Fifty States, Fifty Stories: A Decade of Healthcare Reform Under the ACA

Only available as part of a package
Overview

This session will present the findings published in the report released by the SOA on March 23, 2020, the 10th anniversary of the ACA.This session will provide an assessment and commentary on the viability of the individual and Medicaid marketplaces under the ACA since its inception. Observations will be based on a data-driven analysis of the associations between market characteristics and measureable outcomes indicative of viability. Viability will be measured in the context of achieving the ACA's goal of providing sustainable access to affordable healthcare to the uninsured and underinsured, and will be considered from the perspectives of various stakeholders. 

At the conclusion of this session, attendees will be able to:

  • Define the primary goals of the ACA as they relate to the individual and Medicaid markets
  • Characterize key regulatory changes and other disruptions that have occurred in the years since the ACA was passed.
  • Identify outcomes indicative of viability from the perspective of key stakeholders (consumers, regulators, and insurers)
  • Evaluate observed outcomes in relation to the goals of the ACA and the interests of key stakeholders.
  • Describe potential ways in which disruptions and changes to the law have affected outcomes/viability in the individual and Medicaid markets
  • Identify recent trends in outcomes and key considerations influencing the future success of the individual and Medicaid markets
Agenda and Speakers

Moderator(s): Hans K. Leida, PhD, FSA, MAAA

Presenter(s): Paul R. Houchens, FSA, MAAA; Lindsy M. Kotecki, FSA, MAAA; Hans K. Leida, PhD, FSA, MAAA

Hans K. Leida, PhD, FSA, MAAA (Moderator)

Hans works in health insurance. He has consulted to insurance companies, Blue Cross Blue Shield plans, HMOs, healthcare providers, government health programs, and employers. Recently, he has been working on provider payment analysis and benchmarking, as well as advanced predictive modeling and risk adjustment. Hans is also frequently quoted in the media on healthcare reform in publications such as The Wall Street Journal, Reuters, Bloomberg Businessweek, and Modern Healthcare. Hans has completed many projects involving individual and group health strategy, pricing, and rate filings. In 2007, he co-authored a paper for America's Health Insurance Plans (AHIP) on the impact of guaranteed issue and community rating laws adopted by certain states in the 1990s. That paper (which was updated in 2012) has been widely cited with the advent of federal healthcare reform, most notably by the Chief Justice of the U.S. Supreme Court in his majority opinion for the case upholding premium subsidies in federal exchange states (King v. Burwell). More recently, Hans co-authored the second edition of Individual Health Insurance. This textbook has been on the Society of Actuaries' exam syllabus for many years. Hans also has significant experience with risk adjustment and predictive modeling of healthcare costs. He was the lead developer of the prescription-drug-based risk adjuster included in the Milliman Advanced Risk Adjusters (MARA) software product.

Paul R. Houchens, FSA, MAAA

Paul Houchens is a principal and consulting actuary with Milliman’s Indianapolis Health Practice. He has significant experience providing actuarial services to state agencies related to healthcare reform and Medicaid financing. Mr. Houchens has performed a wide array of analyses on the impact of healthcare reform to the commercial market, including: premium and enrollment change analysis related to the Affordable Care Act, commercial exchange premium revenue forecasts, and insurer financial evaluations for five states.

Lindsy M. Kotecki, FSA, MAAA

Lindsy works with a variety of stakeholders in the health industry. She consults to commercial health insurers, private Medicare and Medicaid plans, government health agencies, and healthcare providers. She has been deeply involved in helping insurers and other stakeholders strategically navigate healthcare reform. She also certifies Medicare Advantage bids, assists healthcare providers with payment analytics, and supports healthcare startups in analyzing and understanding key actuarial concepts related to the markets they serve. More recently, Lindsy has been applying her knowledge of the current ACA and Medicare markets to lead research efforts on the actuarial implications of potential future reforms.

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