The departure of
But even though the departures leave the state with only two ACA exchange options for next year,
The reason: A proposed rule from the
"In particular, we propose updates to better estimate the risk associated with enrollees who are not enrolled for a full 12 months, to use prescription drug data to update the predictive ability of our risk adjustment models and to establish transfers that will better account for the risk of highcost enrollees," according to CMS.
"We propose a number of policies relating to the use of external data gathering environment (EDGE) server data for recalibration of our risk adjustment models, and the use of more recent data for future calibrations."
Will it be enough? Here what some experts say about the marketplace:
"As an industry, we continue to make strides to address costs, but challenges still remain. The ending of risk corridors is only one contributing factor. This year, market trends across the nation have contributed to higher rate increases than consumers have seen in the past, including the rising cost of care, increased utilization and rising drug costs. In addition, individuals who enrolled during a Special Enrollment Period had higher medical expenses."
Aetna (in a statement from August): "Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool. Fifty-five percent of our individual on-exchange membership is new in 2016, and in the second quarter we saw individuals in need of highcost care represent an even larger share of our on-exchange population. This population dynamic, coupled with the current inadequate risk adjustment mechanism, results in substantial upward pressure on premiums and creates significant sustainability concerns.