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: This article is the first in a four-part series about what actuaries see as ideal components of a health care reform package. This part covers health care reform ideas explored at the Conference of Consulting Actuaries’ CCA 2009 Annual Meeting in Tucson, Ariz.

Description: Two responses to 'Predictive Modeling with Consumer Data' article in the Oct/Nov 2011 issue of The Actuary are critical of the proposal for using consumer data as a health insurance marketing tool.

Description: Letter from reader about the article Responsible Health Care Reform Part 2: Access to Care with a response from one of the article’s authors. From The Actuary, August/Sept 2010 Vol 7 Issue 4