Risk adjustment in health insurance exchanges for individuals with mental illness.

The American Journal of Psychiatry
Colleen L BarrySusan H Busch

Abstract

In 2014, an estimated 15 million individuals who currently do not have health insurance, including many with chronic mental illness, are expected to obtain coverage through state insurance exchanges. The authors examined how two mechanisms in the Affordable Care Act (ACA), namely, risk adjustment and reinsurance, might perform to ensure the financial solvency of health plans that have a disproportionate share of enrollees with mental health conditions. Risk adjustment is an ACA provision requiring that a federal or state exchange move funds from insurance plans with healthier enrollees to plans with sicker enrollees. Reinsurance is a provision in which all plans in the state contribute to an overall pool of money that is used to reimburse costs to individual market plans for expenditures of any individual enrollee that exceed a high predetermined level. Using 2006--2007 claims data from a sample of private and public health plans, the authors compared expected health plan compensation under diagnosis-based risk adjustment with actual health care expenditures, under different assumptions for chronic mental health and medical conditions. Analyses were conducted with and without the addition of $100,000 reinsurance. Risk adjustmen...Continue Reading

Citations

Jul 25, 2013·Current Psychiatry Reports·David E GoodrichMark S Bauer
Sep 13, 2013·The Journal of Behavioral Health Services & Research·Anna DurbinRaisa Deber
Mar 8, 2014·Journal of Health Economics·Thomas G McGuireSamuel Zuvekas
Feb 13, 2014·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·S H C M van VeenR C J A van Vliet
May 3, 2014·Health Education & Behavior : the Official Publication of the Society for Public Health Education·Jie ChenRobin Bloodworth
Feb 20, 2015·Medical Care Research and Review : MCRR·S H C M van VeenR C J A van Vliet
Jul 6, 2014·Inquiry : a Journal of Medical Care Organization, Provision and Financing·Jane M ZhuThomas G McGuire
Feb 8, 2020·BMC Medical Informatics and Decision Making·J WolffM Franz

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