Question
Suppose in a given state's new insurance marketplace, with community rating and no restrictions on who can buy at the community rate, the risk pool
Suppose in a given state's new insurance marketplace, with community rating and no restrictions on who can buy at the community rate, the risk pool (distribution of expected health costs) is as follows:
30% of eligible enrollees' expected health costs = $1,000 (per year)
65% of eligible enrollees' expected health costs = $2,000
5% of eligible enrollees' expected health costs = $10,000
What would the pure community premium rate for this risk pool be? (assume zero loading costs for simplicity in this problem)
Now suppose one insurer, and one insurer only, were allowed to offer any premium it wanted to any potential buyer and to exclude those it did not want to cover? What premium would they likely charge and who would they sell to and who would they exclude? What would happen to the other insurers? Does this help you see why the ACA was written to apply to all insurers?
There has been a lot of controversy about the individual mandate in the ACA. The penalty for not complying with the individual mandate is so low, compared with the lowest priced policy in any marketplace, many feared and now observe that many young people are not buying these new insurance products. This can be modeled (as a first approximation) by assuming the lowest risk folks do not end up in the new marketplace insurance pool. What would that do to the community rate in the marketplace? And what would that do to pressure from the middle-risk group to allow them to buy in a risk-rated environment as opposed to a community-rated environment? Which environment would most insurers and most people prefer? Why?
Step by Step Solution
3.38 Rating (154 Votes )
There are 3 Steps involved in it
Step: 1
1 The premium for this risk pool would be 2000 This is because the expected health costs for the ent...Get Instant Access to Expert-Tailored Solutions
See step-by-step solutions with expert insights and AI powered tools for academic success
Step: 2
Step: 3
Ace Your Homework with AI
Get the answers you need in no time with our AI-driven, step-by-step assistance
Get Started