) marketplace, including a discussion of hot topics, challenges, and opportunities on the horizon. Specific topics will include cost-sharing reductions (CSR) loading and the impact on subsidized rates across states (e.g., mandated loading in NM), the interaction of American Rescue Plan (ARP) subsidy expansion, and the impact on ARP-enhanced subsidies end.