Pub. 11 2016-2017 Issue 1

www.nebankers.org 26 Extraordinary Service for Extraordinary Members. The Affordable Care Act Marketplace What It Gets Right, What Needs to Be Fixed T HE AFFORDABLE CARE ACT (ACA) HAS BEEN THE LAW OF the land for six years now, and has brought about many positive changes to the health care system. However, some intrinsic problems with the law remain that are having the opposite intended impact, driving up costs, eliminating competition, and narrowing consumer choice. First, the good news: The ACA put into place some positive reforms that have helped more people enroll in and get help paying for health insurance. What the ACA Gets Right • Elimination of underwriting — People have access to health insurance regardless of medical condition. • Minimum loss ratio— Most insurance companies are required to spend at least 80 percent of their premium income on health care claims and quality improvement. • Tax credits — Financial assistance is available to help people pay for insurance. Now for the not-so-good news: In all too many cases, the ACA is actually driving decreased choice and increased costs, and consumers are paying the price. The announcement byUnitedHealthcare that the company is withdrawing almost entirely from the ACA Marketplace underscores the need to make changes to the ACA to keep the system viable and affordable for Americans. According to national Blue Cross and Blue Shield As- sociation and Blue Cross and Blue Shield of Nebraska data, ACA Marketplace customers are sicker and use significantly more medical services than individual customers have in the past—more than anyone projected. It was for this very reason that when enacted the ACA included what is called the risk corridors program. With millions more people obtaining health care coverage—many with very expensive medical conditions—it was intended to help stabilize the individual market for the first few years while insurers learned how claims would come in. However, ultimately Congress funded only 12.5 percent of the program, Pat Bourne , Senior Vice President, Blue Cross and Blue Shield of Nebraska